Answers, Not Anxiety
Elevated PSA
An elevated PSA result is one of the most common reasons men are referred to a urologist — and most of the time, it does not turn out to be cancer. At Texas Regional Urology, we determine what is actually driving your number using advanced imaging and targeted biopsy techniques, at our offices in The Woodlands, Tomball, and Kingwood.
What is PSA?
Understanding PSA
Prostate-specific antigen is a protein produced by prostate cells and measured with a simple blood test. It is prostate-specific but not cancer-specific, which is the single most important thing to understand about it. PSA rises with prostate cancer, but it also rises with benign prostatic enlargement, prostatitis and infection, recent ejaculation, vigorous cycling, catheter placement, and simply getting older. A single elevated reading is a signal to investigate further, not a diagnosis, and the majority of men referred for an elevated PSA do not have cancer.
How Would I Know If My PSA is Elevated?
Symptoms and Warning Signs
An elevated PSA usually causes no symptoms at all and is discovered on routine screening — that is precisely what makes screening valuable. Some men do have accompanying urinary symptoms such as weak stream, frequency, urgency, or nighttime urination, though these more often point to BPH or prostatitis than to cancer. Blood in the urine or semen, pelvic or bone pain, and unexplained weight loss are more concerning findings that warrant prompt evaluation. Because early prostate cancer is silent, the absence of symptoms should never be taken as reassurance.
How Do You Evaluate an Elevated PSA?
How We Evaluate an Elevated PSA
We rarely act on a single number. Evaluation begins with a careful history, a digital rectal exam, and a urinalysis to rule out infection, followed in many cases by a repeat PSA after an interval to confirm the elevation is real and persistent. We look at the trend over time rather than one value, and consider PSA density relative to prostate size, free versus total PSA, and your age and family history. When further assessment is warranted, multiparametric MRI can identify suspicious areas before any biopsy is performed, allowing us to target them precisely with MRI fusion or transperineal biopsy. Many men complete this pathway and never need a biopsy at all.
Why Choose Texas Regional Urology for PSA Evaluation?
Why Patients Choose TRU
Here is What We Can Do
Next Steps After an Elevated PSA Test
There is no single response to a high PSA, and the right next step depends on how high it is, how fast it is rising, your prostate size, your exam, and your risk profile. For some men the answer is a repeat test in six weeks. For others it is imaging, and for a smaller group it is biopsy. Our goal is to find clinically significant cancer while sparing you procedures you do not need.
Repeat and Interval Testing
For modest elevations, particularly when infection or recent activity may have contributed, a repeat test after an interval often clarifies the picture. Tracking PSA velocity over time tells us far more than any single result.
Multiparametric MRI
Prostate MRI can identify and grade suspicious lesions before any tissue is taken. A reassuring MRI may allow continued monitoring instead of biopsy, while a suspicious one lets us target the biopsy precisely.
MRI Fusion Biopsy
Fusion technology overlays your MRI images onto live ultrasound during the biopsy, letting the urologist sample the exact area of concern rather than sampling the prostate at random. This improves detection of significant cancers while reducing the diagnosis of insignificant ones.
Transperineal Biopsy
This approach takes samples through the skin between the scrotum and rectum rather than through the rectal wall, substantially lowering the risk of infection. It also provides better access to the front portion of the prostate, where cancers are more easily missed.
Answers to your PSA Questions
Frequently Asked Questions
Usually not — most elevated PSAs aren't cancer.
Benign enlargement, infection, recent ejaculation, cycling, and age all raise PSA, and most men referred for an elevated result do not have cancer. The purpose of evaluation is to sort out which cause applies to you.
There is no universal cutoff.
Levels below 4.0 ng/mL have traditionally been considered normal, but cancer can occur below that threshold and many men above it are cancer-free. Your age, prostate size, and rate of change matter more than the raw number.
No — imaging often comes first.
Multiparametric MRI can frequently clarify the situation without any tissue sampling, and a reassuring scan may allow continued monitoring instead. Biopsy is reserved for cases where the combined picture warrants it.
Avoid ejaculation and cycling beforehand.
Both can transiently raise PSA, so abstaining for two days before your blood draw improves accuracy. Tell your urologist about any recent infection, catheter, or prostate procedure, since these also affect results.
Typically every one to two years.
Screening intervals depend on your baseline level, age, and risk factors, and men with elevated or rising results are monitored more closely. Your urologist will set a schedule based on your specific pattern.
Received an elevated PSA result?
