Elevated PSA: What It Means & Next Steps | Dr. Theodore Cisu

The short answer: PSA is a blood test that measures a protein made by the prostate. An elevated PSA doesn't mean you have cancer. An enlarged prostate, inflammation or infection can also raise it. The usual next steps are to repeat the test and then, if it's still high, use tools like an MRI, a risk calculator or another blood or urine test to decide together whether a biopsy makes sense.

Written by Theodore Cisu, MD, board-certified urologist. Based on the American Urological Association (AUA) and Society of Urologic Oncology (SUO) guideline on early detection of prostate cancer (2023, amended 2026). Last reviewed November 2026.

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What is a PSA test?

PSA stands for prostate-specific antigen. It's a protein made by normal prostate cells and by prostate cancer cells. A small amount ends up in your blood, and a simple blood draw measures it.

The AUA guideline names PSA as the first test to use for prostate cancer screening. A rectal exam can add useful information, especially once PSA is elevated, but the guideline doesn't recommend it as a screening test on its own.

Who should get PSA screening, and when?

Screening is a personal choice. The guideline asks doctors to talk through the possible benefits and downsides with you and to respect your values. Here's the general approach it lays out:

• Ages 45 to 50: You may start with a baseline PSA test.
• Ages 40 to 45 if you're at higher risk: This includes men of Black ancestry, men with certain inherited gene changes (such as BRCA2), and men with a strong family history of prostate cancer or related cancers.
• Ages 50 to 69: Regular screening is recommended, usually every 2 to 4 years. Your interval can be shorter or longer depending on your PSA level and risk.
• Age 70 and older: The decision depends on your past PSA results, your health and your life expectancy. Some men can stop, and some benefit from continuing.

What counts as an elevated PSA?

There's no single "normal" number. PSA naturally rises with age and with prostate size, so a level that's worth a closer look at 45 may be expected at 75. Your urologist looks at your number in context: your age, prostate size, past PSA results, family history and other risk factors.

What causes an elevated PSA besides cancer?

• An enlarged prostate (BPH), which is very common with age
• Prostate inflammation or infection (prostatitis) or a urinary tract infection
• A recent urinary catheter, cystoscopy or prostate procedure
• Recent ejaculation, which can raise PSA slightly for a short time

Some medicines do the opposite. Finasteride and dutasteride, often used for an enlarged prostate or hair loss, lower PSA after several months of use. If you take one, make sure whoever orders your PSA knows, so the result is read correctly.

What happens after an elevated PSA?

An elevated PSA is the start of a conversation. The guideline describes a step-by-step approach before any biopsy:

1. Repeat the test. PSA can bounce around. The guideline recommends repeating a newly elevated PSA before moving on to imaging, other tests or a biopsy.
2. Estimate your risk. Risk calculators combine your PSA with your age, exam, family history and other factors. They help you decide together whether a biopsy is worth it right now.
3. Consider a prostate MRI. An MRI before a first biopsy helps find the cancers that matter most and shows whether there's a specific spot to sample.
4. Consider a biomarker test. Additional blood or urine tests can refine your risk when the result would change the decision about a biopsy.
5. Decide on a biopsy, or not yet. If your risk of a significant cancer is low, it's reasonable to hold off and keep checking.

A rising PSA on its own, without other concerning findings, isn't a reason to jump to a biopsy.

What is a prostate biopsy?

A biopsy takes small samples of prostate tissue with a thin needle so a pathologist can look for cancer. If an MRI shows a suspicious area, that spot is targeted directly, often along with samples from the rest of the prostate. If the MRI looks clear but your risk is still elevated, a standard set of samples is usually taken.

A biopsy can be done through the rectum or through the skin between the scrotum and anus (transperineal). The guideline considers both acceptable. Dr. Cisu performs prostate biopsy in his office, including MRI fusion (targeted) biopsy, by either the transperineal or transrectal approach. He can explain which approach fits you and how to prepare.

What if the biopsy finds cancer?

Many prostate cancers found through screening are low-risk and slow-growing. The guideline asks doctors to tell you up front that a biopsy may find this kind of cancer, and that it can often be safely watched with active surveillance instead of being treated right away. Surveillance means regular PSA tests, exams, MRIs and repeat biopsies, with treatment only if the cancer shows signs of changing. Learn more in our article on prostate cancer treatment options.

What if the biopsy is negative?

That's reassuring, though a single negative biopsy doesn't end screening. Your urologist will update your risk and plan follow-up. That usually means another PSA within 2 to 4 years, or sooner depending on your risk. If you didn't have an MRI before your first biopsy, the guideline recommends one before any repeat biopsy.

When to see a urologist

• Your PSA came back elevated, or higher than your past results
• Your doctor felt something unusual on a rectal exam
• You're at higher risk and want to plan when to start screening
• You've had a negative biopsy and aren't sure what comes next
• You'd like a second opinion on whether you need a biopsy

Seeing Dr. Cisu about an elevated PSA

An elevated PSA is a good reason for a telehealth visit from anywhere in Virginia. Our office can request your PSA history, lab results and any MRI or other imaging so Dr. Cisu reviews them before you talk. Together you'll go over your risk and the next sensible step. Second opinions are welcome, and visits are also available at our Charlottesville and Fishersville clinics. No referral is needed. Book a visit.

Frequently asked questions

Does a high PSA mean I have prostate cancer?

No. Many men with an elevated PSA turn out to have no cancer or a slow-growing one. An enlarged prostate, inflammation and infection are common causes. A high PSA means it's worth a closer look.

Should I repeat my PSA test?

Usually, yes. The AUA guideline recommends repeating a newly elevated PSA before ordering an MRI, a biomarker test or a biopsy.

Can I lower my PSA naturally?

Some things, like treating an infection or avoiding ejaculation for a short time before the test, can affect a single reading. Supplements aren't a reliable way to lower PSA. The real goal is to understand what's behind the number.

Do I need an MRI before a prostate biopsy?

An MRI before a first biopsy helps find significant cancers and guides where to sample. The guideline recommends an MRI before a repeat biopsy if you haven't had one.

At what age should I stop PSA screening?

There's no fixed age. After 70, the decision depends on your past PSA levels, your health and your life expectancy. Many men in good health with low PSA levels can stop or test less often.

Does finasteride affect my PSA?

Yes. Finasteride and dutasteride lower PSA after several months of use. Tell your doctor if you take either one so your result is interpreted correctly.

Sources

• American Urological Association. Early Detection of Prostate Cancer: AUA/SUO Guideline (2023, amended 2026).
• American Urological Association. AUA announces updates to the Early Detection of Prostate Cancer Guideline (February 2026).

This article is for general education and isn't a substitute for medical advice. Talk with your doctor about whether PSA screening is right for you.