Do I Need a Referral to Get a PSA Test?

A PSA or Prostate-specific antigen test is part of prostate cancer screening. It's usually combined with a digital rectal exam and can help determine whether or not you have prostate cancer (reference 1). A PSA test, or PSA screening, as it is sometimes called, is not recommended for all patients, and should be discussed with your general practicioner or a trained medical professional, who will guide you through the process in your area and make a referral if required by your health insurance.

How PSA Testing Works

• PSA tests measure the amount of prostate-specific antigen in your blood. PSA is a protein produced by both cancerous and noncancerous tissues in the prostate -- a small gland below men's bladders. Cancerous tissues usually produce more PSA than benign growths, but PSA levels in the blood can also be high because of enlarged or inflamed prostate glands. False positives in PSA testing are common, and according to the Mayo Clinic, only about one in four men who test positive have prostate cancer.

Who Should Take a PSA Test

• Most organizations that recommend PSA screening tests advise that men between 40 and 75, as well as men with an increased risk of protate cancer be tested. This test is often required for life insurance policies for men over age 50. The U.S. Food and Drug Administration has approved the use of PSA tests with a digital rectal exam to help detect prostate cancer in men 50 and older, as well as to monitor reccurence in patients that have had prostate cancer in the past. According to the National Cancer Institute, men aged 65 and older are at a higher risk.

PSA Tests for Self-Payers

• While individuals who plan to pay for their own PSA testing do not need a general practicioner's referral for testing in many hospitals and medical centers, PSA testing remains controversial, and patients are strongly advised to discuss PSA testing with a doctor before and after testing in order to prepare for and better understand their results, and what, if any further testing is required. Some hospitals offer a free-of-charge telephone discussion with a urology nurse practicioner to help patients make an informed choice about going forward with testing.

PSA Tests for HMO Patients

• While many HMOs do not require a referral for yearly "well man" exams at insurance-approved urologists, in many cases the urologist must recommend a PSA test that will then your primary care provider will then coordinate, if you want your insurance dues to cover the procedure. Many states require health insurance policies to provide coverage for annual screening for the early detection of prostate cancer through PSA testing, especially in men who are 45 years of age or older, or 40 years of age or older when a physician orders it.

PSA Testing for Medicare Patients

• For all males with Medicare coverage, 50 years of age or older, Medicare covers a PSA Test every 12 months at no direct cost to the patient. While you do not require a primary physician's referral, the test must be performed by a physician who is knowledgeable about the patient and will be responsible for explaining the results, not a physician that sees the patient infrequently or only once. If you don't need a PSA as part of yearly prostate exams your doctor recommends or you are under age 50, you need a referral from a primary care practitioner, clinical nurse, or specialist that is familiar with the patient and able to explain the results for Medicare to cover the procedure.