“My PSA is high.” “My PSA keeps creeping up.” “They told me to repeat the test.” Prostate cancer often starts with a number, which can easily amplify worry.
This article offers a calm, plain-language overview of what PSA can and cannot tell you, what the typical next-test pathway looks like, how biopsy confirms the diagnosis, how staging tests work, and how treatment choices (including active surveillance) are made. (This is general information, not a diagnosis or medical advice.)
New Series: Untangling Cancer Worries: Organ-by-Organ Basics at a Glance
- Episode 1: Lung cancer (published)
- Episode 2: Colorectal cancer (published)
- Episode 3: Stomach cancer (published)
- Episode 4: Breast cancer (published)
- Episode 5: Prostate cancer (this article)
First, the takeaway: three things to organize
- PSA is not a diagnosis (it’s a signal that may trigger further evaluation)
- Your next step is to enter a structured testing pathway (PSA → exam → mpMRI → biopsy if needed)
- Even if cancer is found, immediate treatment is not always necessary (active surveillance can be appropriate)
Some prostate cancers grow very slowly. In selected cases, avoiding overtreatment can protect quality of life—so “PSA high” does not automatically mean “rush into treatment.”
What PSA can and cannot tell you
PSA is a prostate-related protein measured by a blood test. The key point: PSA can rise for reasons other than cancer, so it’s best viewed as an entry signal, not a conclusion.
Common non-cancer reasons PSA may rise
- Benign prostatic enlargement
- Inflammation (prostatitis)
- Urinary infections
- Other factors depending on clinical context
Knowing this helps you avoid the “number spiral.” The goal is to follow the appropriate pathway to clarify what is actually happening.
Where to start
- Urology is usually the most direct route for PSA evaluation and next-step testing
- If PSA was flagged on screening, booking a urology visit is often the quickest way to regain clarity
The typical testing pathway (big picture)
1) Confirm PSA history + clinical exam (may include DRE)
Clinicians review PSA levels and trends and may perform a clinical exam to estimate the likelihood of significant disease and plan next tests.:contentReference[oaicite:16]{index=16}
2) mpMRI to refine whether biopsy is needed
Many pathways now use multiparametric MRI (mpMRI) to identify suspicious areas and help decide whether biopsy is needed and where to target.:contentReference[oaicite:17]{index=17}
3) Confirmation: prostate biopsy (tissue diagnosis)
- Biopsy collects multiple tissue samples and confirms the diagnosis under the microscope
- Approaches can include transrectal or transperineal methods
- MRI-targeted biopsy may be used in some settings
Imaging and PSA do not “confirm” cancer—tissue (pathology) does.:contentReference[oaicite:18]{index=18}
If biopsy is negative but suspicion remains
If PSA continues to rise or stays high, re-evaluation (repeat MRI and/or repeat biopsy) can be considered, depending on clinical judgment.:contentReference[oaicite:19]{index=19}
Staging tests: building a treatment map
If cancer is suspected or confirmed, additional tests such as CT/MRI/PET/bone scans may be used to map spread and guide treatment selection.:contentReference[oaicite:20]{index=20}
Treatment choices: “monitor” vs “treat”
In some low-risk situations, active surveillance can be the most rational approach—monitor closely and treat only if the cancer shows signs of progressing. This can help avoid side effects from treatments you may not need right away.:contentReference[oaicite:21]{index=21}
1) Active surveillance
Close monitoring with PSA checks and follow-up assessments, with a plan to switch to treatment if risk increases.:contentReference[oaicite:22]{index=22}
2) Surgery
Surgery may be chosen when curative removal is appropriate for the stage and overall health.
3) Radiation therapy
A major treatment option alongside surgery; the best approach depends on staging and clinical details.
4) Systemic therapy (often hormone therapy, and others as appropriate)
Systemic treatments can be combined with radiation or used in advanced settings, depending on stage and risk.:contentReference[oaicite:23]{index=23}
What to write down before the appointment
- Your PSA history (dates and values; trends matter)
- Urinary symptoms (frequency, weak stream, nocturia, incomplete emptying)
- History of prostatitis/BPH/UTIs
- Medications, especially blood thinners (important before biopsy)
- Family history
Common misunderstandings (avoid the “search spiral”)
- “High PSA = cancer” is not always true. PSA is an entry signal.:contentReference[oaicite:24]{index=24}
- “Cancer found = treat immediately” is not always true. Active surveillance can be appropriate.:contentReference[oaicite:25]{index=25}
- Understanding the pathway (mpMRI → biopsy if needed) helps you make decisions calmly.:contentReference[oaicite:26]{index=26}
Summary (one-minute review)
- PSA is a signal, not a diagnosis
- Typical pathway: PSA → exam → mpMRI → biopsy if needed:contentReference[oaicite:27]{index=27}
- Diagnosis is confirmed by tissue
- Treatment may include active surveillance, surgery, radiation, and systemic therapy, depending on risk and stage:contentReference[oaicite:28]{index=28}
Coming next (planned)
- Episode 6: Pancreatic cancer—why it can be hard to detect, calmly explained
- Episode 7: Ovarian cancer—what to check when symptoms are vague
Edited by the Morningglorysciences team.
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