A blood test showing a raised PSA is understandably worrying. The most important thing first: a high PSA does not mean you have cancer. It is a finding to look into calmly and carefully, and in many cases the cause is benign.
To make sense of it, it helps to know what PSA is, why it can go up and the sensible order of steps to follow when it comes back high.
What is PSA?
PSA (prostate-specific antigen) is a protein made by the prostate and measured with a blood test. It is specific to the prostate, but it is not specific to cancer: it can rise for several reasons, some of them common and benign. That is why you cannot draw conclusions from a single high result on its own.
Why PSA can rise
Several causes of a raised PSA have nothing to do with a tumour:
- Benign prostatic hyperplasia (BPH): as the prostate enlarges with age, PSA goes up.
- Prostatitis or a urine infection: inflammation raises it, sometimes considerably.
- Recent procedures: having had a catheter, an examination or other urological tests shortly before the blood test.
- Other factors that can temporarily affect the result.
So when PSA comes back high for the first time, the sensible first step is usually to repeat the test under the right conditions and rule out temporary causes such as an infection, rather than go straight to a biopsy. Many ‘high PSA’ results return to normal when the test is repeated.
The next steps, in order
If the raised PSA is confirmed, assessment today follows a sequence designed to find what matters while avoiding unnecessary tests:
- An individual assessment. Your age, family history, how your PSA has changed over time and the examination are all taken into account.
- An MRI scan of the prostate before any biopsy. European guidelines recommend an MRI scan before a biopsy is considered. It shows whether there are any suspicious areas and, when the result is reassuring, makes it possible to avoid biopsies that would add nothing. When there is a suspicious area, it helps to aim the biopsy precisely at it.
- A targeted biopsy, only if needed. If the overall picture points that way, the biopsy is guided by the MRI scan and is more precise than it used to be.
This step-by-step approach has a clear aim: to pick up in time what needs treating, without over-diagnosing or over-treating what does not.
If prostate cancer is confirmed
Here too there is good reason to stay calm: prostate cancers are not all the same, and they do not all need the same treatment. Many are low-risk and slow-growing. For these, an established option is active surveillance: rather than being treated straight away, the cancer is monitored closely and treated only if there are signs that it is progressing. In other cases treatment is needed. What matters is that there is a range of options, and the decision depends on the type of tumour and on the person. You can read how these cases are approached on my urological cancer page.
So should you have a PSA test?
Whether to have a PSA test for screening is an individual decision, not an automatic one for everyone. It is worth discussing with a urologist, taking into account your age, family history and circumstances, so that you can decide together whether it makes sense and how often to have it. The test has benefits and also limitations, which is why it deserves a proper conversation rather than simply being added to a blood test.
In short
A high PSA calls for investigation rather than alarm. Most of the time the cause is benign or temporary. The test should be repeated before taking bigger steps, an MRI scan before any biopsy avoids unnecessary tests, and when there is a tumour the options range from close monitoring to treatment, depending on the case.
If your PSA is raised and you would like your situation assessed calmly, book an appointment. I see patients in Palma (Quirónsalud Palmaplanas) and Manacor (Més Consultes Mèdiques), in English or Spanish.
Appointments: +34 971 918 000 (Palma) · +34 971 559 000 (Manacor). You can call in English.
This article is general information and does not replace a medical consultation. Each case needs to be assessed individually.
