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Prostate health
A high PSA result is unsettling, but it is a signal, not a diagnosis. Many things besides cancer raise PSA, and today the path from a high number to an answer is far more precise and less invasive than it used to be.
Prostate-specific antigen is a protein made by the prostate. Some of it leaks into the blood, and the amount rises with prostate size, inflammation, infection and cancer. That is why a single number cannot tell those apart, and why the trend over time and the context matter as much as the value itself.
An enlarged prostate is the most frequent cause. Prostatitis or a urinary infection can push PSA sharply higher for weeks. Recent ejaculation, long bike rides, a recent catheter or cystoscopy can raise it briefly. Testosterone therapy can increase it too, which is one reason men on testosterone need PSA monitoring. And some medications for the prostate or hair loss lower PSA by about half, which has to be accounted for when reading the result.
We usually repeat the PSA under the right conditions, check for infection, and may add tests such as free PSA or other blood and urine markers that sharpen the estimate of risk.
A multiparametric MRI shows whether there is an area that looks suspicious. A normal MRI can spare many men a biopsy altogether.
If a biopsy is warranted, MRI guidance lets us aim at the suspicious area, finding significant cancers more reliably while detecting fewer insignificant ones.
If we do find prostate cancer, we say it plainly: you have cancer, and it is very treatable. Many prostate cancers found through PSA testing are slow-growing and are best managed with active surveillance rather than immediate treatment. When treatment is needed, we explain every option, including the least invasive, and how each compares in side effects, before you decide. Read more about prostate cancer care.
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No. Most men with a mildly elevated PSA do not have cancer. Enlargement, inflammation and infection are more common causes.
Usually yes, under the right conditions and after ruling out infection. PSA varies from test to test.
Not necessarily. A prostate MRI and additional markers often show that a biopsy is not needed, and when it is, it can be targeted.
Yes, which is why men on testosterone should have PSA monitored regularly.
There is no single cutoff for everyone. Age, prostate size, medications and the change over time all shape what a given number means for you.
Book a men's-health visit at our Manhattan or Forest Hills office — a simple step that's easy to keep putting off.
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