Raised PSA Levels: What Happens Next and How Prostate Cancer Is Diagnosed

A raised PSA result can be unsettling, but it does not mean you have prostate cancer. PSA can rise for many reasons, and modern diagnostic pathways are designed to minimise unnecessary biopsies while accurately identifying cancers that need treatment.

This guide explains what counts as a high PSA, what happens next, and how prostate cancer is diagnosed.

What Is Considered a High PSA?

PSA thresholds vary with age. Levels above the following values are considered raised:

• 40–49: PSA > 2.5

• 50–59: PSA > 3.5

• 60–69: PSA > 4.5

• 70–79: PSA > 6.5

• Over 79: Clinical judgement, though > 7.5 combined with symptoms may suggest metastatic disease

  
  

These thresholds are not absolute. Context matters, including prostate size, symptoms, and PSA density (PSA relative to prostate volume).

Important: If you are taking finasteride, your PSA reading should be doubled to estimate your true level.

Step 1: Repeat the PSA Under the Right Conditions

If PSA is raised, the first step is to repeat the test after:

• 72 hours abstaining from sex

• Avoiding cycling

• Ruling out infection

These factors can temporarily elevate PSA.

Step 2: MRI Scan of the Prostate

If PSA remains raised, an MRI scan is the next step and is now standard across the UK.

Why MRI first?

• Avoids unnecessary biopsies

• Reduces risk of infection or sepsis

• More accurate identification of clinically significant cancers

The scan takes about an hour and provides detailed imaging of the prostate.

Step 3: Stockholm-3 (S3) Test — If Needed

If MRI findings are uncertain, a Stockholm-3 test may be used. This blood test combines several markers to provide a more accurate assessment of prostate cancer risk.

This test helps to:

• Reduce unnecessary biopsies

• Identify men who would benefit from further investigation

Step 4: Prostate Biopsy

A biopsy may be recommended if:

• MRI shows a suspicious lesion

• Stockholm-3 indicates a high level of risk

• PSA remains persistently elevated

A biopsy provides the only way to confirm the presence of prostate cancer.

What a Raised PSA Does — and Does Not — Mean

A raised PSA does not mean you have prostate cancer. It simply signals that the prostate is active and warrants further assessment. Modern pathways, especially MRI-first, make the process safer, more accurate, and less invasive.

FAQs

1. What is considered a high PSA level?

A PSA above 2.5 (age 40–49), 3.5 (50–59), 4.5 (60–69), or 6.5 (70–79) is considered raised. For men over 79, clinical judgement is required.

2. Does a high PSA mean I have prostate cancer?

No. PSA can be raised due to benign enlargement, infection, ejaculation, cycling, or prostatitis.

3. What happens if my PSA is high on repeat testing?

An MRI scan is usually the next step, providing a detailed assessment of the prostate.

4. What is the Stockholm-3 test?

It is a blood test that combines multiple biomarkers to refine prostate cancer risk when MRI findings are unclear.

5. Will I need a biopsy if my PSA is high?

Only if MRI or S3 testing suggests a suspicious lesion. MRI-first pathways mean fewer men now require biopsies.