PSA test for prostate cancer

What may happen when a PSA test result is abnormal

If a man's PSA level is above normal there are no hard and fast rules and medical experts may not agree on the best course of action. What happens next depends on whether a man has symptoms, his personal risk of prostate cancer, and the PSA level. 

Not all men with a raised PSA level have prostate cancer, so if a PSA test result is 'at the top of the normal range' or slightly above 'normal' it may be repeated quite soon to check that the level wasn't raised because of other causes such as' ejaculation in the 48 hours before the test, or infection or inflammation of the prostate (prostatitis).

One man we talked to had consulted his GP because he was very tired. After other test results were all negative his GP suggested a PSA test. The result was slightly higher than 'normal', so the test was repeated on two occasions. The PSA continued to rise so he was referred to a consultant.

Another man who had a raised PSA test result was told that he could either be referred to a consultant or he could wait six months and then repeat the test. He decided to repeat the test and found that the second PSA result was lower than the first, so he was not referred.

One man recalled that his GP told him that his PSA result was slightly raised, and then said it would be a good idea if he did a digital rectal examination before making any other decisions.

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If a man's PSA result is 'abnormal' some GPs refer patients fairly rapidly to see a consultant urologist. The specialist may repeat the PSA test and digital rectal examination and conduct other tests, such as a cystoscopy. Having seen a consultant some men we talked to were told that they didn't need a biopsy and that their symptoms were due to a urinary infection or benign enlargement of the prostate.

A consultant may recommend a trans-rectal ultrasound scan (TRUS) and a biopsy, even if the PSA is only slightly raised. One man we talked to had mild urinary symptoms, and a slightly raised PSA. Before agreeing to a biopsy he wanted to discuss what a positive biopsy result might mean and how side effects of any treatment might affect his quality of life. He was shocked when the consultant insisted that he ought to have a biopsy immediately. 

If a man's PSA level is raised much above 'normal' he will certainly be referred to a specialist, who will probably recommend a biopsy. (For more about prostate biopsies see 'Biopsy of the prostate' and also the our prostate cancer section). 

Last reviewed May 2016.

Last updated May 2016.


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