Raised PSA: What It Means and What Happens Next

Mr Sarp Keskin

3 days ago

3 min read

Being told your PSA is "raised" is a common reason for men to see a urologist – and a common cause of worry. The good news is that most men with a raised PSA do not have prostate cancer. This guide explains what the PSA test is, why it goes up and what happens next.

What is PSA?

PSA (prostate-specific antigen) is a protein made by the prostate gland. Small amounts leak into the bloodstream, where it can be measured with a simple blood test.

PSA is made by normal prostate tissue as well as by prostate cancer
A raised PSA means the prostate is "active" or disturbed in some way – it does not mean cancer on its own
Equally, a normal PSA does not completely rule out cancer, which is why the result is always interpreted alongside other factors

Why can PSA go up?

Common, non-cancer reasons:

Enlarged prostate (BPH) – a bigger prostate makes more PSA; this is the commonest reason
Prostate or urine infection, or inflammation of the prostate (prostatitis)
Recent ejaculation (within the last 48 hours)
Vigorous exercise, especially cycling, in the 48 hours before the test
A recent catheter, cystoscopy or prostate biopsy
Age – PSA naturally rises as men get older

And of course:

Prostate cancer – which is why a raised PSA needs proper assessment

What counts as "raised"?

Because PSA rises with age, the threshold depends on how old you are. As a general guide, the levels used in the UK to prompt further assessment are:

Age	PSA level that usually needs further assessment
Under 50	Above 2.5
50–69	3.0 or above
70 and over	Above 5.0

Other factors also matter:

How fast your PSA is rising over time
The size of your prostate (a large prostate can explain a higher PSA)
Your family history – a father or brother with prostate cancer, or a strong family history of breast or ovarian cancer (for example BRCA gene changes), increases risk
Ethnicity – Black men have a higher risk of prostate cancer

What happens at your appointment?

1. Discussion

Your urinary symptoms, general health and family history
Any recent infection, exercise or procedure that might have affected the result

2. Examination

A gentle examination of the prostate through the back passage (digital rectal examination), which takes a few seconds and helps assess the size and feel of the prostate

3. Repeat or further blood and urine tests

Sometimes the PSA is repeated, for example after treating an infection (usually after 6 weeks)
A urine test to exclude infection

4. Prostate MRI scan

Today, the key next step for most men is an MRI scan of the prostate:

A painless scan lasting around 30–40 minutes
It shows whether there are any suspicious areas in the prostate
Results are reported on a 1 to 5 scale (called PI-RADS): 1–2 means cancer is very unlikely, 3 is uncertain, and 4–5 means a suspicious area is present
A normal MRI means many men can avoid a biopsy altogether and simply have their PSA monitored

5. Prostate biopsy (only if needed)

If the MRI shows a suspicious area, or your overall risk is high, a biopsy may be recommended:

Small samples of prostate tissue are taken with a fine needle
In the UK, this is now usually done through the skin behind the scrotum (the transperineal route), often under local anaesthetic, which has a very low infection risk
The samples are examined in the laboratory, with results usually in 1–2 weeks

What if cancer is found?

Many prostate cancers found this way are low risk and slow growing, and may never cause harm. These are often best managed with active surveillance – careful monitoring with PSA tests and MRI scans, so treatment is only given if and when it is needed.

For cancers that need treatment, options include surgery, radiotherapy and other therapies. You will be guided to a specialist team who will discuss each option with you in detail.

Before your PSA test – practical tips

To get the most accurate result, for 48 hours before the test avoid:

Ejaculation
Vigorous exercise, especially cycling

And wait at least 6 weeks after a urine infection before testing.

Why see a urologist?

A raised PSA should always be interpreted in context. Mr Sarp Keskin will review your result, examine you, and arrange a prostate MRI and any further tests promptly, so you get clear answers quickly – and avoid unnecessary procedures where possible.