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Free PSA A second look at a borderline PSA

Also called Percent free PSA, Free-to-total PSA ratio and % free PSA Not on a standard checkup No fasting needed

The short answer

Free PSA is the share of your PSA that floats loose in your blood instead of being bound to other proteins. When your total PSA is borderline, a lower free share points to a higher chance of prostate cancer. The usual line is 25%.1,2

A good result
Over 25%. In the study behind the test, men with a PSA of 4 to 10 and a result this high had about a 5% to 9% chance of cancer on biopsy.2
If yours is low
At 10% or under, the chance in that study was about 55%.2 It isn’t a diagnosis, and an MRI usually comes before any biopsy.3,4
Should you test?
It’s designed for a total PSA of 4 to 10 ng/mL with a normal prostate exam. Labcorp’s PSA test adds it automatically in that range.2,5

Check your result

Type the number from your report. It stays on this page.

How old are you?

These figures only apply if your total PSA is 4 to 10 ng/mL and your prostate exam was normal, the group the test was approved for.5 Labcorp only reports free PSA in that range.2 The study behind the numbers enrolled men aged 50 to 75, so if you’re younger or older, the figures don’t apply and a clinician has to read your result.1

10.1 25.1
  • 10% or under Under 10.1
  • 10% to 25% 10.1 to 25.0
  • Over 25% 25.1 or more

Enter your result to see what it means and what to do next.

Got a result from another lab? Ask Picardo about it. The app explains your results, and a physician can follow up.

Chances of cancer from Catalona’s 1998 study, as Labcorp reports them.1,2 They count any cancer found on the standard biopsies of the time. The bar isn’t to scale.

What is a normal free PSA level?

There’s no normal range for free PSA on its own. What matters is the percentage, and only when your total PSA is 4 to 10 ng/mL and your prostate exam is normal. The lower it is, the higher the chance of cancer:1,2

10% or under 10% or less

10% or under: the highest-risk group

Based on the study behind these numbers, the estimated chance of cancer on biopsy with a result this low is about 56% for men aged 50 to 64 and 55% for men aged 65 to 75.2 That study counted any cancer, including slow-growing ones, and used the standard biopsies of the 1990s.1

How worried to be

Worth acting on in the next few weeks. It isn’t an emergency, and it isn’t a diagnosis.

What to do next
  1. 1 See a clinician or urologist about the next step. An MRI of the prostate usually comes before any biopsy.3,4
  2. 2 If this was your first high PSA, US guidelines say to repeat it before an MRI or biopsy.3
10% to 25% 10.1% to 25%

10% to 25%: in between

Based on the study behind these numbers, the estimated chance of cancer on biopsy for men aged 50 to 64 is about 24% at 10% to 15% free PSA, 17% at 15% to 20% and 10% at 20% to 25%. For men aged 65 to 75 it’s 35%, 23% and 20%.2 The study’s single cutoff of 25% or under caught 95% of cancers while sparing 20% of men without cancer a biopsy.1

How worried to be

Not urgent, but worth talking through with a clinician in the next few weeks.

What to do next
  1. 1 Ask a clinician whether an MRI is the right next step.3,4
  2. 2 Risk calculators that combine free PSA with your age, family history and other results can sharpen the estimate.3
  3. 3 If this was your first high PSA, US guidelines say to repeat it before an MRI or biopsy.3
Over 25% Over 25%

Over 25%: the lowest-risk group

Based on the study behind these numbers, the estimated chance of cancer on biopsy with a result over 25% is about 5% for men aged 50 to 64 and 9% for men aged 65 to 75.2 Cancers found at this level were more common in older men, and tended to be smaller and lower grade.1

How worried to be

Reassuring, though not a guarantee.

What to do next
  1. 1 Ask whether you can keep an eye on your PSA rather than have a biopsy now. US guidelines say a biopsy can wait when your risk is low enough.3
  2. 2 Keep testing your PSA as your clinician suggests.3
Base Core Annual – Men panel
$204.25 · Free PSA plus 21 more tests, one visit
Order
Or order just the PSA test with a free PSA reflex, $8.00

What is free PSA?

Total PSA tells you how much PSA there is. Free PSA tells you how much of it is loose. Two men with the same PSA of 6 can have very different free shares, and the one with less free PSA is more likely to have cancer.1

Most of the PSA in your blood is bound to other proteins, and a smaller part floats free. A free PSA test measures that free part and divides it by your total PSA, which gives a percentage.2

An enlarged prostate and prostate cancer can both push total PSA up. A lower free percentage makes cancer the more likely of the two.1,3

When does free PSA help?

It was designed for one situation: a total PSA of 4 to 10 ng/mL and a normal prostate exam, in men 50 or older. That’s the group the FDA approved it for, and the range in which Labcorp adds it.2,5

Outside that range, it helps less:

  • Below 4, it can’t spare many biopsies without missing cancers. In men with a PSA of 2.6 to 4, a 25% cutoff missed 15% of cancers, against 5% in the 4 to 10 range, and a 30% cutoff that caught 93% spared only 9% of men without cancer a biopsy.1,7
  • Above 10, the chance of cancer is high enough that US guidelines say an extra test like this is unlikely to change the decision to look further.3

What does your free PSA percentage mean?

Free PSA Ages 50 to 64 Ages 65 to 75
10% or less56%55%
10.1% to 15%24%35%
15.1% to 20%17%23%
20.1% to 25%10%20%
Over 25%5%9%

The chance of prostate cancer on biopsy for men with a total PSA of 4 to 10 ng/mL and a normal prostate exam, from Catalona’s 1998 study as Labcorp reports it. Any cancer counts, including slow-growing ones.1,2

These numbers come from one study of 773 men aged 50 to 75 at seven US university centers, published in 1998.1 It counted any cancer found on the standard biopsies of the time, including slow-growing cancers that might never need treatment. US guidelines say tests that predict any cancer do less to avoid finding those harmless cancers than tests that predict aggressive ones.3

The study also used a different lab method from Labcorp’s, and Labcorp warns that results from different methods aren’t interchangeable.1,2 Treat the figures as a rough guide.

How does free PSA fit with MRI and newer tests?

Today, an MRI of the prostate usually comes before any biopsy.3,4 Free PSA is one input among several. US urology guidelines say extra blood or urine tests may be used when the result would change whether you have a biopsy, and rate the evidence for this as limited.3

Several newer blood tests build on free PSA:4

  • The Prostate Health Index adds a third form of PSA. It’s FDA-approved.4
  • The 4Kscore adds other forms of PSA and a related protein. It’s FDA-approved too.9
  • Stockholm3, developed in Sweden, adds more blood markers, a genetic score and personal details such as family history.4

In studies, both the Prostate Health Index and the 4Kscore did better than free PSA alone.4 In November 2025, the FDA approved IsoPSA, which measures total and free PSA after a lab step that sorts PSA by its structure, and combines them into one score. It’s meant to help find higher-grade cancer in men 50 or older with a PSA of 4 to 10 whose urologist is already considering a biopsy.6

What can throw off your result?

  • A prostate exam, prostate massage or ultrasound just before the blood draw. These can raise the free percentage for a while, so it reads higher than it should.2
  • A recent biopsy. Labcorp asks you to wait at least 6 weeks.2
  • Switching labs. Results from different methods can’t be compared directly.2

Finasteride seems to matter less here than for total PSA. It lowers total and free PSA about equally: in one small study of men with an enlarged prostate, the percentage was about the same in men taking it as in men who weren’t.8

Who should get a free PSA test?

Men 50 or older whose total PSA is between 4 and 10 ng/mL, whose prostate exam is normal and who are weighing an MRI or a biopsy.2,5 If you order Labcorp’s PSA test with a free PSA reflex, you don’t need to decide: it adds free PSA only when your total lands in that range.2

It isn’t a screening test on its own, and it doesn’t replace an MRI or a biopsy.3,5 For what your total PSA means, see the PSA guide.

How to get a free PSA test, and what it costs

It comes from the PSA test with a free PSA reflex, which costs $8.00 through Picardo. The Base Core Annual – Men panel adds 21 more tests from the same visit for $204.25.

Recommended

Base Core Annual – Men panel

$204.25
22 tests · fast for 12 hours first

The panel includes this PSA test, so free PSA is added if your total is 4 to 10. It also adds testosterone, LH and FSH, a blood count and kidney and liver tests, all from one draw.[2]

Order the Base Core Annual – Men panel
Just this test

PSA test with a free PSA reflex

$8.00
Labcorp 480772 · no fasting needed

The test this number comes from.

Order the PSA test with a free PSA reflex
  • Results in 2 to 3 days, in the app
  • Physician follow-up if you want one
  • Free Labcorp draw, or $75 at home
  • No other fees. HSA and FSA eligible.
Already have a result? Ask Picardo about it

Questions people ask

Is a higher or lower free PSA better?

Higher. Over 25% means a lower chance of prostate cancer; 10% or under means a higher one.1,2

Why didn’t my lab report free PSA?

Labcorp’s test only adds it when your total PSA is between 4.0 and 10.0 ng/mL. Outside that range, you get total PSA alone.2

Can free PSA replace an MRI or a biopsy?

No. It helps decide whether you need the next step, and today that’s usually an MRI.3,4 Only a biopsy can diagnose prostate cancer.5

Can I use free PSA if I’m under 50?

It wasn’t built for that. The study behind the numbers enrolled men aged 50 to 75, and the FDA approved the test for men 50 or older.1,5

Often checked alongside

PSA
A prostate protein used in cancer screening
Total testosterone
All the testosterone in your blood
LH
A brain hormone that triggers ovulation and testosterone
SHBG
The protein that binds sex hormones

Test details

Labcorp test
Prostate-specific Antigen (PSA), Free:Total Ratio Reflex, 480772
LOINC
12841-3
Sample
Blood
Fasting
Not needed
Typical lab range
None given. Labcorp cites 25% or under as the cutoff for a higher chance of cancer.2
Units
%, from free PSA divided by total PSA
When it’s reported
Only when total PSA is 4.0 to 10.0 ng/mL2
Before the test
No prostate exam, massage or ultrasound just before the draw, and no biopsy in the past 6 weeks2

Sources

  1. 1 Catalona WJ, Partin AW, Slawin KM, et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA. 1998;279(19):1542–1547. doi.org/10.1001/jama.279.19.1542
  2. 2 Labcorp. Prostate-specific Antigen (PSA), Free:Total Ratio Reflex, test 480772. Labcorp test menu. Accessed October 28, 2026. www.labcorp.com/tests/480772/prostate-specific-antigen-psa-free-total-ratio-reflex
  3. 3 Lin DW, Carlsson S, Filson CP, et al. Updates to early detection of prostate cancer: AUA/SUO guideline (2026). J Urol. 2026;215(5):491–501. doi.org/10.1097/JU.0000000000004995
  4. 4 Cornford P, Tilki D, van den Bergh RCN, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on prostate cancer. Limited update March 2026. Arnhem: EAU Guidelines Office; 2026. Accessed October 28, 2026. d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-EANM-ESTRO-ESUR-ISUP-SIOG-Guidelines-on-Prostate-Cancer-2026_2026-03-14-104356_ixav.pdf
  5. 5 US Food and Drug Administration. Premarket approval P000027: Elecsys free PSA immunoassay (Roche Diagnostics). Approved December 12, 2000. Accessed October 28, 2026. www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P000027
  6. 6 US Food and Drug Administration. Premarket approval P200048: IsoPSA assay (Cleveland Diagnostics). Approved November 28, 2025. Accessed October 28, 2026. www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P200048
  7. 7 Roehl KA, Antenor JA, Catalona WJ. Robustness of free prostate specific antigen measurements to reduce unnecessary biopsies in the 2.6 to 4.0 ng/ml range. J Urol. 2002;168(3):922–925. doi.org/10.1016/S0022-5347(05)64543-0
  8. 8 Keetch DW, Andriole GL, Ratliff TL, Catalona WJ. Comparison of percent free prostate-specific antigen levels in men with benign prostatic hyperplasia treated with finasteride, terazosin, or watchful waiting. Urology. 1997;50(6):901–905. doi.org/10.1016/S0090-4295(97)00453-6
  9. 9 US Food and Drug Administration. Premarket approval P190022: 4Kscore Test (OPKO Health). Approved December 7, 2021. Accessed October 28, 2026. www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P190022

Updated 28 Oct 2026.

This is general health information, not medical advice: talk to your clinician about your results and before changing any treatment.