What happens if my PSA is high?

If you had normal results on a digital rectal examination and your PSA is slightly high, your doctor may want to repeat the test later to see if the PSA remains high.

It is important to follow up with your doctor if something unusual is found on the digital rectal exam or if your PSA level is high. If your doctor has ordered more tests or suggested repeating the PSA test, keep your appointments.

Don’t let fear keep you from having the tests – you need to detect or help rule out cancer. Prostate cancer is most successfully treated when found early.

The PSA test does not provide a perfect method for screening. Approximately 15% of men with prostate cancer have a normal PSA level. In order to confirm the presence of cancer, men with raised PSA levels are referred as an out-patient to a urology clinic for a biopsy. About two thirds of men with an elevated PSA level do not have a cancer detected in a biopsy. For more information on the tests and their possible outcomes see this link.

How is prostate cancer diagnosed?

A diagnosis of prostate cancer must be made by a biopsy. During a biopsy, several small pieces of prostate tissue are removed with hollow needles and then examined under a microscope for cancer. The biopsy sampling takes about 20 minutes and can be very painful and so you may want to ensure an anaesthetic is used.

If cancer is found in a sample removed by biopsy, a Gleason score (named after the American who devised it) is used to describe its aggressiveness. Patients may then be given a CT scan and a bone scan to assess the spread of the cancer and to describe its staging. For more information on the staging or progression of the cancer see here.

There is a wide variation in the advice given by GPs and specialists on PSA test results, Gleason readings etc and the treatment choices. Prospect members have been down this route, and you may find a discussion with them helpful (via our helpline 0800 035 5302 or by attending a meeting).

Download the leaflet How prostate cancer is diagnosed

Don’t go it alone

It is wise to take someone with you when you meet the consultant. We recommend you both take notes. It is a stressful experience and recollecting afterwards what was said can be difficult. Your companion will then share the diagnosis and prognosis (expected outcome) of treatment.