PSA Testing for Men in South Africa

In brief

A PSA result is a risk signal; it does not diagnose or completely exclude prostate cancer.
South African guidance uses age, African ancestry, family history, genetics and general health to decide when a screening discussion should begin.
Infection, urinary retention, some procedures, medicines, ejaculation and vigorous cycling can affect interpretation.
A newly raised result often needs confirmation and context before MRI, biopsy or another investigation is considered.

September is a useful prompt to deal with the prostate-health question many men postpone: should I have a PSA test? The best answer is not a blanket yes or no. It is a calm, informed decision based on your own risk and a clear plan for what happens after the result.

What a PSA test measures—and what it cannot tell you

Prostate-specific antigen, or PSA, is a protein produced by prostate tissue. The test measures its level in a blood sample. Prostate cancer can raise PSA, but so can benign prostate enlargement, inflammation or infection, acute urinary retention and recent procedures involving the prostate or urinary tract. PSA also varies naturally between measurements.

This is why PSA is better understood as a marker that helps estimate risk, not a stand-alone cancer test. A raised result does not mean that you have cancer. A result within a reference range cannot guarantee that cancer is absent. The number only becomes useful when it is interpreted with your age, previous results, symptoms, family history, medicines and clinical findings.

A point that may ease some anxiety: current South African guidance uses PSA as the first screening test. It found no added screening benefit from automatically combining PSA with a routine rectal examination in asymptomatic primary-care patients. A rectal examination can still be important when symptoms or other findings need diagnostic assessment.

Screening and diagnostic assessment are not the same

Screening is testing someone who feels well and has no symptoms. If you have persistent or worsening urinary symptoms, visible blood in your urine, persistent blood in semen, unexplained weight loss, or persistent pelvic, back or bone pain, you need a clinical assessment rather than waiting for a screening milestone. These symptoms have several possible causes and do not by themselves mean prostate cancer.

Seek urgent care if you cannot pass urine, or if fever or chills occur with painful urinary symptoms and you feel acutely unwell. New severe back pain with leg weakness or numbness, numbness around the saddle area, or new loss of bladder or bowel control requires emergency assessment.

Who should discuss PSA screening in South Africa?

The 2024 South African Prostate Cancer Screening Guidelines recommend an informed, shared decision for asymptomatic men who are likely to benefit from early diagnosis. They identify these starting points for discussion:

Screening may detect a clinically significant cancer earlier and reduce the risk of metastasis or prostate-cancer death for some men. It can also produce false-positive results, cause anxiety and lead to biopsy, or detect a slow-growing cancer that would never have caused harm. Treatment can affect urinary, sexual and bowel function. Testing therefore makes most sense after discussing these trade-offs—and when you would consider appropriate follow-up or treatment if a significant cancer were found.

From age 50: all men.
From age 45: Black African men, and men with a first-degree relative who has had prostate and/or breast cancer.
From age 40: men known to carry certain inherited variants, including BRCA2, BRCA1, HOXB13, ATM or CHEK2—or 10 years before the youngest affected relative if that diagnosis occurred before age 40.

These are ages to begin a conversation, not instructions for automatic annual testing. The interval after a baseline result should be individualised. The same guideline generally advises against routine screening after age 70 or when life expectancy is under 10 years, while allowing an individual discussion for a healthy, interested man at 70.

If you are unsure where you fit, a private men’s health assessment can review your family history, ancestry, symptoms, current treatment and preferences before any test is requested.

How to prepare for a PSA test

Preparation helps reduce avoidable confusion, particularly when confirming a borderline or newly raised result.

Avoid ejaculation and vigorous cycling for at least 48 hours before the blood draw. Avoid unusually strenuous exercise during the same period.
Tell the clinician if you have symptoms of a urinary infection or prostatitis, or recently had difficulty passing urine.
Mention recent catheterisation, cystoscopy, biopsy or other urinary-tract or prostate procedures. Testing may need to be deferred while a temporary rise settles.
Provide a complete list of medicines, supplements and hormones. Finasteride and dutasteride can lower PSA and change how the result is interpreted.
Do not stop prescribed medicine or take antibiotics simply to change a PSA result unless your treating clinician has given a clear medical reason.

A PSA test by itself does not require fasting, although other blood tests requested at the same time might. If a result is being repeated, using the same laboratory and assay can make comparison more useful.

Timing matters: South African guidance advises waiting 6–8 weeks after bacterial prostatitis symptoms resolve, and about 6 weeks after acute urinary retention or urethral instrumentation. Your clinician should set the timing for your circumstances.

What happens after a raised result?

There is no single PSA number that answers every question. A clinician will first check the result against age-related guidance, prior PSA values, symptoms, possible infection, recent activity or procedures, medicines, family history and any examination findings.

For an asymptomatic man with an initially raised PSA below 10 ng/mL and no suspicious examination findings, South African guidance recommends repeating the PSA before proceeding to more invasive investigation. A repeat is often arranged after several weeks, once temporary influences have cleared. A meaningful proportion of newly raised results is lower or back within range on repeat testing.

If PSA remains raised for age or the examination is abnormal, referral to a urologist is appropriate. The PSA trend can contribute to the overall risk assessment but is not interpreted alone. Depending on the full risk picture, the next step may involve:

A repeat PSA and review of the trend over time
A free-to-total PSA ratio or another risk-refining tool in selected cases
Assessment of prostate size and PSA density
A prostate MRI to look for suspicious areas and help plan sampling
A targeted and/or systematic biopsy when tissue confirmation is warranted

An MRI is not the first screening test and cannot diagnose or completely exclude cancer. A biopsy is usually required to confirm prostate cancer, but not every raised PSA automatically leads to one. The purpose of this staged pathway is to investigate meaningful risk while reducing avoidable procedures.

How PSA fits into testosterone care

PSA sometimes enters the conversation when a man is considering or already receiving testosterone replacement therapy. Depending on age and individual risk, prostate-risk assessment may be appropriate before treatment and during monitoring. An unexplained raised PSA should be evaluated rather than ignored before testosterone is started.

A change in PSA during treatment does not, on its own, prove cancer or prove that testosterone caused the change. It does call for confirmation and appropriate review. This is one reason a responsible TRT assessment and monitoring plan is broader than prescribing testosterone from a symptom list or one laboratory result. For the diagnostic basics, read why symptoms and blood tests both matter.

One clear pathway across distinct brands

The wider brand network is designed to make each role clearer, not to make you navigate several competing services:

MaleHealth is the men-focused information and private consultation gateway. This is where male-specific questions, preparation and next steps are explained.
Dr Luhard is the medical author and consulting doctor. His broader professional profile is available at DrLuhard.com.
Medify is the patient-care practice through which Dr Luhard provides consultations and treatment. Practice information is available at TheMedify.com.
MedCentre Waterkloof is the separate multidisciplinary facility at 265 Main Street where the practice is located. Location information is available at TheMedCentre.co.za.

For a PSA or prostate-health concern, your enquiry can remain with MaleHealth. Dr Luhard’s Medify team will arrange the appropriate consultation and, where indicated, referral or further investigation.

What to bring to the consultation

Your previous PSA results, with their dates and laboratory names
A short family history of prostate, breast, ovarian and pancreatic cancer where known
A list of all medicines, supplements, testosterone or other hormones
Details of urinary symptoms, infection, recent procedures or urinary retention
The questions you want answered about testing, follow-up and referral

Private consultations · Waterkloof

Ready to discuss your prostate-health risk?

Start with a private medical consultation with Dr Luhard through Medify in Waterkloof, Pretoria. You do not need to diagnose yourself or arrive with a treatment plan.

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References and further reading

Medical disclaimer: This article is for general education and adults 18+. It is not a diagnosis, a screening instruction for every man, or a substitute for a consultation with a suitably qualified medical practitioner. Screening suitability, test interpretation and follow-up are individual. MaleHealth is not an emergency service. If you may be experiencing a medical emergency, use the appropriate emergency services.