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A follow-up test that measures free prostate-specific antigen (free PSA) may be used to see if a prostate biopsy should be done to check for cancer. Free PSA is the percent of prostate-specific antigen that is not attached to proteins in the blood. The lower a man's free PSA percentage, the more likely he is to have prostate cancer. A man with a total PSA between 4 and 10 ng/mL may have a test to find out his free PSA, to see if cancer is likely to be present.
PSA exists in serum in multiple forms: complexed to alpha-1-anti-chymotrypsin (PSA-ACT complex), unbound (free PSA), and enveloped by alpha-2-macroglobulin (not detected by immunoassays). Higher total PSA levels and lower percentages of free PSA are associated with higher risks of prostate cancer.