Elevated PSA – Not All That It Seems

When introduced in the 80s, Prostate Specific Antigen or PSA measurement was a revolutionary advancement in the detection and treatment of prostate cancer. Without it, prostate cancer detection would be an even more significant concern and we would certainly miss more cases.

However, the concept of elevated PSA and subsequent treatment is not as cut and dried as the simple number may suggest. Because while we are always cognizant of elevated PSA number (above 4) this does not necessarily indicate significant cancer that needs to be treated. This lack of understanding in the early days caused many urologists, myself included, to overtreat with what may or may not have been necessary biopsies and subsequent treatment.

Today, however we know a lot more about PSA and the characteristics of prostate cancer. The first and most important concept to understand is that a single elevated PSA reading – one single reading – is not an absolute determinant of prostate cancer that should be treated. In fact, elevated PSA is a normal function of a number of temporary or longer-standing conditions that are benign in nature.

So, How Can You Interpret Your PSA Reading?

When I analyze PSA and potential risk for prostate cancer, I use a trend line rather than a single result. This means that only after multiple PSA readings – usually spaced out over the course of weeks and months, do I even consider the possibility of a biopsy of the prostate. If the PSA is trending upward during this time, and there’s no other plausible reason, we must begin to suspect prostate cancer and will move forward accordingly.

There are, of course, exceptions to every rule and PSA readings are no exception. In some cases, we may decide that follow up care is necessary without waiting for longer-term trend lines to materialize. Of course, this will be a judgment made based on the patient’s individual medical history, the physical exam and diagnostic scans and/or bloodwork.

The bottom line? The PSA reading is important but must be taken with a grain of salt, especially when we only have one reading to work with. Most importantly, speak to a highly experienced urologist to get a proper diagnosis and treatment plan.

While this is just a primer on PSA and prostate surgery (more available on our PSA discussion page), I certainly hope that is in useful to you. I’d like you to look out for our online webinar, which will be announced in the coming weeks, that will offer more context on what you’ve read as well as give you the opportunity to ask questions.


Urologic Surgeons of Washington is a proud member of Privia Medical Group. The best doctors in our community have joined together to form Privia Medical Group (PMG), a multi-specialty, high-performance medical group that puts patients first. Our physicians are united by the mission of providing better, more coordinated care for their patients.

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