A raised PSA means your blood test showed a higher level of prostate-specific antigen (PSA). PSA can go up for many reasons, and a higher PSA does not automatically mean prostate cancer.
Common reasons PSA can be temporarily higher include:
- Urine infection or prostate inflammation
- Recent ejaculation
- Recent prostate “manipulation” (for example, catheterization or some procedures)
- Bike riding
Your clinician may give you instructions before a repeat test if required (for example, avoid ejaculation for a short time beforehand).
Important medication note: If you take finasteride or dutasteride (often used for an enlarged prostate), PSA readings may be lower than expected, so your clinician will interpret your number differently.
Further tests/investigations/examination following a raised PSA test
1.Prostate exam (DRE)
A digital rectal exam (DRE) is a quick exam where a clinician feels the prostate through the rectum to check for a lump or firmness.
DRE is not used by itself as a screening test, but it can help estimate risk along with PSA, especially after a raised PSA result.
Your clinician will also consider other risk factors, such as:
Age
Family history
Black African ancestry
Prior biopsy results (if any)
2.MRI of the prostate
Many men will be offered a multiparametric MRI (mpMRI) before any biopsy. MRI can help:
- Find areas that look suspicious
- Help target a biopsy more accurately
- Reduce the chance of finding very low-risk cancers that may never cause harm
MRI results are usually reported as PI-RADS (1 to 5):
PI-RADS 1–2: low suspicion
PI-RADS 3: unclear (equivocal)
PI-RADS 4–5: higher suspicion
If MRI is negative (PI-RADS 1–2):
This lowers the chance of an important cancer, but it does not reduce the chance to zero.
If your overall risk still seems high, your clinician may still recommend a biopsy.
PSA density and risk calculators (sometimes used)
Your clinician may also use:
PSA density (PSA-D): PSA level divided by prostate size (from MRI or ultrasound). PSA-D can help decide who needs a biopsy, especially when MRI is negative or unclear.
A risk calculator (a tool that combines PSA and other risk factors) to better estimate your risk and help decide on MRI/biopsy.
3.Prostate biopsy (only if needed)
A prostate biopsy takes small tissue samples from the prostate to look for cancer cells.
When biopsy is more likely to be recommended:
- MRI shows a suspicious area (especially PI-RADS 4–5)
- MRI is unclear (PI-RADS 3) and risk is higher (based on PSA level, PSA density, exam findings, family history, etc.)
- MRI is negative but overall risk remains high
How biopsies are done:
Transperineal biopsy: through the skin between the scrotum and anus
Transrectal biopsy: through the rectum
Many guidelines now prefer the transperineal approach because it tends to have fewer infection complications.
However, some guidance considers either approach acceptable depending on local expertise and your situation.
If cancer is found, does it always need treatment?
This guide is not a substitute for professional medical advice. If symptoms worsen or you have new concerns, contact your doctor or seek emergency care.
