Raised PSA result: what it means and what usually happens next

Prostate-specific antigen is a protein made by the prostate gland, and a small amount is always present in the blood. The NHS says a PSA test checks the level, and that high levels may be a sign of a prostate condition. A raised result is an alert that something affecting the prostate may be present, not a finding of cancer. The NHS states directly that a high PSA does not mean you have cancer.

The test is imperfect in both directions. The NHS says there is a risk that a PSA result may not be accurate, and that you may be offered tests and treatment you do not need. Some men with cancer have a normal PSA, and many with a high PSA turn out to have a benign cause. That imperfection is why the pathway after a raised result is built from several steps rather than a single threshold.

The NHS says the PSA test may be raised because of an enlarged prostate, and that results of tests can point to conditions such as an enlarged prostate or prostate infection (prostatitis) rather than cancer. A urine infection can also affect results; the NHS advises waiting 4 to 6 weeks after a urine infection has cleared before having a PSA test.

Preparation matters too. For 48 hours before the test the NHS says not to have anal sex, ejaculate, do anything that leaves you out of breath such as exercise, or ride a bike, because these can increase PSA levels and make the test less accurate. If you were tested after any of these, mention it, since it may be reasonable to repeat the test under standard conditions before drawing conclusions.

• Benign prostate enlargement, which becomes more common with age.

• Prostatitis or a urinary tract infection.

• Recent ejaculation, vigorous exercise or cycling in the previous 48 hours.

• Prostate cancer, the possibility the work-up is designed to address.

The NHS says that if you have a raised PSA level you may be offered another test to check whether it is still high, and that if it is, a GP may discuss referring you to a specialist for further tests such as a biopsy and an MRI scan. You may get an urgent referral if the GP thinks you have symptoms that could be cancer or your PSA is higher than normal, which the NHS stresses does not definitely mean you have cancer.

NICE Clinical Knowledge Summaries say urgent referral to a urological cancer specialist should be arranged if prostate cancer is suspected because the prostate is hard and nodular on examination, and should be considered if the PSA is above the threshold for the person's age, with a worked example of more than 4.5 in a person aged 60 to 69. The person's preferences and any other health conditions are considered in making the decision.

The NHS says that if you are referred to a specialist because you could have prostate cancer, you will have an MRI scan, which can give a clearer view of the prostate and show whether you need further tests, and that if more information is needed you may be offered a biopsy, where a small needle takes a tissue sample. NICE guideline NG131 offers multiparametric MRI as the first-line investigation and reports the result on a 5-point Likert scale, with MRI-influenced biopsy offered at a score of 3 or more.

NICE is explicit that biopsy should not be offered automatically on the PSA level alone. The decision is made after discussion of the PSA, examination findings including prostate size, other health conditions, risk factors such as age and Black African-Caribbean family background, and any previous negative biopsy. For scores of 1 or 2, biopsy may be omitted after a shared decision, with the benefits and disadvantages set out, including the chance of being diagnosed with a cancer that would never have caused harm.

For someone with a raised PSA and an MRI score of 1 or 2 who has not had a biopsy, NICE describes repeating the PSA at 3 to 6 months. A biopsy is offered if suspicion is strong, for example if PSA density is greater than 0.15 nanograms per millilitre per millilitre, PSA velocity is greater than 0.75 nanograms per millilitre per year, or there is a strong family history. If suspicion is low, the person can return to primary care follow-up with PSA checks at 6 months and then yearly, and an agreed PSA level at which to re-refer.

After a negative biopsy with a reassuring scan, the NICE interval is every 2 years, with an agreed re-referral level based on the same density and velocity measures. The common thread is that a single raised number is followed over time instead of being treated as a one-off. Knowing the schedule in advance avoids the anxiety of unexplained gaps.

The NHS says PSA results usually take 1 to 2 weeks and that you should contact the GP surgery or hospital if nothing is heard after a few weeks. For specialist tests it says it can take a few weeks to get results, and you can call the hospital or contact your GP if you are still waiting after 2 weeks or your symptoms worsen. You may be able to see your PSA result using the NHS App or by logging into your account on the NHS website.

Waiting is stressful, and the number can feel like a verdict. Writing down the date, the result, the laboratory units and the next planned step helps you keep track, and asking what level would prompt re-referral gives you a clear marker. If cancer is diagnosed the NHS describes a specialist nurse who becomes the main contact and the Macmillan helpline available daily.