What Happens if My PSA is Elevated?

Roscoe Nelson, MDUpdated 2026-08-242 min read

A note from 2026. I wrote this in 2016, and the path from an elevated PSA to a biopsy has changed since then. A few things to know before you read on. An MRI of the prostate is now commonly done before a biopsy rather than after. It helps target the biopsy, and in some men it means no biopsy is needed at all. Blood and urine tests such as the 4Kscore, PHI, and SelectMDx can now help decide whether a biopsy is warranted in the first place. None of them existed in routine practice when this was written. PSA velocity, meaning the rate at which your PSA rises, is discussed below as a reason to biopsy on its own. Guidelines have since moved away from using it that way. It is still useful context, but by itself it is not a reason to go to biopsy. The rest of it still holds. The basic logic of what an elevated PSA means, and why a young healthy man with a mild elevation usually gets a repeat test instead of a needle, has not changed.

After you get your PSA results (which usually take about a week from the day your blood is drawn), you will likely meet with your doctor to discuss what to do next.

Regardless of your age or PSA level, your doctor will perform a digital rectal exam (DRE) in order to detect any abnormalities of the prostate that can be felt. The PSA test and DRE are complimentary tests that are nearly always done together.

If your PSA is markedly elevated, regardless of your age, then your doctor will likely want to proceed with a test that will definitively say why your PSA is elevated. The only test that allows for a certain diagnosis is a prostate biopsy. A biopsy involves obtaining a tiny sample of tissue from the prostate, which can then be analyzed.

Prostate cancer, BPH, prostatitis, and other conditions can be diagnosed with a biopsy.

If your PSA is mildly elevated and you are young, otherwise healthy, and don’t have much of a family history of prostate cancer, then your doctor will likely wait and recheck your PSA level. Many conditions such as prostatitis are more likely to be the cause of a high PSA in a young, healthy man. On follow-up PSA testing, the PSA level should return to normal if it was temporarily elevated due to prostatitis.

If your PSA is not elevated and your digital rectal exam is normal, your doctor will likely do nothing more at the time, but will want to see you again in a year for another PSA test and DRE. Sometimes, if your PSA level is not elevated, but it has increased quickly in recent years (ie. a high PSA velocity), your doctor may be more concerned and recommended a biopsy.

If your PSA is not elevated, but there is an abnormality on your DRE, then a biopsy will likely be considered as well.

Complex PSA questions are welcome

If your PSA situation is complicated, if you have had conflicting advice, or if you want a second opinion before agreeing to a biopsy or a treatment, that is a conversation I am glad to have. Complex urologic second opinions are an active part of my practice.

Request a second opinion

A note on this article. This is general education, not medical advice. It cannot account for your individual history, and reading it does not create a doctor-patient relationship. If something here raises a question about your health, bring it to a clinician who can actually examine you.

Questions this article raises

Direct answers first.

What is the very first step after an elevated PSA?

Repeat it properly. No ejaculation for 48 hours, no cycling, no active urinary infection, same lab if possible, and confirm nobody examined the prostate right before the draw. A meaningful share of elevated PSAs normalize on a clean repeat, and everything downstream, anxiety included, waits comfortably for that confirmation. One number is a data point. Two, under known conditions, is information.

Does an MRI replace a biopsy?

It increasingly decides whether a biopsy is needed at all, which is nearly as good. A high-quality prostate MRI can show whether a suspicious lesion exists and grade the suspicion, letting many men with elevated PSA and a clean scan skip the needles, and letting the men who do need biopsy get a targeted one aimed at the actual spot. The old reflex, elevated PSA straight to twelve random cores, is fading for good reason.

How fast do I need to act on a high PSA?

Almost never fast, and the calm is medically justified. Prostate cancer, when present, is typically slow, measured in years, and the difference between acting this week versus in two months is essentially zero. What you should not do is the other extreme: file one abnormal result away and skip the follow-through. Deliberate beats both panicked and passive. The evaluation has a pace; keep the appointment and let it work.

What Happens if My PSA is Elevated?

Complex PSA questions are welcome

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Questions this article raises

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