Understanding PSA: Total PSA, Free PSA, and % Free PSA - Body of Harmony

Understanding PSA: Total PSA, Free PSA, and % Free PSA

by: Payam Hakimi
March 2025
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Prostate-Specific Antigen (PSA) is a protein produced by the prostate gland, primarily found in semen but also present in small amounts in the bloodstream. PSA levels are commonly measured as a screening tool for prostate health, particularly in the detection of prostate cancer, benign prostatic hyperplasia (BPH), and prostatitis. PSA testing includes Total PSA, Free PSA, and % Free PSA, each providing valuable insights into prostate conditions.

Total PSA, Free PSA, and % Free PSA: What Do They Mean?

Total PSA:
- Represents the overall amount of PSA in the blood, including PSA bound to proteins and unbound (free) PSA.
- Elevated levels (typically above 4.0 ng/mL) may indicate prostate issues such as cancer, BPH, or inflammation.
- However, some men with prostate cancer have PSA levels below 4.0 ng/mL, while others with high PSA may not have cancer.
Free PSA:
- This is the portion of PSA that circulates freely in the blood without being bound to proteins.
- Higher levels of free PSA suggest benign conditions (such as BPH), while lower levels may indicate a higher likelihood of prostate cancer.
% Free PSA:
- The ratio of Free PSA to Total PSA, expressed as a percentage.
- A low % Free PSA (<10%) is more likely associated with prostate cancer, whereas a higher % Free PSA (>25%) suggests benign conditions.

How Often Should PSA Levels Be Checked?

PSA testing frequency depends on a patient’s age, family history, and risk factors:

Men Under 50:
- PSA testing is generally not recommended unless they have significant risk factors such as a strong family history of prostate cancer or African American heritage (higher risk group).
Men 50-69 (Average Risk):
- PSA screening every 1–2 years is typically advised based on individual risk and physician recommendations.
Men Over 70:
- Routine PSA testing is often not recommended unless symptoms or a history of prostate issues are present.
High-Risk Individuals (Family History, Genetic Predisposition, African American Men):
- PSA screening may start as early as 40-45 years old, with annual monitoring.
Patients with a History of Elevated PSA or Prostate Cancer:
- Regular PSA testing every 3–6 months to 1 year, depending on disease progression and treatment status.

Natural Ways to Support Prostate Health

If PSA levels are elevated but not due to cancer, lifestyle modifications can help manage prostate health:

Dietary Changes:
- Increase: Tomatoes (lycopene), cruciferous vegetables (broccoli, cauliflower), green tea, and omega-3 fatty acids.
- Reduce: Red meat, processed foods, and excessive dairy.
Regular Exercise:
- Helps reduce inflammation and supports overall metabolic health.
Supplements:
- Saw Palmetto, Pygeum, Zinc, and Vitamin D may support prostate function.
Hydration & Healthy Urinary Habits:
- Avoiding excessive caffeine and alcohol can prevent irritation of the prostate.

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