What a raised PSA result means, and what happens next

Maybe a letter has arrived saying your PSA is raised. Maybe you're about to have the test because of a birthday, a family history or a friend's diagnosis. Either way, the number can feel like a verdict before anyone has explained it.

It isn't one. PSA is a protein made by the prostate, and the NHS is clear that a high PSA does not mean you have cancer. It may be down to an enlarged prostate or other changes that have nothing to do with cancer. What the number means for you depends on your age and the rest of the picture, which is where a doctor comes in.

If you'd rather skip the reading, doctor-led prostate screening is available at our Harley Street clinic Monday to Friday, with appointments from 30 minutes and no referral needed. Essential screening is £349, Advanced £699 and Elite £1,299.

What is PSA, and what does it measure?

Prostate-specific antigen is a protein produced by the prostate. Prostate Cancer UK describes the gland as usually the size and shape of a walnut. It sits under the bladder, grows bigger with age, and its main job is helping to make semen. High levels of PSA in the blood can be a sign of a prostate condition, which is why the NHS uses the test to help check for prostate cancer or an enlarged prostate.

PSA tells you the prostate is doing something, but on its own it can't tell you what. Prostate Cancer UK notes that about 1 in 8 men in the UK will get prostate cancer in their lifetime, and that the risk rises with age and is higher for black men and men with a family history. Those facts are why so many men ask for the test.

Some prostate cancers grow too slowly to cause problems, and many men with one will never need treatment. Equally, urinary problems can be mild, build over years and turn out to be a benign prostate problem. That overlap is why a doctor who has examined you reads the number better than any chart can on its own.

What PSA level is considered raised?

There are two sets of numbers in UK practice, and which one applies depends on whether you have symptoms.

For men aged 50 to 69 who feel well and ask for the test, the NHS Prostate Cancer Risk Management Programme uses a single threshold: a PSA of 3.0 ng/mL or higher prompts referral for further tests. Prostate Cancer UK's 2024 GP consensus kept that 3.0 line, because there wasn't enough evidence to agree age-specific thresholds for men without symptoms.

For men with symptoms such as needing to pee more often, a weak stream or erection problems, NICE guideline NG12 uses age-specific thresholds, because PSA naturally rises as the prostate grows with age.

Age-specific PSA thresholds for men with possible prostate symptoms. Source: NICE NG12 (table 2, 2021). 1 ng/mL is the same as 1 microgram per litre.

These are lines for deciding on further tests, not diagnoses. A result just over the line is often benign enlargement or inflammation, and a result under it isn't a guarantee. That is why every tier here reads your PSA in context: with your age, symptoms, the examination and any earlier results. A rise between tests often says more than one printout.

PSA density, velocity and free PSA

Once a PSA is raised, doctors use three refinements to judge how much weight to give it.

Sources: NICE NG131; Lab Tests Online UK.

PSA density is the one to remember. It explains why a man with a large, benign prostate can have a higher PSA than a man with a small prostate and a significant cancer, and why the MRI matters so much.

What happens after a raised PSA?

On the NHS, a raised result usually leads to a repeat PSA test to see whether the level is still high. If it stays high, a GP may discuss referral to a specialist. Since NICE guideline NG131, the first test after referral is an MRI scan rather than a biopsy. The radiologist scores the scan from 1 to 5. A biopsy is offered for a score of 3 or more, and for a score of 1 or 2 you and the specialist may agree to skip it and keep watching your PSA instead.

So a low-suspicion scan can spare you a biopsy. The NHS also notes that a PSA result may not be accurate, and that you may be offered tests and treatment you don't need, which is why a doctor talks this through with you first.

Routine PSA testing isn't offered on the NHS unless you carry a BRCA2 gene change, but any man can ask a GP about it. Prostate Cancer UK's consensus supports access from 50, or from 45 for black men and men with a family history. You can also talk through the benefits and risks with one of our GPs before deciding.

How does the GP read the number here?

At Medical Express Clinic your PSA is read alongside the thresholds above, your age, your symptoms and the examination. Depending on your tier, the GP also has the broader Prostate Profile or a prostate MRI to work with, and any further investigation follows that complete picture. The Prostate Profile measures total PSA and free PSA and gives the calculated free-to-total ratio.

Age matters because the prostate often enlarges as you get older. Symptoms matter because urinary change, pain or a testicular lump change which tests make sense. Family history and previous results matter most of all, because a trend over several tests often says more than one printout.

The service is led by Dr Mohammad Bakhtiar, GMC 4694470, a GP with a special interest in health screening and men's health. The clinic has been at 117a Harley Street since 1984 and is CQC-registered.

Essential, Advanced or Elite: which tier suits you?

Prostate screening here comes as three doctor-led tiers, each with a GP review, which is the difference from a PSA blood test posted back on its own. Appointments run Monday to Friday and last from 30 minutes.

What each prostate screening tier includes

Essential suits men who want a clinical assessment and a PSA baseline. Advanced suits men who want more laboratory information from the same consultation, and Elite suits men who want a structural look at the prostate too. On Elite, a multi-parametric MRI upgrade can be added for £400 when that scan is appropriate and offered; it isn't automatic.

Result timing varies by tier, because a PSA, a broader profile and an MRI don't come back together. When everything is in, the GP sits down with you in person and explains whether monitoring, repeat testing or specialist assessment is the right next step.

If you have symptoms now

If urinary symptoms or a testicular lump are the reason you're here, book a men's urology assessment. It's GP-led care for a problem you have now, with referral when specialist input is needed. Our sister clinic also offers separate prostate screening.

If you'd like a wider male check, Well Man examinations can include prostate testing alongside cardiovascular, hormone and metabolic tests.

See a doctor promptly if you notice blood in your urine or semen, new bone or back pain, or unexplained weight loss. If you can't pass urine, have sudden severe testicular pain or have symptoms of a heart attack, call 999 or go to A&E.

How do I prepare for a PSA test?

A little preparation makes the number far more useful. The NHS advises that for 48 hours before the test you avoid anal sex, ejaculation, anything that leaves you out of breath such as exercise, and cycling, because all of these can raise PSA and make the test less accurate. You can eat and drink as usual.

• If you've had a urine infection, wait 4 to 6 weeks after it has cleared before testing, because the infection can affect the result.
• If you've recently had a prostate examination, a catheter or another procedure around the gland, mention it when you book.
• If you have previous PSA results, letters, a family history or a medication list, bring them together so the GP can see the whole story and work out your PSA velocity.

Related reading: what a low testosterone result means for treatment and erection problems and your wider health.