Cancer Survivorship & Post-Op ED
What a high PSA means and doesn't, and how repeat testing, PSA density, and prostate MRI guide whether a biopsy is needed.
Written and reviewed by Shervin Badkhshan, MD · Last reviewed
November 2026
Part of:
After prostate cancer treatment
Office care
Fellowship-Trained Reconstructive Urology
AT A GLANCE
From symptoms to treatment
1. SYMPTOMS
• Usually no symptoms • Found on routine blood work
PSA (prostate-specific antigen) is a blood test that helps screen for prostate cancer. A high PSA is not a cancer diagnosis. It's a signal to look more closely.
PSA is prostate-specific, not cancer-specific
PSA can rise with an enlarged prostate, infection or inflammation, recent ejaculation, a long bike ride, or a recent catheter or procedure. Medications like finasteride and dutasteride lower it by about half, which has to be accounted for.
What happens after a high PSA
Repeat the test, often with free PSA
PSA density, which compares PSA with prostate size
Prostate MRI, scored by PI-RADS, to look for areas of concern
A biopsy only when the overall risk supports it, often MRI-guided
An enlarged prostate is not cancer
Benign enlargement (BPH) is common with age and causes urinary symptoms, not cancer. The two can coexist, which is why PSA is interpreted alongside prostate size and MRI.
Related
PSA results explained · Prostate MRI and PI-RADS explained · Enlarged prostate
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