Our experts can help guide you to what’s best for you.
- A high PSA does not automatically mean prostate cancer
- Further evaluation is personalized and often starts with repeating the PSA test
- MRI and biopsy are used selectively to avoid unnecessary procedures
The PSA test is a blood test used to help early detection of prostate cancer. This simple blood test — developed at Roswell Park Comprehensive Cancer Center in the 1970s — measures the amount of the PSA, or prostate-specific antigen protein, in your blood. If cancer is present in the prostate, PSA levels typically rise.
Getting your PSA checked and taking appropriate follow-up action is critical to detecting prostate cancer and treating it appropriately. Developing prostate cancer often has no symptoms, which is why the PSA test is crucial to diagnose prostate cancer in the early stages when treatment is highly successful.
It’s important to remember that the PSA test is merely a screening test. A high PSA reading does not necessarily mean you have cancer.
Not every man with a high PSA needs the same next steps. We don’t go right to biopsy based only on your PSA. How we manage your PSA result is very nuanced and personalized and follows evidence-based guidelines. We don’t want men to undergo invasive testing they may not need.
What is a normal PSA level?
That depends primarily on your age and the size of your prostate. What is considered a normal PSA level is lower for younger men than it is for older men. This is because in older men the prostate tends to grow larger in a noncancerous way and this can also cause the PSA to rise.
Your PSA is considered elevated if it’s around or above the upper limit of normal for your age. Any elevated PSA result needs further investigation.
Age | Upper limit of normal |
|---|---|
40-49 | 2.5 |
50-59 | 3.5 |
60+ | 4.5 |
What can cause an elevated PSA?
In addition to prostate cancer, several benign (noncancerous) conditions may also raise your PSA. These include an enlarged prostate, inflammation in the prostate, a urinary tract infection and some medications. In addition, having sex or vigorous exercise (especially bike riding) in the day or two before your PSA test can result in a higher level.
What’s next with a high PSA?
If your PSA level is higher than normal — for your age — you should consult with a urologist who specializes in prostate cancer for guidance on your next steps. Roswell Park now offers a program where our urologists help men get the answers they need quickly. With this program, here’s what to expect:
Visit with urologist
Meeting in person with the urologist is important and the doctor will want to discuss your personal and family cancer history, as well as any prostate cancer risk factors. In addition, this visit should include:
- physical examination and digital rectal exam
- A repeat PSA test
- Discussion of any urinary or other symptoms you may have
We always repeat the PSA test if there has only been a single result. This helps us determine whether your high PSA is a real, persistent concern, or if it’s a temporary spike due to a benign cause such as a urinary tract infection, recent sexual activity, or vigorous exercise.
If your PSA level remains high, or rises, your urologist will discuss further tests to determine if you have prostate cancer or not.
Discussion about your risk for prostate cancer
At our clinic, we use your PSA number along with other factors to determine your risk for having prostate cancer and whether further tests are appropriate. These factors include:
- your general health and health history
- your family history of prostate cancer and other cancers
- African American race
Learning these factors helps doctors to counsel you on how manage the PSA result.
Possible MRI scan
A prostate MRI scan provides detailed pictures of the prostate gland and surrounding tissues. These pictures help us determine whether your high or rising PSA is caused by a possible cancer which would be seen as an abnormal area in your prostate on the MRI scan. If we then decide that a biopsy is truly necessary, the MRI scan will allow us to map out and target specific areas during the biopsy.
Biopsy (only if necessary)
We only move to biopsy if the MRI scan reveals a strong suspicion of cancer. A biopsy takes samples of tissue or cells from the prostate to be examined in a laboratory to determine if cancer is present and other characteristics that help guide treatment decisions. It’s the only way to officially diagnose prostate cancer.
Roswell Park performs fusion or targeted prostate biopsy where we target the specific area of concern by fusing your MRI images with real-time ultrasound images. The urologist will use a slender hollow needle to take several samples or “cores” of tissue. If cancer cells are present, the pathologist assigns the samples a number, called the Gleason score, which describe how abnormal the cells look and how aggressive or fast they are growing.
Being able to perform the advanced targeted biopsy also is very important in the event that cancer is present. This approach reduces the risk of missing the tumor and allows us to map the prostate so that we can determine which treatment options to recommend including whether you might be a candidate for focal therapy or high intensity focused ultrasound (HIFU) treatment.
If you do not need a prostate biopsy we will continue to monitor your PSA at 6- to 12-month intervals and provide advice on when action is needed.
Get your PSA evaluated
If you are concerned about your PSA level, our team can provide personalized next steps and monitoring guidance.
Ongoing PSA monitoring and peace of mind
Having a raised PSA level creates a lot of anxiety. Through our program, patients are followed by prostate cancer experts over time. We manage your PSA result in the context of you as the individual patient.
At Roswell Park, we have a whole team of specialists — urologists, pathologists, radiologists and medical and radiation oncologists — and this expertise matters. We hope this PSA program gives patients the opportunity to discuss their results and the next steps and reduce anxiety about early detection of prostate cancer.
