High PSA: what next? Understanding the PSA test

Have you just received a blood test showing a PSA "above normal"? It's a common situation, and often a worrying one. Yet a high PSA does not mean cancer: it simply means the prostate deserves a closer look.

Here is what PSA really measures, what can raise it and what happens next, step by step.

What is PSA?

PSA (prostate-specific antigen) is a protein produced by the prostate. It helps make semen more fluid, and a small amount normally passes into the blood. It is measured with a simple blood test and expressed in nanograms per millilitre (ng/ml).

PSA is specific to the prostate, but not to cancer: anything that irritates or enlarges the prostate can raise it.

What can raise PSA?

In the so-called "grey zone", between 4 and 10 ng/ml, only about one man in four is found to have cancer at biopsy.

Before repeating the PSA test

A single PSA result is not enough to make a decision. It is often repeated a few weeks later, in the same laboratory if possible, so that values can be compared.

What happens at the urologist's?

The visit puts your PSA into context: age, family history, urinary symptoms, medication. The urologist performs a digital rectal exam, quick and only mildly uncomfortable, which shows the size and texture of the prostate.

Depending on the case, the urologist may suggest:

• a repeat PSA test, sometimes with the free-to-total PSA ratio;
• a urine test to rule out an infection;
• an ultrasound to measure the prostate and calculate PSA density;
• a prostate MRI if doubt remains.

Prostate MRI

MRI is now the key test before any biopsy. It spots suspicious areas and gives them a score from 1 to 5 (PI-RADS score): the higher it is, the more likely a significant cancer. A normal MRI often means a biopsy can be avoided and simple monitoring offered.

Prostate biopsy

If the MRI shows a suspicious area, a targeted biopsy takes small samples of the prostate for analysis. It is usually done under local anaesthesia. Blood in the urine or semen is common for a few days; fever after a biopsy needs prompt medical attention.

What if it is prostate cancer?

Prostate cancer is one of the most common cancers in men, but it often grows slowly. Found early, it is very treatable. For low-risk forms, active surveillance — with PSA tests, MRI and follow-up biopsies — avoids unnecessary treatment. More aggressive forms are treated with surgery or radiotherapy, depending on the case.

Should you have a PSA test without symptoms?

Prostate cancer screening is an individual choice, to discuss with your doctor or urologist. It is usually offered between 50 and 75, and from 45 if you have a family history of prostate cancer or African ancestry. The decision weighs the expected benefits against possible drawbacks, such as extra tests.

To learn which other signs should prompt a visit, read our article When should you see a urologist? 7 signs not to ignore.

Getting a high PSA checked in Agadir

Dr. Abdellatif Mitach, urologist and andrologist, sees patients on Avenue Hassan II in Agadir to interpret PSA results and arrange further tests when needed. See the prostate conditions page or book an appointment online, and bring your previous results.

Sources

• French Association of Urology (AFU), patient information: urofrance.org
• European Association of Urology (EAU), Patient Information: patients.uroweb.org
• French National Authority for Health (HAS): has-sante.fr