Checking the level of prostate-specific antigen (PSA) in a man’s blood is an important part of screening for prostate cancer. According to Dr. Brian Miles, a urologic oncologist at the Houston Methodist Neal Cancer Center, “A higher level of PSA is not a diagnosis of cancer. It’s one several screening tools we use to see if you might need further testing.”
The PSA test involves a simple blood draw that measures the amount of this protein produced by the prostate gland. While it is normal for men to have some PSA in their blood, levels can vary based on age, prostate size, or conditions such as inflammation or infection.
Routine PSA screening is generally not recommended for men at average risk until age 50. However, those with family history or other risk factors may be advised to start earlier.
An elevated PSA does not always indicate cancer; benign prostatic hyperplasia (BPH), a common non-cancerous condition, can also cause higher readings.
There is no fixed threshold for what counts as an “elevated” PSA level because various factors influence these numbers. Typically, if the result is 2.5 nanograms per milliliter (ng/mL) or less, retesting may occur every two years; above 2.5 ng/mL may prompt annual testing. Decisions about follow-up are individualized based on health factors and trends over time.
Dr. Miles notes: “We consider all your health factors to determine what ‘normal’ means for you. For example, you might have a PSA that started out around 2 and has slowly gone up to over 5. That’s when a primary care doctor should refer you to a urologic oncologist.”
If further investigation is needed after an elevated result, additional tests may include advanced blood work such as the 4Kscore test—which analyzes variations within PSA proteins and checks for human kallikrein 2 (hK2). This test can help avoid unnecessary biopsies in many cases.
“We put all this data into an equation that shows the likelihood of cancer,” says Dr. Miles. “A high 4K score doesn’t mean that you have cancer, but it does mean that we need to consider a prostate biopsy.”
Before recommending biopsy procedures, doctors often perform digital rectal exams and magnetic resonance imaging (MRI) scans to look for suspicious areas in the prostate.
Biopsies may still be recommended regardless of other results if there are strong risk factors—such as family history or being African American—or if firm nodules are detected during examination.
The biopsy itself takes about ten minutes and uses local anesthesia along with ultrasound guidance to collect tissue samples from the prostate using a spring-loaded needle device. Dr. Miles explains: “The biopsy instrument is a spring-loaded device that inserts and removes a hollow needle in just a fraction of a second… The probe feels uncomfortable, but the procedure is actually painless.” Afterward, minor bleeding can occur and antibiotics are prescribed to reduce infection risk.
Dr. Miles emphasizes: “The PSA is an important test, but high levels don’t automatically mean you have cancer… It’s important to get the 4K done, the MRI and, if need be, schedule your biopsy.”
