Prostate health

Raised PSA: What to Do Next

A high PSA result is worrying, but it is a reason for further tests, not a diagnosis. Many men with a raised PSA do not have cancer. This page explains what PSA is, why it can be high, and the usual steps that follow.

Book a consultationOnline consultation

Written for patients and reviewed by Dr. Anshuman Singh, Uro-Oncologist, on 7 October 2026.

The basics

What is PSA?

PSA (prostate-specific antigen) is a protein made by the prostate gland and measured with a simple blood test. A little always leaks into the blood. When the prostate is enlarged, inflamed or contains cancer, the level can rise.

There is no single “normal” number. What is expected rises with age, and the laboratory’s own range matters. Many reports use about 4 ng/mL as a rough line, but a lower value can still need attention in some men, and a higher value is often not cancer. What matters is the number together with your age, your prostate size, your earlier results and how fast it is changing.

Causes

Why PSA can be raised

Benign prostate enlargement
The most common reason. A larger prostate makes more PSA.
Infection or inflammation
Prostatitis or a urine infection can push PSA up, sometimes a great deal. It falls once treated.
Recent procedures
A catheter, cystoscopy, or a prostate biopsy can raise PSA for weeks.
Ejaculation and cycling
Ejaculation in the previous two days, or long rides on a bicycle, can cause a temporary rise. Avoid both before the test.
Prostate cancer
Cancer is one possible cause. The tests below help to find out whether it is present and whether it matters.

The usual steps

What happens after a raised PSA

1. Review and repeat
Your history, medicines and examination are reviewed. Any infection is treated, and the PSA is repeated after some weeks under proper conditions. Some medicines for prostate enlargement (such as finasteride and dutasteride) lower PSA, which needs to be taken into account.
2. Further PSA measures
The free-to-total PSA ratio, PSA density (PSA divided by prostate volume) and the rate of change help to judge the chance of a significant cancer.
3. MRI of the prostate
An MRI often comes before a biopsy. It can show suspicious areas and may spare some men an unnecessary biopsy.
4. Biopsy, if needed
If the results suggest a significant cancer, a biopsy confirms it and gives the grade. MRI findings can be used to aim the needle at the suspicious area.
5. If cancer is found
The next step is the risk group, scans if needed, and a discussion of options, from careful watching to surgery or radiotherapy.

Who should be tested

PSA testing without symptoms

Screening is a personal decision to make with your doctor, weighing the chance of finding an important cancer early against the risk of finding a harmless one. Men are commonly advised to discuss it from about 50 years of age.

The discussion may begin earlier, from the mid-forties, for men with a father or brother who had prostate cancer, or a known inherited gene change such as BRCA.

Prepare

Before you see a specialist

  • Bring all PSA reports, with the dates, in order. The trend is as important as the latest value.
  • Bring any MRI, ultrasound or biopsy reports.
  • Note your urine symptoms, any recent infection, catheter or procedure, and the medicines you take.
  • Note any family history of prostate, breast or ovarian cancer.

When to get help quickly

  • You cannot pass urine, or pass blood or clots.
  • Fever with shivering, or burning urine.
  • New back pain together with weakness or numbness in the legs.

Read next

Related guides

A free patient tool

Divide your PSA by your prostate volume to see how it compares.

PSA density calculator

Common questions

Questions patients ask

Does a high PSA mean I have cancer?

No. Most raised PSA results are due to benign enlargement, infection or other causes. A high PSA means more tests are needed.

What is a normal PSA?

It varies with age and the laboratory. There is no single number that separates normal from abnormal, so the result should be read by a doctor with your age, prostate size and earlier values.

Should I repeat the test?

Often yes, after any infection is treated and without recent ejaculation, cycling or catheter use. A rise on repeat testing is more meaningful than a single value.

Do I always need a biopsy?

No. An MRI and other measures help decide. Some men can be watched with repeat PSA and MRI, and others need a biopsy.

Is a biopsy dangerous?

It is a common, usually safe procedure. Some blood in the urine, semen or stool is expected, and infection is uncommon but needs prompt treatment if fever appears.

My PSA fell after antibiotics. Is it safe to ignore it?

A fall suggests infection or inflammation was a cause, but follow-up testing is still advised to make sure it stays low.

Talk it through with Dr. Anshuman Singh

This page is general information and does not replace a medical opinion. An unhurried one-to-one discussion with Dr. Anshuman Singh, with your family welcome, so that you understand every option before you decide. About Dr. Singh

Book a consultationOnline consultation