A raised PSA blood test can be unsettling, but it does not automatically mean you have prostate cancer, as many common, non-cancerous conditions can cause the protein level to rise. Mr Denosshan Sri, Consultant Urologist & Robotic Surgeon at New Victoria Hospital, explains what a raised PSA means, why results need to be interpreted in context, and how a specialist assessment can provide clarity, reassurance and a personalised plan. 

What is PSA? 

PSA stands for prostate-specific antigen, a protein made by the prostate gland. Small amounts naturally enter the bloodstream, and a simple blood test measures the level.  

The test can help identify men who may need further investigation for prostate cancer, but PSA is not a cancer-specific test. A raised level can have several explanations, including: 

• Benign prostate enlargement (BPH): the prostate naturally tends to grow with age, which can increase PSA levels. 

• Prostatitis: inflammation of the prostate, sometimes caused by an infection. 

• Urinary tract infections: infections can temporarily raise PSA levels. 

• Recent ejaculation or vigorous exercise: activities leading to pressure on the perineum, such as cycling, may affect PSA results in some circumstances. 

• Recent urological procedures: catheterisation, cystoscopy and other procedures involving the urinary tract or prostate can influence the result. 

• Medication: hair-loss and BPH medicines such as finasteride and dutasteride can lower PSA levels, meaning the result needs to be interpreted accordingly. 

PSA levels can also fluctuate naturally. There is no single PSA value that is normal for every man, so the result needs to be considered alongside your age, symptoms, prostate size, medical history, family history and previous PSA readings. 

"A PSA result that is higher than expected often prompts one immediate question: “Does this mean I have prostate cancer?”. In most cases, the honest answer is no – not on its own. PSA is a useful signal that deserves careful follow-up, but many benign prostate conditions, recent activities, and even the timing of the test can affect the result. My approach is to replace uncertainty with a clear, evidence-based pathway – without rushing into unnecessary tests or dismissing a result that needs attention." Mr Denosshan Sri, MA Cantab MB BChir FRCS Urol, Consultant Urologist at New Victoria Hospital

Is a raised PSA always cancer?

No. Many men with a raised PSA do not have prostate cancer. In the commonly discussed PSA range of 3–10 ng/mL, which is considered a borderline or elevated range, prostate cancer is found in approximately 1 in 4 men who undergo further investigation and prostate biopsy.  This is a broad estimate rather than an individual prediction, and the likelihood varies according to factors such as age, prostate size, family history and other clinical findings. 

A raised PSA should therefore be neither ignored nor treated as a diagnosis. Further assessment helps establish whether the result is likely to reflect a benign condition, whether monitoring is appropriate or whether investigations are needed to check for cancer. 

The aim is to understand your individual risk and choose the most appropriate next step, rather than making decisions based on a single blood test. 

Prostate cancer risk factors

Prostate cancer remains a significant men’s health issue. It is the most commonly diagnosed cancer in the UK: around 1 in 8 men will be diagnosed with it during their lifetime. 

Although prostate cancer can affect any man with a prostate, some factors increase the likelihood of developing the disease. These include: 

• Age: the risk increases as men get older, particularly after the age of 50. 

• Family history: having a father or brother who has had prostate cancer, or a mother or sister diagnosed with breast or ovarian cancer, increases your risk, particularly if they were diagnosed at a younger age. 

• Ethnicity: Black men have a higher risk of developing prostate cancer. In the UK, around 1 in 4 Black men will be diagnosed during their lifetime. 

• Inherited genetic variants: changes in certain genes, including BRCA2, can increase the risk. 

These factors are worth discussing with your GP or Urologist, particularly if you are considering a PSA test or have already received a raised result. 

Your PSA level should always be interpreted in context. A result that warrants further investigation in one man may have a different significance in another, depending on factors such as age, prostate size and family history. 

What symptoms should you look out for?

Prostate cancer does not always cause noticeable symptoms, particularly in its early stages. When symptoms do occur, they can overlap with those caused by benign prostate enlargement or other urinary conditions. 

Possible symptoms include: 

• Difficulty starting or maintaining a stream of urine. 

• A weak or interrupted urine flow. 

• Straining to pass urine. 

• Needing to urinate more frequently, particularly at night. 

• A sudden or urgent need to urinate. 

• Difficulty emptying the bladder fully. 

• Blood in the urine or semen. 

• Persistent pain in the back, hips or pelvis, particularly if accompanied by other concerning symptoms. 

• Unexplained weight loss. 

These symptoms do not necessarily indicate prostate cancer, but they should not be ignored. If you notice persistent urinary changes, blood in your urine or other unexplained symptoms, contact your GP for assessment. 

If you have a raised PSA result, it is important to follow up even if you feel perfectly well. The absence of symptoms does not rule out prostate cancer. 

What should you do after a raised PSA result?

If you have received a raised, borderline or rising PSA result, your next step is to discuss it with a Urology Consultant. At your appointment, your Consultant will consider several factors, including: 

• Your PSA level and any changes over time.

• Your age, general health and medical history.

• Your urinary symptoms, if any.

• Your family history and other risk factors.

• The findings of a prostate examination, where appropriate.

• Whether infection, inflammation or another condition could explain the result.

Depending on your circumstances, your specialist may recommend repeating the PSA blood test. This can be useful if a temporary factor, such as a recent urinary infection, may have affected the initial reading. However, a repeat test is not always the right next step, and further investigation should not be delayed when the clinical findings indicate a need for it. 

At New Victoria Hospital, Mr Denosshan Sri provides specialist assessment for men with raised, borderline or rising PSA. The aim is to give you clear information about what the result may mean, whether monitoring or further investigation is appropriate, and what the next steps should be. His expertise includes the surgical management of localised and locally advanced prostate cancer 

The role of MRI and targeted biopsy

If your PSA result and overall assessment suggest that further investigation is needed, your urologist may recommend a prostate MRI scan. 

A multiparametric MRI produces detailed images of the prostate. It can help assess the size of the gland, identify areas that may be suspicious for cancer and guide decisions about whether a biopsy is necessary. 

An MRI does not automatically mean you need a biopsy. If the scan indicates a low likelihood of clinically significant cancer, your Consultant may recommend monitoring instead, depending on your PSA level and other risk factors. If the findings are suspicious, a biopsy may be advised to establish whether cancer is present. 

What is a fusion-guided transperineal prostate biopsy?

At New Victoria Hospital, a fusion-guided transperineal prostate biopsy may be recommended as a urological diagnostic procedure. It combines MRI images with real-time ultrasound to help the urologist target areas of concern. The samples are taken through the perineum – the area of skin between the scrotum and anus – rather than through the rectum.

This approach allows the urologist to investigate suspicious areas identified during the MRI scan. Your Consultant will explain why a biopsy may be appropriate, the potential benefits and risks, and what the procedure involves before you decide how to proceed.

Imaging plays an important role at several stages of assessment. New Victoria Hospital’s scans and imaging services support timely diagnostics, helping you move from concern to a clear plan. 

What happens if prostate cancer is found?