Quick Facts
- Sample: Blood (serum)
- Fasting: Not required
- Turn-around: 2-3 business days. May take longer based on weather, holiday or lab delays.
Benefits
- Reduce unnecessary biopsies by refining prostate cancer risk assessment beyond total PSA alone
- Get clearer answers when your PSA is borderline elevated (4.0–10.0 ng/mL)
- Differentiate between prostate cancer and benign conditions like BPH with greater confidence
- Order conveniently online with confidential, direct-access testing—no doctor referral needed
- Make informed decisions about next steps in your prostate health journey
Who Is This Test For?
- Men aged 50+ with total PSA levels between 4.0 and 10.0 ng/mL
- Anyone with an abnormal digital rectal exam but unclear diagnosis
- Men monitoring prostate health with a family history of prostate cancer
- Those seeking a more nuanced prostate cancer risk assessment
- Men considering whether a prostate biopsy is necessary
How It Works – Just 3 Steps
- Order online and visit a nearby lab for a simple blood draw—no appointment needed.
- Get tested with our electrochemiluminescence immunoassay (ECLIA) technology for accurate free and total PSA measurement.
- Review your results securely online within 2–3 business days.
FAQ
What does the free:total PSA ratio measure? It measures the percentage of free (unbound) PSA compared to total PSA in your blood, helping distinguish cancer risk from benign prostate conditions (Mayo Clinic 2024).
Do I need to fast before this test? No fasting is required. However, avoid testing within 48 hours after ejaculation or prostate manipulation for accurate results.
What if my ratio is low? A ratio below 25% suggests higher prostate cancer risk and typically warrants urologist consultation and possible biopsy (NCCN 2024).
Can medications affect my PSA levels? Yes. Drugs like finasteride lower PSA levels. Discuss any medications with your healthcare provider before testing (CDC 2024).
How is this test different from a standard PSA test? Standard PSA measures total PSA only. This ratio test adds specificity, potentially reducing unnecessary biopsies by up to 30% (Mayo Clinic 2024).
Will I need additional testing? If your ratio is abnormal, your doctor may recommend urologist consultation, biopsy, or imaging based on your complete clinical picture.
More Details
What is the purpose of this test?
The PSA Free:Total Ratio Test measures the percentage of free PSA relative to total PSA in your blood. While total PSA can be elevated in both prostate cancer and benign conditions like BPH, the ratio provides additional diagnostic specificity. Lower ratios suggest higher prostate cancer risk, while higher ratios often indicate benign conditions. This helps you and your doctor determine whether further investigation, such as a biopsy, is needed (Mayo Clinic 2024).
Who would benefit from this test?
This test is particularly valuable for men aged 50 and older with PSA levels in the borderline range of 4.0–10.0 ng/mL—the range where approximately 15% of men have prostate cancer. It's also recommended for those with an abnormal digital rectal exam but unclear diagnosis, men with a family history of prostate cancer, and anyone seeking to refine their prostate cancer risk assessment before deciding on a biopsy (AUA 2023).
When should I order this test?
Order this test when your total PSA is borderline elevated (4.0–10.0 ng/mL) to better determine your likelihood of prostate cancer and need for biopsy. It's also appropriate if you're monitoring prostate health with risk factors or tracking changes over time. The test is not typically used for initial screening but rather as a follow-up to help interpret elevated total PSA results (NCCN 2024).
How do I interpret the results?
Your results will show the percentage of free PSA relative to total PSA. Here's what different ratios typically indicate:
Free:Total PSA Ratio: Less than 10%
- What it means: High probability of prostate cancer
- Typical action: Urologist referral and biopsy strongly recommended
Free:Total PSA Ratio: 10–25%
- What it means: Moderate probability of prostate cancer
- Typical action: Urologist consultation; biopsy often considered
Free:Total PSA Ratio: Greater than 25%
- What it means: Lower probability; likely benign condition
- Typical action: Continue monitoring; biopsy may be deferred
The free:total PSA ratio has sensitivity and specificity of approximately 70–80% for prostate cancer diagnosis, making it a valuable but not definitive screening tool (AUA 2023).
Disclaimer: Reference ranges may vary by laboratory. Listed ranges are general guidelines and may differ from those used by the performing lab. Always consult your healthcare provider for interpretation.
Pre-test preparation
No fasting is required for this test. However, avoid PSA testing within 48 hours after ejaculation, as this can temporarily elevate PSA levels. Also avoid testing shortly after prostate manipulation, such as a digital rectal exam, catheterization, or prostate biopsy. If you take medications like finasteride or dutasteride for BPH or hair loss, discuss timing with your healthcare provider, as these drugs lower PSA levels. Following these guidelines ensures the most accurate results (CDC 2024).
How often should I get tested?
Testing frequency depends on your individual risk factors and previous results:
Initial borderline PSA (4.0–10.0 ng/mL)
- Suggested interval: Order free:total ratio as follow-up test
Low-risk, normal ratio (>25%)
- Suggested interval: Retest total PSA annually or as advised
Moderate risk or family history
- Suggested interval: Every 6–12 months with total PSA monitoring
After abnormal ratio or biopsy
- Suggested interval: Follow urologist's individualized plan
Why early detection matters
Prostate cancer is one of the most common cancers among men globally. Early detection through accurate risk stratification significantly improves outcomes and reduces healthcare costs. The free:total PSA ratio helps avoid both missed diagnoses and unnecessary biopsies—potentially reducing unnecessary procedures by up to 30%. By providing clearer insight when total PSA is borderline elevated, this test enables timely intervention when cancer is present while sparing men with benign conditions from invasive procedures (Mayo Clinic 2024, NCCN 2024).
Related tests you may consider
Prostate-specific Antigen (PSA) Serum Test - Measures PSA levels in the blood to screen for prostate cancer or other benign prostate conditions.
Testosterone Free (Direct) and Total Testosterone Test - Detects for abnormal testosterone levels or hormone imbalances by measuring the free and total testosterone.
Prostate-specific Antigen (PSA) Hormone Blood Test Panel - Measures PSA, testosterone total & free, and estradiol levels to screen for prostate cancer or disorders.
