What Happens If Your PSA Level Is Elevated?

A high PSA can indicate cancer and may require further testing

Doctor looking at tablet
Portra/Getty Images

Once you get the results of your PSA test, usually about a week from the day your blood is drawn, you will likely meet with your doctor to discuss what to do next. PSA, short for prostate specific antigen, is a blood test used to screen for prostate cancer. As you age, your PSA level increase, making some PSA elevations normal. While a high PSA can indicate cancer, it can signal a number of other non-cancerous conditions as well.

How PSA Is Evaluated

Regardless of your age or PSA level, your doctor will perform a digital rectal exam (DRE) in order to detect any abnormalities of the prostate that can be felt. The PSA test and DRE are complimentary tests that are nearly always done together.

If your PSA is not elevated and your digital rectal exam is normal, your doctor will likely do nothing more at the time but will want to see you again in a year for another PSA test and DRE. Sometimes, if your PSA level is not elevated, but it has increased quickly in recent years (ie. a high PSA velocity), your doctor may be more concerned and recommended a biopsy.

If your PSA is not elevated, but there is an abnormality on your DRE, then a biopsy will likely be considered as well.

What Happens If Your PSA Is High?

If your PSA is markedly elevated, regardless of your age, then your doctor will likely want to proceed with a test that will definitively say why your PSA is elevated. The only test that allows for a certain diagnosis is a prostate biopsy. A biopsy involves obtaining a tiny sample of tissue from your prostate, which can then be analyzed. Prostate cancer, BPH, prostatitis, and other conditions can be diagnosed with a biopsy.

If your PSA is mildly elevated and you are young, otherwise healthy, and don’t have much of a family history of prostate cancer, then your doctor will likely wait and recheck your PSA level. Many conditions, such as prostatitis, are more likely to be the cause of a high PSA in a young, healthy man. If your PSA level is elevated due to prostatitis, during your follow-up PSA testing, your PSA level should return to normal.

Other Causes of a High PSA 

In some cases, your doctor might hold off on a prostate biopsy and recheck your PSA levels within a few weeks. There are a number of reasons, beyond prostate cancer, why your PSA levels may be higher than expected. Ejaculating within 24 hours of the test or riding a bicycle can raise your PSA as can infections such as a urinary tract infection. Other conditions like an enlarged prostate (benign prostate hyperplasia) or procedures to treat urinary issues (scopes or catheters) can also raise your PSA. 

If you think your PSA might be elevated due to a different condition or cause, ask your doctor if you can have your PSA rechecked in several weeks and treat any underlying issues, or abstain from PSA-raising activities, in the meantime.