When Your PSA Is High

A healthy prostate also makes PSA

PSA stands for prostate-specific antigen, a protein made by prostate cells. Most is released into semen, but a small amount enters the blood.

The term ‘cancer marker’ may suggest that PSA is only present when there is cancer. In fact, a healthy prostate also makes PSA.

Benign prostate enlargement and inflammation of the prostate (prostatitis) can also increase PSA in the blood. A high result is a reason to take a closer look at your prostate.

Japanese Urological Association: Patient information (in Japanese)

A PSA above 4 does not automatically mean cancer

A PSA of 4.0 ng/mL is commonly used as a reference level, although a lower threshold may be used depending on age.

This is not a clear dividing line between having cancer and not having it. Cancer may not be found above this level, and it can sometimes be found below it.

The likelihood of prostate cancer generally rises as PSA increases. Please discuss your result with us rather than assuming that a slightly raised value is harmless, or that a high value definitely means cancer.

National Cancer Center Japan: Prostate cancer tests (in Japanese)

Why can the same PSA of 6 mean different things?

The meaning of a PSA result can change depending on the size of the prostate.

Consider these two fictional examples, provided to explain the idea.

In someone with a larger prostate, the higher PSA may reflect its size. If the prostate is relatively small but PSA is high, we look more carefully for an explanation.

PSA density describes how high the PSA is relative to prostate size. It helps us consider whether a biopsy is needed, together with MRI and other findings.

These numbers alone do not tell us that Person A is cancer-free or that Person B has cancer.

European Association of Urology: Diagnostic evaluation

We also look at changes over time (PSA velocity)

As well as your current result, we review changes over time. PSA velocity describes how quickly PSA has risen over a period of time.

Results from the past one or two years help us see whether PSA has stayed at a similar level or has recently risen. Inflammation, ejaculation and vigorous exercise can temporarily raise PSA, so we may repeat the test when needed.

National Cancer Institute: PSA test fact sheet

Dr. Nishimoto, our clinic director, reported research on using PSA velocity, MRI and biopsy findings to assess the extent of prostate cancer as first author in 2008. This was his first original research paper written in English. His experience studying changes in PSA informs his everyday clinical practice.

Nishimoto et al., International Journal of Urology, 2008

In clinical practice, we do not decide on further testing from PSA velocity alone. We also consider prostate size, imaging and other information.

AUA/SUO: Early detection of prostate cancer, Part I

Finasteride and dutasteride, used for prostate enlargement or male-pattern hair loss, can lower PSA. Your medicines are important when interpreting the result. Please tell us what you take, for example by bringing your medication record, and do not stop them on your own.

National Cancer Institute: Factors that affect PSA

MRI and biopsy provide different information

MRI looks for areas in the prostate that may be cancer and shows their location and extent. Finding a suspicious area can help guide a targeted biopsy, which takes tissue from that area.

Even if MRI shows no clear abnormality, it cannot completely rule out cancer. A biopsy may still be considered if PSA density, examination findings or family history suggest a continuing risk.

AUA/SUO: Considerations for a prostate biopsy, Part II

A biopsy uses a thin needle to take small samples of prostate tissue for examination under a microscope. It looks for cancer cells and, if cancer is found, provides information about its characteristics.

Because biopsy can cause bleeding or infection, we discuss its potential benefits and risks when considering whether it is needed. Even if one biopsy finds no cancer, changes in PSA or other findings may make further assessment necessary.

National Cancer Center Japan: Prostate cancer tests (in Japanese)

Does finding cancer mean immediate surgery?

Some prostate cancers grow slowly, while others need earlier treatment. Decisions take account of the cancer’s extent and tissue characteristics, your age and general health, and your preferences.

If the risk of progression is considered low, active surveillance may be an option. This means regular tests to check for changes rather than starting surgery or radiotherapy immediately.

Active surveillance uses scheduled PSA tests, MRI and biopsies when needed to look for changes that would make treatment advisable. We discuss the need for treatment alongside its possible effects on daily life, including urinary and sexual function.

National Cancer Center Japan: Prostate cancer treatment (in Japanese)

Please bring earlier health check results to your visit

At our clinic, we review your current and previous PSA results, urinary symptoms and medicines. When needed, we arrange repeat blood tests, urine tests or ultrasound. If MRI or a prostate biopsy is needed, we coordinate with a medical institution that provides these tests.

Please bring the following to your appointment:

• Your latest health check results
• Earlier results showing your PSA levels
• Your medication record
• A referral letter or imaging data, if you have them

Please also tell us if you have a family history of prostate cancer or have recently had a fever or pain when passing urine.

We will review your results with you and explain what the numbers may mean and which tests, if any, should come next.