PSA (Prostate-Specific Antigen)

What PSA can and can't tell you

PSA is prostate-specific, not cancer-specific. It rises with:

• Prostate cancer
• Benign prostatic enlargement (BPH)
• Prostatitis (inflammation or infection)
• Instrumentation (catheter, cystoscopy, biopsy) and recent ejaculation
• Vigorous cycling shortly before the test

Finasteride and dutasteride roughly halve PSA — your clinician should double the result to interpret it.

Contextualizing PSA

• PSA velocity — how quickly it's changing
• PSA density — PSA divided by prostate volume on imaging
• Free / total PSA ratio
• Secondary markers (4Kscore, PHI, SelectMDx, ExoDx) refine risk before biopsy

Next steps if PSA is elevated

1. Rule out infection and confirm on a repeat draw
2. Risk-stratify with a secondary marker
3. Multiparametric prostate MRI to look for suspicious lesions (PI-RADS scoring)
4. Targeted MRI-fusion biopsy only when indicated

PSA is a tool, not a diagnosis. It works best as part of a shared-decision plan with a urologist.