Elevated PSA: A Patient Guide

Hearing that you have an “elevated PSA” can feel confusing and even frightening. PSA (Prostate-Specific Antigen) is a blood test that has become one of the most common tools for monitoring prostate health. While an abnormal result doesn’t always mean cancer, it does mean further evaluation is important.

At Advanced Urology, we specialize in helping men understand what their PSA results mean, guiding them through the evaluation process, and ensuring they get the right care in our state-of-the-art facilities. This guide explains what PSA is, what can cause it to rise, and what to expect if your test comes back elevated.

What Is PSA?

PSA stands for Prostate-Specific Antigen, a protein made only by the prostate gland. Normally, small amounts of PSA are present in the blood. When the prostate is enlarged, inflamed, or affected by cancer, PSA levels may rise.

Because PSA is specific to the prostate but not specific to prostate cancer, the test is a helpful tool but not a perfect one. That’s why an elevated PSA always needs careful interpretation.

Why Is PSA Tested?

PSA testing is commonly used to:

Screen for prostate cancer in men over 50, or earlier in men with risk factors such as family history or African American heritage.
Monitor prostate health in men with known conditions such as benign prostatic hyperplasia (BPH) or prostatitis.
Follow-up after prostate cancer treatment to ensure the disease has not returned.

What Is Considered Elevated?

Traditionally, a PSA level above 4.0 ng/mL has been considered “elevated.” However, PSA interpretation is more nuanced than a single cutoff. Doctors consider:

Age: PSA tends to rise naturally as men age.
PSA velocity: A rapid increase over time may be concerning even if the value is not very high.
PSA density: PSA level relative to prostate size.
Free vs. total PSA: Ratios can help distinguish benign conditions from cancer.

Causes of Elevated PSA

An elevated PSA does not automatically mean prostate cancer. In fact, many common, non-cancerous conditions can raise PSA levels, including:

Benign Prostatic Hyperplasia (BPH): Enlargement of the prostate, common with aging.
Prostatitis: Inflammation or infection of the prostate.
Urinary tract infection
Recent ejaculation
Recent prostate procedures such as catheterization, cystoscopy, or biopsy.
Vigorous exercise such as cycling or long-distance running.

Because PSA can fluctuate, sometimes repeating the test after avoiding these triggers provides more accurate information.

When to Be Concerned

While non-cancerous causes are common, prostate cancer remains the most important reason for evaluating an elevated PSA. Prostate cancer is highly treatable when detected early. Warning signs that make a high PSA more concerning include:

Rapidly rising PSA over time.
PSA much higher than expected for age.
Abnormal findings on digital rectal exam (DRE).
Strong family history of prostate cancer.

How an Elevated PSA Is Evaluated

At Advanced Urology, we use a step-by-step, modern approach to determine the cause of an elevated PSA.

1. Repeat Testing

Sometimes the first step is simply repeating the PSA test, especially if there are possible temporary causes such as infection or recent activity.

2. Risk Assessment

We combine PSA results with other tools, including DRE findings, prostate volume, family history, and race, to estimate risk.

3. Advanced Testing

We may use additional blood or urine tests (such as PHI, 4Kscore, or SelectMDx) to refine cancer risk assessment.

4. Imaging

Multiparametric MRI of the prostate can identify suspicious areas and help guide whether a biopsy is needed.

5. Prostate Biopsy

If cancer is suspected, a biopsy remains the definitive test. Using ultrasound or MRI guidance, small tissue samples are taken from the prostate and examined under a microscope. At Advanced Urology, biopsies are performed in our state-of-the-art ASCs, using modern techniques to maximize comfort and accuracy.

What If Cancer Is Found?

Not all prostate cancers are the same. Some are slow-growing and may not need immediate treatment, while others are more aggressive. Depending on results, treatment options may include:

Active surveillance for very low-risk cancers.
Minimally invasive surgery (robotic prostatectomy).
Radiation therapy.
Focal therapies (emerging options for selected patients).
Systemic treatments for advanced disease.

The key is that finding cancer early provides many safe and effective options with excellent outcomes.

Why Choose Advanced Urology?

We understand that hearing “elevated PSA” creates anxiety. At Advanced Urology, we aim to replace fear with knowledge and a clear plan. Our patients benefit from:

Expert physicians specializing in prostate health.
State-of-the-art ASCs, designed for comfort, safety, and painless procedures.
Advanced diagnostic tools, including MRI, modern lab testing, and image-guided biopsy.
Personalized care, with clear explanations and shared decision-making at every step.

Conclusion

An elevated PSA doesn’t always mean cancer, but it is never something to ignore. With careful evaluation, we can identify whether the cause is benign or serious, and if cancer is present, begin treatment early for the best outcomes.

At Advanced Urology, we guide patients through the process with expertise, compassion, and the latest technology—all in a safe, comfortable outpatient environment. If you or a loved one has an elevated PSA, don’t panic—but do get answers.