Many primary care doctors refer patients to Greater Boston Urology after their blood test results show an elevated PSA. While this can be a sign of the presence of prostate cancer, it’s not always that cut and dry. There are a variety of factors that can result in an elevated PSA, which is why having a trusted care team is important for helping you figure out what to do for your specific needs.
When it comes to protecting your long-term health, we try to give patients and their loved ones the information they need to feel comfortable getting started and asking questions. In this blog, Dr. Michael Geffin will walk you through what happens if you have an elevated PSA and the potential next steps your doctor might recommend.
The information from this blog was featured in Dr. Geffin’s video, “What Happens When You Have an Elevated PSA?” As always, this content is education and should not be considered medical advice. Please reach out to your doctor if you have specific questions about your test results.
Reasons for Elevated PSA Other Than Cancer
The PSA test is a simple blood test commonly used as a screening tool for prostate cancer. PSA stands for prostate-specific antigen, a protein produced by the prostate gland. Elevated PSA levels may indicate the presence of prostate cancer, but they can also result from other conditions.
“Men can have elevated PSAs for many reasons,” Dr. Geffin said. “They can't be falsely low, but can be falsely elevated due to issues like inflammation in large prostates.”
At Greater Boston Urology, specialized laboratory tests go beyond the general PSA test, examining specific isoforms of PSA. These more advanced tests help clarify whether the elevation is more or less likely related to prostate cancer.
What Happens if Patients Have a Persistently Elevated PSA?
When a man continues to have elevated PSA results, additional testing may be recommended. This can include repeat blood tests, MRIs, or even urine tests designed to assess the risk of prostate cancer more precisely.
“We have a laboratory which has tests which are specific to men who have elevated PSAs,” Dr. Geffin said. “They're much more specific than just the general PSA test. The tests look at pieces of PSA, the isoforms of the PSA, which help parse out whether the PSA elevation is more likely or less likely due to prostate cancer.”
If these follow-up tests suggest a higher likelihood of cancer, the next step is often a discussion about whether to move forward with a biopsy.
The Pros and Cons of Biopsies
A biopsy can provide a definitive diagnosis of prostate cancer, but it also comes with considerations. The decision to proceed with a biopsy involves weighing the benefits of early detection against the risks of unnecessary procedures. Because PSA tests can sometimes be falsely elevated, men may undergo testing they don’t actually need. This makes careful evaluation and discussion with a urologist critical.
Prostate-Cancer Screening Guidelines
Screening recommendations vary based on an individual’s risk factors. For men at average risk, PSA screening can begin at age 45 and continue until around age 75. In higher-risk individuals, screening may start earlier—sometimes at age 40. In general, the decision is individualized and something your doctor will work with you to decide based on your test results.
“A screening is a very complex issue because some patients really shouldn't be screened, and other patients should be screened,” Dr. Geffin said. “In general, for someone who has a good 10-year survival or greater, screening is generally recommended.”
How Your Urologist Helps You Understand PSA Screenings
Because PSA screening is complex, a urologist’s role is to guide patients through the process. By using more specific testing, imaging, and ongoing monitoring, urologists help determine whether a patient should undergo a biopsy, have an MRI, or simply continue observation with follow-up PSA testing at set intervals. This personalized approach ensures that patients receive the most appropriate care for their situation.
If you have questions about your PSA test results or your elevated PSA levels, schedule an appointment at one of our convenient locations today.