Ordering Recommendation

Acceptable initial test for prostate cancer screening. Preferred test is Prostate Specific Antigen, Total (0070121) in conjunction with digital rectal exam (DRE). May be useful in distinguishing cancer from benign conditions in patients with mildly elevated total PSA and negative DRE.

New York DOH Approval Status

This test is New York state approved.

Specimen Required

Patient Preparation

Serum Separator Tube (SST). Also acceptable: Green (lithium heparin), Lavender (K2EDTA), or pink (K2EDTA).

Specimen Preparation

Allow specimen to clot completely at room temperature. Separate serum or plasma from cells ASAP or within 2 hours of collection. Transfer 1 mL serum or plasma to an ARUP Standard Transport Tube. (Min: 0.5 mL)

Storage/Transport Temperature


Unacceptable Conditions

Grossly hemolyzed specimens. Vaginal washings.


After separation from cells: Ambient: 8 hours; Refrigerated: 5 days; Frozen: 3 months


Quantitative Electrochemiluminescent Immunoassay (ECLIA)




Within 24 hours

Reference Interval

Refer to report.

Test Number
Reference Interval
  Prostate Specific Antigen, Reflex 0.0-4.0 ng/mL
  Prostate Specific Antigen, Free, Reflex By report
  Prostate Specific Antigen-Pct Free, Rflx By report

Interpretive Data

Compliance Category



If PSA Total is between 3.0-10.0 ng/mL, then Free PSA testing will be added. Additional charges apply.

The Free PSA percentage is calculated using results of the Total and Free PSA tests.

Hotline History


CPT Codes

84153; if reflexed, add 84154


Component Test Code* Component Chart Name LOINC
0080286 Prostate Specific Antigen, Reflex 2857-1
0080287 Prostate Specific Antigen, Free, Reflex 10886-0
0080288 Prostate Specific Antigen-Pct Free, Rflx 12841-3
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.


  • Free PSA
  • Free Ratio Reflex
  • PSA Free/Total Ratio
  • PSA ratio
  • PSA Total
  • PSA Total and Free
  • Total PSA
Prostate Specific Antigen, Total with Reflex to Free PSA (Includes Free Percentage)