Frequently Asked Urologic Questions

Elevated PSA

What Is PSA? Understanding the Prostate-Specific Antigen Test

PSA, or Prostate-Specific Antigen, is a protein produced by both normal and cancerous cells of the prostate gland. The PSA test is a simple blood test commonly used to screen for prostate cancer and monitor prostate health in men.

When prostate cells are inflamed, enlarged, or affected by cancer, they often release higher levels of PSA into the bloodstream. While an elevated PSA level does not necessarily mean cancer is present, it can be an early warning sign that further evaluation by a urologist is needed.

Why PSA Testing Is Important

Regular PSA screening can help detect prostate cancer in its early stages—often before symptoms appear. Early detection can significantly improve treatment outcomes and long-term survival rates. PSA testing is especially recommended for:

  • Men over 45

  • Men over 40 with a family history of prostate cancer

  • African American men, who are at higher risk for prostate cancer

What Do PSA Levels Mean?

PSA levels are measured in nanograms per milliliter (ng/mL) of blood. Here's a general breakdown:

  • 0–4 ng/mL: Typically considered normal, though not guaranteed to be cancer-free

  • 4–10 ng/mL: Slightly elevated; may suggest benign prostatic hyperplasia (BPH), prostatitis, or early prostate cancer

  • Above 10 ng/mL: Higher risk of prostate cancer; further testing such as MRI or prostate biopsy may be recommended

It's important to note that high PSA levels can also be caused by non-cancerous conditions like prostatitis (prostate inflammation) or BPH (enlarged prostate), so a high PSA does not always mean cancer.

Next Steps After Elevated PSA

If your PSA levels are elevated, your urologist may recommend:

  • A repeat PSA test for confirmation

  • A digital rectal exam (DRE) to assess the prostate

  • Prostate imaging (MRI) or a prostate biopsy to rule out or confirm cancer

What is the difference between a transrectal versus transperineal prostate biopsy?

There are two methods for obtaining a prostate biopsy, either via the rectum or the perineum (the skin between the scrotum and rectum). Transrectal biopsies carry a slightly higher risk for infections (between 2-6%) than do transperineal prostate biopsies. In addition to having a decreased risk of infections, transperineal biopsies are also superior in sampling the anterior zone of the prostate.