Private specialist assessment for men with a raised PSA blood test. MRI-first, NICE-aligned diagnostic pathway, typically completed within 7–14 working days.
A raised PSA is not a diagnosis of prostate cancer. Around 60–70% of men with a mildly elevated PSA (4–10 ng/mL) do not have prostate cancer — common benign causes include an enlarged prostate, prostate inflammation, recent ejaculation, or vigorous cycling. However, an elevated PSA must be properly investigated, particularly in men aged 50 and over.
The modern UK pathway is clear: a confirmatory PSA under standardised conditions, a multiparametric MRI of the prostate before any biopsy, and a targeted transperineal biopsy only if MRI or other clinical features warrant it. Under NICE guidance, this is the standard of care.
This rapid access clinic, led by Consultant Urological Surgeon Mr Neil Haldar, delivers the full pathway — consultation, repeat PSA, mpMRI, and biopsy if indicated — typically within 7–14 working days. Clinics are available for patients from across Buckinghamshire, Berkshire, West Herts and Oxfordshire.
When to Use This Service
This pathway is designed for men with a raised PSA, urinary symptoms, or other prostate concerns who want a fast, NICE-aligned assessment by a consultant urological surgeon and high-volume robotic prostate cancer surgeon.
Book this assessment if you have:
- A PSA result above the age-specific threshold
- A rising PSA over time
- A family history of prostate cancer or a known BRCA mutation
- Black African or Black Caribbean heritage and want a baseline PSA assessment
- Lower urinary tract symptoms (weak flow, frequency, nocturia, hesitancy)
- Been advised you need a prostate MRI or biopsy
- A previous PSA test you would like reviewed by a specialist
The pathway follows NICE guidance — multiparametric MRI before biopsy, with transperineal biopsy as the preferred technique where biopsy is required.
A raised PSA does not mean prostate cancer, but it should be interpreted carefully alongside age, symptoms, infection status, prostate size, MRI and family history.
About Mr Neil Haldar
I am a Consultant Urological Surgeon at Buckinghamshire Healthcare NHS Trust, where I served as urology cancer lead and established the da Vinci robotic prostatectomy surgery programme. I have personally performed over 1,000 radical prostatectomies, placing me among the higher-volume prostate surgeons in the UK.
For prostate cancer in particular, this matters: published evidence consistently shows better functional and oncological outcomes with high-volume surgeons. Every patient I see is assessed personally by me from the first consultation through to diagnosis and, if required, treatment or referral for radiotherapy.
GMC: 3683914 | BUPA Platinum Consultant
What Is PSA?
PSA (prostate-specific antigen) is a protein produced almost exclusively by cells in the prostate gland. Small amounts circulate in the bloodstream and can be measured with a simple blood test.
PSA is best understood not as a “cancer test” but as a marker of prostate activity. It rises in a wide range of conditions, from benign prostate enlargement to inflammation to cancer. The art of interpreting PSA lies in placing the number in a clinical context — alongside age, prostate size, symptoms, examination findings, family history, ethnicity, MRI findings, and previous PSA trend.
What Counts as an Elevated PSA?
The UK Prostate Cancer Risk Management Programme (PCRMP) uses age-specific PSA reference values:
| Age Range | PSA Threshold for Further Action |
|---|---|
| 40–49 years (with risk factors) | > 2.5 ng/mL |
| 50–59 years | > 3.0 ng/mL |
| 60–69 years | > 4.0 ng/mL |
| 70–79 years | > 5.0 ng/mL |
Three additional measures matter as much as the absolute number:
- PSA velocity — how quickly the PSA is rising (>0.75 ng/mL per year is considered significant)
- PSA density — PSA relative to prostate volume on MRI (>0.15 is suggestive)
- Free-to-total PSA ratio — a low ratio (<15%) is more suggestive of cancer
A PSA that is “normal” for one man may be abnormal for another. Specialist interpretation matters more than the headline number alone.
What Causes an Elevated PSA?
There are several possible causes of a raised PSA:
- Benign prostatic enlargement (BPH) — the single most common cause in men over 50
- Prostatitis (prostate inflammation or infection) — can cause dramatic PSA rises that resolve once inflammation settles
- Urinary tract infection — defer testing until 4–6 weeks after the infection has fully resolved
- Recent ejaculation — abstain for at least 48 hours before a PSA test
- Vigorous cycling — avoid for 48–72 hours before testing
- Recent catheterisation, cystoscopy, or biopsy — PSA may remain elevated for 6–8 weeks
- Increasing age — PSA rises naturally with age and prostate size
- Prostate cancer — the most clinically important cause to exclude
Two important points:
- Most men with a raised PSA do not have prostate cancer.
- Some men with prostate cancer have a normal PSA — particularly in aggressive variants. PSA is sensitive but not specific.
Symptoms That May Occur with a Raised PSA
Many men with an elevated PSA have no symptoms at all. However, some may notice:
- Passing urine more frequently
- Getting up at night to pass urine (nocturia)
- A weaker urinary stream
- Hesitancy or difficulty starting urination
- Urgency
- A feeling of incomplete bladder emptying
- Burning or discomfort when passing urine
- Blood in the urine or semen
- Pelvic discomfort
These symptoms are most often caused by benign prostate enlargement or inflammation, but they still warrant careful assessment alongside the PSA result.
NICE Guidance and the 2-Week-Wait Pathway
Under NICE guideline NG12 (Suspected cancer: recognition and referral), GPs should refer men using the suspected cancer (2-week-wait) pathway when:
| Patient Profile | NICE Recommendation |
|---|---|
| Prostate feels malignant on digital rectal examination | 2-week-wait referral for prostate cancer |
| PSA above age-specific threshold | 2-week-wait referral for prostate cancer |
| Symptoms suggestive of prostate cancer plus elevated PSA | Consider 2-week-wait referral |
NICE guideline NG131 (Prostate cancer: diagnosis and management) sets out the diagnostic pathway itself, with multiparametric MRI as the first-line investigation before any biopsy.
If you meet these criteria but want to avoid waiting, this rapid access clinic delivers the same NICE-aligned pathway in a private setting, typically within 7–14 working days.
The Pathway
1. Consultant Consultation
A 30–45 minute consultation reviewing your PSA history, urinary symptoms, family history, ethnicity, and risk factors. Digital rectal examination as appropriate.
2. Repeat PSA Under Standardised Conditions
Where indicated, a confirmatory PSA test is arranged with proper preparation (no ejaculation, no cycling, no infection). Free-to-total PSA ratio and PSA density are calculated where useful.
3. Multiparametric MRI of the Prostate (mpMRI)
Performed at your chosen site, typically within 3–7 working days. Reported by a specialist uroradiologist using PI-RADS scoring. Around 1 in 4 men with a normal MRI can safely avoid biopsy altogether.
4. Transperineal Prostate Biopsy (Only If Indicated)
If MRI is suspicious (PI-RADS ≥3) or other clinical features warrant biopsy, this is performed under local anaesthetic in the outpatient setting. The transperineal approach has a near-zero risk of sepsis compared with the older transrectal technique.
5. Results, Diagnosis, and Plan
A follow-up consultation reviewing all results, explaining the diagnosis, and agreeing on the management plan. If cancer is found, the case is reviewed at the Urology MDT, and the full range of treatment options is discussed.
Typical timeline: 7–14 working days from first contact to diagnosis.
Clinic Locations
Choose the site most convenient for you. The same consultant and the same pathway apply at every location.
| Location | County | Consultation | mpMRI | Transperineal Biopsy |
|---|---|---|---|---|
| Chiltern Hospital, Great Missenden | Buckinghamshire | ✓ | ✓ | ✓ |
| Clementine Churchill Hospital, Harrow | Middlesex | ✓ | ✓ | ✓ |
| GenesisCare, Windsor | Berkshire | ✓ | ✓ | ✓ |
| Shelburne Hospital, High Wycombe | Buckinghamshire | ✓ | ✓ (arranged) | — |
| Beaconsfield Clinic | Buckinghamshire | ✓ (selected dates) | — | — |
Notes for clinic-only sites: Patients seen at the Shelburne Hospital or Beaconsfield Clinic who require mpMRI or transperineal biopsy will have these arranged at Chiltern Hospital, Clementine Churchill Hospital, or GenesisCare Windsor — usually within the same week.
The catchment includes south Oxfordshire (Henley, Thame, Wallingford), Buckinghamshire, West Hertfordshire, East Berkshire and North West London.
If Treatment Is Required
If the assessment identifies prostate cancer requiring treatment, you remain under my direct care. Treatment options include:
- Active surveillance for low-risk disease — many men never need treatment
- Radical prostatectomy — performed with over 1,000 cases of personal experience
- Radiotherapy — coordinated with named oncology colleagues
- Focal therapy — discussed where appropriate
The same consultant who diagnoses you treats you. There is no handover, no waiting list jump, no loss of continuity.
What If the PSA Is Raised but No Cancer Is Found?
This is a common and reassuring outcome. However, it is still important to understand why the PSA was raised and whether follow-up is needed. Depending on the findings, the recommendation may include:
- PSA monitoring
- Repeat MRI in the future
- Treatment for prostatitis or urinary infection
- Management of benign prostate enlargement (medical or surgical)
- Lifestyle advice
- Further assessment if the PSA continues to rise
A negative assessment does not always mean “nothing further ever needs to be done”. It means a more informed and safer plan can be made.
What’s Included
| Component | Detail |
|---|---|
| Initial consultation | Consultant-led, 30–45 minutes |
| Repeat PSA + ancillary tests | Standardised conditions |
| Multiparametric MRI prostate | PI-RADS reported |
| Transperineal biopsy | Local anaesthetic, outpatient (if indicated) |
| MDT review | If cancer is identified |
| Follow-up consultation | Results, diagnosis, plan |
| Onward treatment | Continuity through to robotic prostatectomy if required |
Who This Clinic Is For
This service is suitable for men with:
- A raised PSA blood test
- A rising PSA trend
- A borderline PSA and uncertainty about what to do next
- An abnormal prostate examination
- A family history of prostate cancer or a known BRCA mutation
- Black ethnicity seeking a baseline assessment
- Persistent PSA elevation after prostatitis
- A previous negative biopsy, but ongoing concern
- A raised PSA found through health screening
- Concerns about prostate cancer despite minimal symptoms
Preparing for Your Appointment
Please bring, or send in advance:
- Your most recent PSA result
- Previous PSA results, if available
- GP letters
- Urine test results
- Any MRI or scan reports
- Previous biopsy results
- A list of medications
- Details of family history
This helps Mr Haldar assess your PSA in context and avoid unnecessary repeat testing.
Indicative Fees
Recognised by all major UK private medical insurers, including BUPA, AXA, Aviva, Vitality, WPA, and Cigna. Most policies cover the full pathway with a valid GP referral. Self-pay patients welcome.
For a personalised quote, please contact my secretary.
Frequently Asked Questions
Can I have an MRI before any biopsy?
Yes — and you should. This pathway follows NICE NG131, which recommends multiparametric MRI as the first-line investigation in men with a raised PSA. A normal MRI can safely avoid biopsy in around 1 in 4 men.
How quickly can I get an MRI?
mpMRI is typically arranged within 3–7 working days of your initial consultation, subject to scan availability.
Is a transperineal biopsy painful?
The biopsy is usually performed under local anaesthetic in the outpatient setting and is generally well tolerated. It can be performed under a general anaesthetic if preferred. The transperineal route avoids the rectum entirely, which means a near-zero risk of serious infection compared with the older transrectal approach.
Does a normal PSA rule out prostate cancer?
No. Around 15% of prostate cancers occur in men with a PSA in the “normal” range. This is why context — DRE findings, family history, ethnicity, PSA trend, and, where appropriate, MRI — all matter alongside the absolute number.
What if cancer is found?
If prostate cancer is diagnosed, the case is reviewed at the Urology MDT, and a personalised plan is agreed. Many men with low-risk disease are best managed with active surveillance. Where surgery is appropriate, robotic radical prostatectomy is performed by me with over 1,000 cases of personal experience.
Book Your Assessment
Related Reading
Surgical care: Robotic radical prostatectomy is performed at The Princess Grace Hospital, London — one of the UK’s leading private hospitals, with dedicated da Vinci robotic surgery facilities.
Mr Neil Haldar, MBBS, MD, FRCS (Eng), FRCS (Urol). Consultant Urological Surgeon and Urology Cancer Lead, Buckinghamshire Healthcare NHS Trust. GMC 3683914.
