What Does a Urologist Do If Your PSA Is Elevated?

Reviewed on 3/11/2022

A man sitting in a chair at the doctor's office
After an initial test result of elevated PSA levels, a urologist will want to perform another PSA test and other tests to diagnose the issue.

Prostate-specific antigen, or PSA, is a protein produced in cells of the prostate gland and a PSA test measures the level of PSA in a man’s blood. The PSA test is a standard screening test for prostate cancer because PSA levels are often elevated in men with prostate cancer.

In general, the more elevated a man’s PSA level, the more likely it is that he has prostate cancer, and a constant rise in a man’s PSA level over time may also be a sign of prostate cancer.

However, elevated PSA levels don’t always mean there are prostate problems. PSA levels can fluctuate throughout the month and a urologist will want to perform another PSA test about four to six weeks after the first test to confirm the initial finding. If PSA is elevated after the second test, a urologist may do tests such as: 

  • A digital rectal exam (DRE) to check for structural abnormalities in the prostate
  • Recommend continuing with PSA tests and DREs at regular intervals to monitor for changes over time 
  • Urine test to check for urinary tract infection (UTI)
  • Imaging tests
  • Perform a prostate biopsy if prostate cancer is suspected

What Are Symptoms of an Elevated PSA?

Prostate problems can cause an elevated PSA, which may result in symptoms such as: 

  • Frequent urge to urinate
  • Frequent nighttime urination
  • Feeling an urgent need to urinate, but being unable to urinate or only urinating a little
  • Dribbling urine
  • Leaking urine
  • Weak urine stream
  • Unusual color or odor to urine
  • Blood in urine or semen
  • Pain or burning urination
  • Painful ejaculation
  • Recurrent pain or stiffness in lower back, hips, pelvic or rectal area, or upper thighs
  • Chronic pain and discomfort in the penis or scrotum, the area between the scrotum and anus, the abdomen, and lower back

What Causes an Elevated PSA?

Causes of an elevated PSA include:

  • Enlarged prostate (benign prostatic hyperplasia, or BPH) -- common in older men
  • Bacterial prostatitis 
    • Acute bacterial prostatitis usually comes on quickly due to a bacterial infection
    • Chronic bacterial prostatitis is recurring infection 
  • Chronic prostatitis (chronic pelvic pain syndrome)
  • Urinary tract infection (UTI)
  • Prostate cancer 
  • Older age
  • Recent ejaculation
  • Certain urologic procedures
    • Prostate biopsy
    • Cystoscopy
  • Certain medicines
    • Male hormones such as testosterone or other medicines that raise testosterone levels 
  • Riding a bicycle (it is thought pressure put on the prostate may cause this to occur, but not all studies confirm this)


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How Is an Elevated PSA Diagnosed?

Prostate-specific antigen (PSA) levels are checked with a blood test. A digital rectal examination (DRE) is often performed at the same time to check for structural abnormalities of the prostate. 

In general:

  • For men in their 40s and 50s
    • A PSA greater than 2.5 ng/ml is considered too high
    • The median PSA for men in this age range is 0.6 to 0.7 ng/ml
  • For men in their 60s
    • A PSA greater than 4.0 ng/ml is considered too high
    • The normal PSA range for men in this age range is between 1.0 and 1.5 ng/ml
  • An abnormal rise
    • A PSA may also be considered abnormal if it rises a certain amount in one year

Other tests to diagnose prostate problems include: 

  • Urine testing
  • Urodynamic tests of the urethra and bladder
  • Cystoscopy
  • Ultrasound of the prostate
  • Biopsy of the prostate if prostate cancer is suspected

What Is the Treatment for Elevated PSA?

Treatment for elevated PSA depends on the prostate problems that caused the PSA levels to rise. 

Treatment for benign prostatic hyperplasia (BPH) includes:

  • Watchful waiting (active surveillance)
    • If symptoms are not bothersome
    • Regular checkups
  • Lifestyle changes 
    • For mild symptoms 
    • Limit drinking liquids before bedtime or before going out
    • Avoid or limit alcohol or caffeine
    • Avoid medications that can affect the bladder, such as certain cold and allergy medicines
    • Change the timing of certain medicines, such as diuretics (water pills) or high blood pressure drugs
  • Medications to help stop prostate growth or shrink the prostate 
  • Alpha-blocker medications to relax prostate and bladder muscles to ease symptoms
  • Radio waves, microwaves, or lasers which use different kinds of heat to reduce extra prostate tissue to treat urinary problems caused by BPH
  • Surgery 
    • To help urine flow
    • To remove the prostate

Treatment for bacterial prostatitis includes:

Treatment for chronic prostatitis includes:

  • Medications 
    • To reduce pain and inflammation
    • Alpha-blockers such as tamsulosin (Flomax) and silodosin (Rapaflo) to relax the muscles in the prostate and part of the bladder
  • Lifestyle changes
    • Warm baths
    • Relaxation exercises
    • Physical therapy 
  • Surgery

Treatment for prostate cancer depends on whether cancer is in part or all of the prostate, if it has spread (metastasized) to other parts of the body, and the age and overall health of the patient and may include one or more of the following:

  • Watchful waiting (active surveillance)
  • Surgery: removal of the whole prostate and some nearby tissue
  • Radiation therapy
  • Hormone therapy
    • Drugs are used to stop the body from making testosterone

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Reviewed on 3/11/2022
Image Source: iStock Images