Elevated PSA: what happens next
A high PSA result does not mean you have prostate cancer. This page explains what PSA is and the steps that usually follow a referral to one of our urologists.
What is PSA?
Prostate-specific antigen (PSA) is a protein made by the prostate. A blood test measures how much is in your blood. PSA can be raised for many reasons, and most men with a raised PSA do not have prostate cancer.
Common reasons PSA can be raised
- An enlarged prostate, which becomes more common with age
- Inflammation or infection of the prostate or urinary tract
- Recent ejaculation or vigorous cycling
- A recent urinary catheter or procedure on the bladder or prostate
- Prostate cancer
Some medications for an enlarged prostate lower PSA levels. Tell your urologist about all the medications you take.
The usual steps after a referral
Your first visit
Your urologist reviews your PSA results over time, your symptoms, your family history and any medications that affect PSA. A prostate examination is usually part of this visit. Your PSA may be repeated, sometimes with additional blood tests.
Prostate MRI
If your PSA remains a concern, you may be sent for an MRI of the prostate. The radiologist scores any areas of concern on a scale from 1 to 5, called PI-RADS. Higher scores make cancer more likely, and the score helps your urologist decide whether a biopsy is needed and which areas to sample.
Prostate biopsy, if needed
A biopsy takes small samples of prostate tissue and is the only way to confirm prostate cancer. Our urologists perform transperineal biopsies, which pass the needle through the skin between the scrotum and anus rather than through the rectum. The biopsy is done under local anesthetic, and antibiotics are usually not needed.
Your results
Your urologist reviews the biopsy results with you at a follow-up visit. If cancer is found, it is given a grade (Grade Group 1 to 5, also known as the Gleason score) that describes how quickly it is likely to grow.
Next steps
- No cancer found. Your PSA is usually monitored over time.
- Low-risk cancer. Many men are monitored closely with regular PSA tests, MRI and repeat biopsies when needed. This is called active surveillance.
- Higher-risk cancer. Your urologist explains the treatment options, such as surgery or radiation therapy, and arranges referrals to other specialists when needed.
Appointments are by referral
Ask your family doctor or nurse practitioner to send a referral to the office of one of our urologists.