Understanding the PSA Blood Test –
What an Elevated PSA Means for You
What Is PSA and Why Is It Tested?
PSA (Prostate-Specific Antigen) is a protein produced by the prostate gland and is normally found in semen. A small amount of PSA naturally enters the bloodstream, but when the prostate is irritated, inflamed, enlarged, or affected by cancer, more PSA can leak into the blood, leading to an elevated PSA level
Why Is PSA Tested?
A PSA test measures the level of PSA in the blood to help detect potential prostate abnormalities, including:
✔ Benign conditions like BPH (enlarged prostate) or prostatitis (inflammation).
✔ Prostate cancer, which can increase PSA levels as cancerous cells disrupt normal prostate tissue.
📌 If your PSA is elevated, it does not automatically mean cancer—but further evaluation is important.
What Causes an Elevated PSA?
A high PSA level does not always mean cancer—several benign conditions can also raise PSA.
✔ Benign Prostatic Hyperplasia (BPH) – A non-cancerous enlargement of the prostate that can elevate PSA levels.
✔ Prostatitis – Inflammation or infection of the prostate can cause a temporary PSA spike.
✔ Recent Ejaculation or Prostate Stimulation – Sexual activity and activities like bike riding may temporarily increase PSA.
✔ Urinary Tract Infections (UTIs) – Infections affecting the bladder or prostate can elevate PSA.
✔ Prostate Cancer – While not the only cause of high PSA, prostate cancer remains an important concern that requires further testing.
📌 A digital rectal exam (DRE) does not significantly affect PSA levels, so you can have a PSA test shortly after a prostate exam
Understanding PSA Test Results
What Is Considered an Elevated PSA?
There is no absolute “normal” PSA level, but in general:
✔ PSA above 2.5 or 3 ng/mL increases the risk of prostate cancer.
✔ Higher PSA levels do not always mean cancer, but they indicate the need for further evaluation.
Factors That Influence PSA Levels
✔ Age & Prostate Size – The prostate naturally enlarges with age, which can lead to higher PSA levels.
✔ Recent Activity – Sexual activity and bike riding can cause temporary spikes.
✔ Infection or Prostatitis – Prostate inflammation or a urinary tract infection (UTI) can temporarily raise PSA levels.
✔ Medications – Finasteride (Proscar, Propecia) for BPH can lower PSA levels by about 50%, so adjustments may be needed when interpreting results.
How We Evaluate an Elevated PSA
Rather than relying on a single PSA number, Dr. Bevan-Thomas uses a combination of advanced tools to assess prostate cancer risk, including:
✔ PSA Trends Over Time (PSA Velocity) – A rising PSA is more concerning than a single high result.
✔ PSA Density – Compares PSA level to prostate size using imaging.
✔ Free vs. Total PSA – A lower percentage of free PSA may indicate a higher risk of cancer.
✔ Molecular Biomarker Tests – Advanced urine or blood-based tests that help determine cancer risk.
✔ Prostate MRI – Provides high-resolution imaging to detect concerning areas before considering a biopsy.
📌 If your PSA is elevated, it does not mean you have cancer—but it does mean further evaluation is important.
Next Steps if Your PSA Is Elevated
If your PSA is elevated, Dr. Bevan-Thomas takes a comprehensive approach to determine the next steps based on your PSA trends, risk factors, and additional testing.
Step 1: Confirming the PSA Level
✔ Repeat PSA Testing – PSA levels can fluctuate, so a second test may be needed to confirm the results.
✔ Rule Out Temporary Causes – If infection or prostatitis is suspected, treatment may be recommended before retesting.
Step 2: Additional Testing & Risk Assessment
Rather than jumping straight to a biopsy, Dr. Bevan-Thomas uses advanced tools to better assess your prostate cancer risk:
✔ Free vs. Total PSA – Helps differentiate between cancer and benign conditions.
✔ PSA Density & PSA Velocity – Evaluates PSA in relation to prostate size and rate of change.
✔ Prostate MRI – High-resolution imaging to detect suspicious areas before considering a biopsy.
✔ Molecular Biomarker Tests –
- ExosomeDx (ExoDx Prostate Test) – A urine test that detects cancer-related RNA markers.
- MyProstateScore 2.0 – A genetic test that helps determine the likelihood of clinically significant prostate cancer.
📌 These tests help determine who truly needs a biopsy—reducing unnecessary procedures.
When Is a Prostate Biopsy Needed?
Not every man with an elevated PSA needs a biopsy. Dr. Bevan-Thomas carefully evaluates each patient’s risk before recommending a biopsy, using a combination of PSA trends, molecular testing, and MRI results.
✔ MRI Fusion Biopsy – A more accurate, image-guided biopsy that targets suspicious areas seen on MRI.
✔ Transperineal Biopsy (if covered by insurance) – A minimally invasive approach that:
- Reduces infection risk compared to the transrectal approach.
May provide better sampling of hard-to-reach areas of the prostate, improving diagnostic accuracy.
What If My Biopsy Is Positive?
If a prostate biopsy confirms prostate cancer, the next step is understanding the aggressiveness of the cancer and determining the best treatment plan.
✔ Genomic Testing (Decipher, Oncotype DX, Prolaris) – Helps predict how aggressive the cancer is and whether treatment is needed.
✔ PSMA PET Scan – Used in certain cases to evaluate whether cancer has spread beyond the prostate.
✔ Prostate MRI Review – Examines tumor location, size, and possible spread to nearby structures.
📌 For a more detailed discussion on prostate cancer, visit our Understanding Your Prostate Cancer page.
Why Choose Dr. Bevan-Thomas for PSA Evaluation?
✔ Over 20 years of experience with several thousand robotic-assisted prostatectomies performed.
✔ Performing MRI Fusion Biopsies since 2012, ensuring precise prostate cancer detection.
✔ Expert in prostate ablation therapies, including NanoKnife (Irreversible Electroporation) and Cryoablation.
✔ Trained at the world-renowned MD Anderson Cancer Center.
✔ Comprehensive, patient-focused approach, ensuring the right tests and treatments for each patient.
📌 If you’ve been told you have an elevated PSA, take control of your prostate health. Schedule a consultation today.
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