When an upward arrow appears next to PSA on a health checkup report, it is easy to immediately think of prostate cancer. However, PSA is not a definitive marker for cancer; it is a value that measures the concentration of proteins produced by the prostate in the blood. It can also rise due to benign prostatic hyperplasia, inflammation, or recent stimulation, and a low value does not completely rule out the possibility of cancer.
Therefore, when consulting about PSA results at Gangnam Urology Clinic, it is important to consider not just a single number, but also the circumstances at the time of the test, age and family history, and the trend of previous values. Receiving a high result does not mean that a biopsy is immediately confirmed, nor does it mean you can just put the results in a drawer and forget about them.
PSA does not indicate whether there is cancer on its own
PSA is produced in both normal prostate cells and prostate cancer cells. Conditions such as benign prostatic hyperplasia, prostatitis, urinary tract infections, recent urinary retention, prostate biopsies, or procedures can also raise levels. Some activities may temporarily affect levels, so it is important to inform medical staff of your situation before the test.
The figure of 4 ng/mL is often mentioned, but it is not an absolute threshold for all ages and situations. The significance of the same result varies depending on laboratory standards, age, prostate size, family history and genetic risk, and previous values. The key point is that PSA alone cannot distinguish between cancer and benign conditions.
Some drugs used for benign prostatic hyperplasia or hair loss, such as finasteride or dutasteride, can lower PSA levels. If you hide the names of the drugs and the duration of use, the actual risk may be misinterpreted, so you should inform about both prescription drugs and hair loss medications. Do not stop taking your medication on your own because of the results.
Look at the conditions and trends of change rather than a single figure
If a PSA level higher than expected is detected for the first time, you should first check whether there have been recent infections, fever, difficulty urinating, catheter insertion, or prostate-related procedures. If such factors are present, re-testing can be considered at an appropriate time after recovery. You may also be advised about activities that can temporarily affect the test, such as intense cycling or ejaculation, before the examination.
The purpose of a retest is not to make the results lower, but to distinguish between random fluctuations and continuous increases. If possible, bring previous health checkup results and organize the test dates and values in chronological order. Rather than deciding on a biopsy based solely on the rate of increase, use it as part of an overall risk assessment.
Auxiliary indicators such as PSA density, which reflects prostate size, and free PSA ratio are sometimes used in judgment. These, too, are not standalone confirmatory tests, and which tests to add depends on an individual’s situation.
After re-examination, MRI and biopsy are reviewed step by step
If PSA remains elevated or there are risk signals in a workplace urine test or family history, a multiparametric prostate MRI can be considered. MRI shows suspicious areas and helps target biopsies, but even if the imaging appears normal, it does not rule out all clinically significant cancers.
A biopsy is a definitive process in which a pathologist examines prostate tissue under a microscope. The necessity of the test is determined not just by PSA levels, but also by a combination of factors such as MRI results, prostate size, age and health status, family history, and previous biopsy results. During a consultation at Gangnam Urology, be sure to ask about the benefits of the test, the risks such as infection and bleeding, and the next options based on the results.
Even if abnormalities are found through additional tests, not all prostate cancers immediately require the same treatment. Active surveillance may be considered in cases of low risk, and treatment options such as surgery or radiation therapy vary depending on risk and stage. There is no need to jump to a treatment conclusion based solely on the first PSA result.
Information to prepare before and after the test helps interpret the results
Check whether your parents or siblings have been diagnosed with prostate cancer and the age at diagnosis, and prepare as many of your past PSA results as possible. You should also provide information about symptoms that may suggest an infection, such as painful urination, frequent urination, or fever, recent occurrences of urinary blockage or the use of a catheter, and the dates when you had prostate examinations or procedures.
Include not only prostate medication but also hair loss medication in the list of medications you are taking. When the results are high, it is advisable to specifically ask, ‘What should be checked in a few weeks or months?’, ‘Are there any conditions to avoid before retesting?’, and ‘What are the criteria for deciding on an MRI or biopsy?‘
Screening is decided by understanding its benefits and limitations
PSA screening in people without symptoms carries the possibility of early cancer detection as well as false positives, anxiety, unnecessary biopsies, and overdiagnosis of cancers that might never have caused problems in their lifetime. Therefore, various guidelines recommend discussing the pros and cons with healthcare providers based on individual risk factors such as age, life expectancy, and family history to make a decision.
A high PSA result is the beginning of the questions, not the end of a cancer diagnosis. Do not panic and avoid the test results or draw conclusions based on a single number; check for temporary factors, evaluate past trends and personal risk factors together, and then decide on the next steps.
Referenced Medical Information
- U.S. National Cancer Institute (NCI) PSA Test Guide
- American Urological Association (AUA/SUO) Prostate Cancer Early Detection Guidelines
- European Association of Urology (EAU) Prostate Cancer Diagnostic Evaluation
This article is intended to provide general health information and does not replace diagnosis or treatment. PSA screening and additional tests should be decided in consultation with medical professionals based on individual risk factors and preferences.
