Raised PSA Test Result | Thames Valley Urologist

By Mr Neil Haldar, Consultant Urological Surgeon — Buckinghamshire, Berkshire, Oxfordshire and London

If your PSA blood test has come back raised, it is natural to feel anxious. The important first point is this: a raised PSA is not a diagnosis of prostate cancer.

PSA can rise for several reasons, including benign enlargement of the prostate, inflammation, infection, recent ejaculation, vigorous exercise, cycling, urinary retention, catheterisation or prostate procedures. In many men, the explanation is not cancer.

Take a raised PSA seriously, but calmly. The next step is usually a structured assessment, which may include repeating the PSA, checking for infection, reviewing urinary symptoms, arranging a prostate MRI and deciding whether a biopsy is actually needed.

I assess men with elevated PSA levels across Buckinghamshire, Berkshire, Oxfordshire, West Hertfordshire, and London, including Great Missenden, High Wycombe, Windsor, Harrow, Ealing, Beaconsfield, Gerrards Cross, Slough, Maidenhead, Amersham, and Aylesbury.

What is PSA?

PSA stands for prostate-specific antigen. It is a protein produced by prostate tissue and measured with a simple blood test.

A small amount of PSA in the blood is normal. PSA becomes useful because the level often rises when something is happening in the prostate. The limitation is that PSA cannot tell us, by itself, exactly what that something is.

A raised PSA may be caused by prostate cancer, but it may also be caused by benign prostatic enlargement, prostatitis, a urine infection or recent irritation of the prostate.

That is why PSA is best understood as a signal for assessment, not a final answer.

A raised PSA is common — and often not cancer

Many men with a raised PSA do not have prostate cancer. PSA levels tend to rise with age, and they can also rise because the prostate has enlarged. This is very common in midlife and later life.

The meaning of a PSA result also depends on context. A PSA that is acceptable for one man may be more concerning in another depending on age, prostate size, family history, ethnicity, medication, symptoms and whether the PSA is rising over time.

That is why you shouldn’t interpret a PSA number in isolation. The trend, the prostate examination, the urine test, the MRI and the wider clinical picture all matter.

Common causes of a raised PSA apart from cancer

A raised PSA can be caused by several non-cancerous factors, including:

Benign prostatic enlargement, also called BPH or enlarged prostate.
Urine infection, which can temporarily raise PSA.
Prostatitis, meaning inflammation of the prostate.
Recent ejaculation, which can raise PSA for a short period.
Vigorous exercise or cycling, particularly shortly before the blood test.
Recent catheterisation, cystoscopy, prostate biopsy or prostate surgery.
Urinary retention occurs when the bladder can’t empty properly.
Medication effects, especially drugs such as finasteride or dutasteride, can lower PSA and make interpretation more complex.

This is why I often ask not only “what is the PSA?” but also “what was happening around the time of the blood test?”

Before repeating a PSA test

If a PSA is unexpectedly raised, repeating it under the right conditions can be useful.

Before a repeat PSA, it is usually sensible to avoid ejaculation and vigorous exercise, including cycling, for 48 hours. If there has been a urine infection, the PSA should usually be delayed until the infection has fully settled. If there has been recent catheterisation, biopsy or prostate surgery, the PSA may need to be deferred for longer.

A urine test is often helpful, especially if there are urinary symptoms such as burning, frequency, urgency or cloudy urine.

The aim is not to dismiss a raised PSA. It is to make sure the result we act on is reliable.

How I interpret a raised PSA

When I assess a raised PSA, I look at the whole picture, not just one number. Important factors include:

your age;
the actual PSA value;
whether the PSA is rising, stable or falling;
previous PSA results;
prostate size;
PSA density, which relates the PSA to prostate volume;
urinary symptoms such as weak stream, urgency, frequency or nocturia;
urine infection or prostatitis symptoms;
family history of prostate, breast, ovarian or pancreatic cancer;
Black ethnicity, which is associated with a higher prostate cancer risk;
medications, especially finasteride or dutasteride;
digital rectal examination findings;
MRI findings, if already performed.

Sometimes repeat testing and assessment are reassuring. Sometimes an MRI is needed. Occasionally, the PSA pattern, examination or MRI suggests that a biopsy is necessary.

What happens next after a raised PSA?

The modern pathway is staged. The purpose is to avoid missing important prostate cancers while also avoiding unnecessary biopsies and unnecessary anxiety.

1. Clinical assessment

The first step is to understand the background. This includes your PSA history, urinary symptoms, infection symptoms, family history, medication, general health and any previous prostate investigations.

A prostate examination may be recommended, depending on the situation.

2. Urine testing and repeat PSA where appropriate

If infection is suspected, a urine test is important. If there has been a recent infection, ejaculation, cycling or prostate irritation, repeating the PSA under better conditions may be the right first step.

3. Prostate MRI

A prostate MRI has transformed raised PSA assessment. It can identify suspicious areas in the prostate and help decide whether a biopsy is needed.

MRI is particularly valuable because it can reduce unnecessary biopsies in men with reassuring scans, while helping target biopsies accurately when there is a suspicious area.

4. Biopsy only if indicated

A prostate biopsy is not automatically needed for every raised PSA. If an MRI shows a suspicious area, a targeted biopsy may be recommended. If the MRI is reassuring, the decision may be to monitor, repeat PSA, or occasionally still biopsy, depending on the overall risk.

The decision should be individualised and explained clearly.

When a raised PSA may need more urgent assessment

Most raised PSA results can be assessed calmly and methodically. However, you should seek prompt medical advice if you have:

inability to pass urine;
visible blood in the urine;
fever or feeling acutely unwell with urinary symptoms;
severe new back or bone pain;
unexplained weight loss;
leg weakness, numbness or loss of bladder or bowel control.

These symptoms do not automatically mean cancer, but they should not be ignored.

Who should consider PSA testing?

PSA testing is a personal decision. It has potential benefits, including detecting significant prostate cancer earlier, but also limitations, including false alarms, unnecessary biopsies and diagnosis of slow-growing cancers that may never have caused harm.

Some men may wish to be more proactive because their risk is higher. This includes men with:

a family history of prostate cancer;
a close family history of breast, ovarian or pancreatic cancer, especially at a younger age;
known BRCA2 genetic risk;
Black African or Black Caribbean ethnicity;
urinary symptoms or abnormal prostate examination.

In 2026, the UK National Screening Committee recommended targeted screening for men aged 45 to 61 with a pathogenic BRCA2 variant and relevant family history. It did not recommend population-wide PSA screening.

If you are unsure whether to have a PSA test or what a result means, it is worth discussing the pros and cons with a clinician.

Private raised PSA assessment across the Thames Valley

I see men with raised PSA results from across Buckinghamshire, Berkshire, Oxfordshire, West Hertfordshire and London.

My clinic locations include:

The Chiltern Hospital, Great Missenden — convenient for Amersham, Aylesbury, Chesham, Wendover, Beaconsfield and the Chilterns.
The Shelburne Hospital, High Wycombe — convenient for High Wycombe, Marlow, Beaconsfield, Maidenhead, Gerrards Cross and South Buckinghamshire.
The Clementine Churchill Hospital, Harrow – convenient for Harrow, Ealing, Wembley, Pinner, Stanmore, Ruislip
The Princess Margaret Hospital, Windsor — convenient for Windsor, Slough, Maidenhead, Ascot, Berkshire and West London.

Patients also commonly travel from Stoke Poges, Denham, Henley, Thame, Watlington, Hemel Hempstead, Berkhamsted, Rickmansworth, and the surrounding M40, M4, and M25 areas.

If your raised PSA is part of broader urinary symptoms, you may also wish to read about my specialist LUTS and urinary symptoms clinic. If cancer has already been diagnosed, you may find my prostate cancer second opinion page helpful.

Frequently asked questions

Does a raised PSA mean I have prostate cancer?

No. A raised PSA does not mean you have prostate cancer. PSA can be raised by benign enlargement, infection, inflammation, urinary retention, recent ejaculation, cycling and other prostate irritation. It prompts assessment, not a diagnosis.

What can cause a high PSA apart from cancer?

Common causes include enlarged prostate, urine infection, prostatitis, urinary retention, recent ejaculation, vigorous exercise or cycling, catheterisation, cystoscopy, biopsy or prostate surgery.

Should I repeat my PSA test?

Sometimes, yes. A repeat PSA may be useful if the first result was unexpected, if there was a possible infection, or if the test was done soon after ejaculation, cycling or prostate irritation. A clinician should guide this.

Do I need an MRI for a raised PSA?

Many men with a persistently raised PSA are offered a prostate MRI. MRI helps identify suspicious areas and can help decide whether a biopsy is needed.

Does everyone with a raised PSA need a biopsy?

No. A biopsy is usually considered when the overall risk is high enough, particularly if an MRI shows a suspicious area. Some men with a reassuring MRI and lower-risk features can avoid immediate biopsy after discussion.

Where can I get a raised PSA assessed privately?

I assess raised PSA results privately across the Thames Valley, including Great Missenden, High Wycombe, Windsor and Harrow.

Arrange a raised PSA assessment

If a raised PSA result is worrying you, an expert assessment can usually replace uncertainty with a clear plan.

I can review your PSA history, symptoms, urine results, prostate examination, MRI findings where available, and advise whether you need monitoring, repeat testing, MRI, biopsy or treatment.

Arrange a private consultation

Mr Neil Haldar is a Consultant Urological Surgeon (GMC 3683914). This page provides general information and is not a substitute for individual medical advice. If a raised PSA result is worrying you, please speak with a qualified clinician.

Raised PSA: What It Means, Common Causes, and What Happens Next