Other names: PSA, % Free, PSA, FREE
Prostate-specific antigen (PSA) is a protein produced by the prostate. In the bloodstream, PSA exists in two forms:
Free PSA – not attached to other proteins
Bound PSA – attached to carrier proteins
Total PSA measures both forms combined.
PSA, % Free shows what percentage of the total PSA is unbound:
(free PSA ÷ total PSA) × 100.
This percentage helps determine whether an elevated PSA level is more likely due to prostate cancer or a benign condition such as benign prostatic hyperplasia (BPH) or prostatitis. Cancer tends to produce more bound PSA, lowering the % free PSA.
When the total PSA is between 4–10 ng/mL—often called the diagnostic gray zone—PSA alone cannot reliably distinguish cancer from benign causes.
The % free PSA significantly improves risk assessment and helps determine who may benefit from a prostate biopsy.
General interpretation:
Lower % free PSA = higher likelihood of prostate cancer
Higher % free PSA = more consistent with benign conditions
Men with total PSA between 4–10 ng/mL and a non-suspicious digital rectal exam (DRE)
Source: Catalona et al., JAMA 1998
| % Free PSA | Risk (Age 50–64) | Risk (Age 65–75) |
|---|---|---|
| 0.00–10.00% | 56% | 55% |
| 10.01–15.00% | 24% | 35% |
| 15.01–20.00% | 17% | 23% |
| 20.01–25.00% | 10% | 20% |
| >25.00% | 5% | 9% |
How to use this:
A % free PSA below 10% indicates the highest likelihood of prostate cancer in this PSA range.
A % free PSA above 25% suggests a low risk, and many men may be able to avoid biopsy.
The middle ranges (10–25%) represent intermediate risk, and further clinical evaluation is usually recommended.
Total PSA gives the overall PSA level.
Free PSA measures the unbound portion.
% Free PSA helps refine cancer risk when total PSA is moderately elevated.
Using these together helps clinicians reduce unnecessary biopsies while still identifying men at meaningful risk for prostate cancer.
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PSA levels naturally increase with age, and different age groups have different expected ranges (ng/mL):
Age ≤49: 0.0–2.5
Age 50–59: 0.0–3.5
Age 60–69: 0.0–4.5
Age ≥70: 0.0–6.5
A value above the age-adjusted range may suggest an increased risk of prostate cancer, but it is not diagnostic. Total PSA can also rise due to benign prostatic hyperplasia (BPH), prostatitis, recent ejaculation, or even catheterization. Because total PSA alone is nonspecific, clinicians use additional measures—especially free PSA and % free PSA—to refine interpretation.
PSA circulates in two forms:
Free PSA: unbound
Bound PSA: attached to proteins
The % free PSA is calculated as:
(free PSA ÷ total PSA) × 100
How to interpret it:
Higher % free PSA: More consistent with benign conditions
Lower % free PSA: Suggests a higher likelihood of prostate cancer
Typical interpretive thresholds:
0–10%: Risk of cancer can be as high as ~50–60%
>25%: Risk drops to roughly 8–15% (depends on age)
These values help guide whether a biopsy is appropriate, especially when total PSA is in the gray zone of 4–10 ng/mL.
This combination can be confusing, but it does occur.
Normal total PSA: Typically suggests no significant prostate disease
Low % free PSA (especially <10–15%): Suggests increased production of bound PSA, which may occur in prostate cancer—even before total PSA rises
Very early-stage prostate cancer
Biological variation
Assay variability
Temporary effects (e.g., inflammation)
Repeat PSA in several weeks or months to look for trends
Digital rectal exam (DRE)
MRI or targeted imaging
Biopsy, if clinical suspicion remains elevated
Context always matters. Family history, race, age, prior PSA history, and symptoms must be included in the assessment.
How PSA changes over time can be as important as the absolute value:
PSA Velocity: Speed of change; a rapid rise raises concern
PSA Doubling Time: Faster doubling times suggest more aggressive disease
These metrics are especially useful after cancer treatment or in active surveillance programs.
Several benign conditions can raise PSA:
BPH (benign prostate enlargement)
Prostatitis or infection
Recent ejaculation
Prostate manipulation (e.g., catheterization)
Long bike rides (less common but documented)
These must be considered before assuming cancer risk.
For men with non-suspicious DRE and total PSA between 4.0–10.0 ng/mL
(Roche E602 immunoassay system, 2015)
| % Free PSA | 50–59 yrs | 60–69 yrs | ≥70 yrs |
|---|---|---|---|
| ≤10% | 49.2% | 57.5% | 64.5% |
| 11–18% | 26.9% | 33.9% | 40.8% |
| 19–25% | 18.3% | 23.9% | 29.7% |
| >25% | 9.1% | 12.2% | 15.8% |
Interpretation:
≤10% free PSA: Highest cancer probability
>25% free PSA: Lowest probability
Risk increases with age in every category
Note: In very low total PSA ranges (<1–2 ng/mL), calculation of % free PSA may not be technically possible or clinically meaningful.
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Anthony
Unlimited Plan Member since 2021
I have been using Healthmatters.io since 2021. I travel all over the world and use different doctors and health facilities. This site has allowed me to consolidate all my various test results over 14 years in one place. And every doctor that I show this to has been impressed. Because with any health professional I talk to, I can pull up historical results in seconds. It is invaluable. Even going back to the same doctor, they usually do not have the historical results from their facility in a graph format. That has been very helpful.
Karin
Advanced Plan Member since 2020
What fantastic service and great, easy-to-follow layouts! I love your website; it makes it so helpful to see patterns in my health data. It's truly a pleasure to use. I only wish the NHS was as organized and quick as Healthmatters.io. You've set a new standard for health tracking!
Paul
Healthmatters Pro Member since 2024
As a PRO member and medical practitioner, Healthmatters.io has been an invaluable tool for tracking my clients' data. The layout is intuitive, making it easy to monitor trends and spot patterns over time. The ability to customize reports and charts helps me present information clearly to my clients, improving communication and outcomes. It's streamlined my workflow, saving me time and providing insights at a glance. Highly recommended for any practitioner looking for a comprehensive and user-friendly solution to track patient labs!
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AFP-L3%, Serum, Alpha Fetoprotein (AFP), CA 125, CA 15-3, CA 19-9, CA 27.29, CA 72-4, Carcinoembryonic Antigen (CEA), CD19, Chromogranin A (CgA), CYFRA 21-1 (Cytokeratin 19 Fragment), Leukemia/Lymphoma/Myeloma Panel by Flow Cytometry, Matrix Metalloproteinase 9 (MMP 9), MMP-9 (Matrix Metalloproteinase-9), Neuron-specific Enolase (NSE), Neurone Specific Enolase, Prostate Cancer Risk Score, Prostate Specific Antigen (PSA), PSA, % Free, S100, Squamous Cell Carcinoma, Total Prostate Specific Antigen (TPSA), Tumor Necrosis Factor-Alpha, Highly Sensitive, Urinary Bladder Cancer Antigen
