[Smart Doctor] A high PSA level in a health check-up doesn't always mean cancer! The order of steps is important! | PSA Prostate-Specific Antigen

Q. What is PSA?

A. PSA stands for ‘Prostate-Specific Antigen’, which is a protein specifically produced in the prostate gland.

It measures the amount of this protein in a drop of blood. If the level is 3 ng/mL or higher, a more detailed examination is usually recommended.

Many people worry excessively if their PSA exceeds 3, but PSA levels can rise for various reasons other than cancer.

Q. What causes PSA to rise?

A. International guidelines officially recognize three main causes for elevated PSA:

First, benign prostatic hyperplasia (BPH); second, prostatitis or urinary tract infections; and third, instrumental manipulation such as biopsy, cystoscopy, or catheter insertion.

Ejaculation within 48 hours is also a factor, though guidelines vary slightly on its impact.

Q. What should I do if my PSA is over 3 in a check-up?

A. The first step is to retest by drawing blood again in 2-4 weeks, under three specific conditions:

First, avoid ejaculation within 48 hours. Second, if you had a urinary tract infection, retest after treatment is complete.

Third, if you recently underwent instrumental procedures like cystoscopy, catheter insertion, or prostate biopsy, it's best to allow sufficient time before retesting.

In fact, simply retesting can bring about 25% of PSA levels in the 4-10 range back to normal.

Q. What if my PSA is still high after retesting, even after following all three conditions?

A. In the past, a biopsy would be performed immediately. However, recent international guidelines have changed.

Now, the new standard is to undergo a prostate MRI before a biopsy.

The MRI assigns a PI-RADS score to suspicious areas, ranging from 1 to 5 points.

If the score is 3 or higher, a targeted biopsy is performed on that specific area. This is done in conjunction with a traditional biopsy method, including areas identified by MRI.

Since MRI interpretation has limitations and some cancers may not be visible on imaging, combining both methods is considered the most standard international approach.

Q. Is prostate MRI available in local areas?

A. Prostate MRI is a routine examination performed in the Urology departments of tertiary hospitals.

At Gangneung Asan Hospital, urology and radiology specialists jointly interpret the results to determine the necessity of a biopsy.

This is a common concern, but residents in the Yeongdong region do not need to travel to Seoul for an MRI scan.

Please remember these three points!

First, a single high PSA level does not immediately mean prostate cancer.

Second, retest your PSA in 2-4 weeks, adhering to the specified conditions.

Third, if the retest is still high, start with an MRI, and then, if necessary, proceed with a detailed examination including a targeted biopsy.

Do not worry by searching the internet alone; consult a specialist at a nearby urology clinic.

By following these steps in order, you can reduce unnecessary worries and unnecessary tests.

Frequently Asked Questions

If my PSA level is 3 or higher in a health check-up, does that automatically mean I have prostate cancer?

No, it does not. PSA (Prostate-Specific Antigen) levels can be elevated for various reasons other than prostate cancer, such as benign prostatic hyperplasia, prostatitis, urinary tract infections, or even instrumental manipulation like a bladder endoscopy. Therefore, you don't need to immediately worry about cancer just because the level is high.

What is the first thing I should do if my PSA level is high?

The first thing you should do is to get re-tested with another blood draw 2-4 weeks later. Before the re-test, avoid ejaculation within 48 hours, complete treatment if you have a urinary tract infection, and allow sufficient time if you've had any instrumental procedures. In fact, about 25% of re-tests show normal PSA levels.

If my PSA level remains high after a re-test, do I immediately undergo a biopsy?

No, you do not. According to recent international guidelines, it is standard to undergo a prostate MRI first before a biopsy. The MRI scores suspicious areas, and if a score of 3 or higher is found, a targeted biopsy of that area is performed in conjunction with the traditional biopsy method.

Is prostate MRI only available at large hospitals in Seoul?

No, it is not. Prostate MRI is a routine examination performed in urology departments at tertiary hospitals. Regional tertiary hospitals like Gangneung Asan Hospital also have urology and radiology specialists who interpret the results together, so you don't necessarily need to go to Seoul for accurate examination and diagnosis.