[Smart Doctor] High PSA Levels in Health Checkups Don’t Always Mean Cancer! The Sequence Matters!

Q. What is PSA?

A. PSA stands for ‘Prostate-Specific Antigen,’ a protein specifically produced by the prostate.

It measures the amount present in a drop of blood; if it is 3 ng/mL or higher, a more detailed look is required.

While some people worry immediately when the level exceeds 3, PSA can rise for many reasons other than cancer.

Q. What causes PSA levels to rise?

A. There are three main causes of PSA elevation officially recognized by international guidelines.

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

Additionally, ejaculation within 48 hours is sometimes included, though positions on this vary by guideline.

Q. What should I do if my PSA is over 3 in a checkup?

A. The first step is to retest with a blood draw after 2 to 4 weeks, following three conditions.

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

Third, if there was recent instrumental manipulation like a cystoscopy, catheter insertion, or prostate biopsy, it is best to wait a sufficient amount of time.

In fact, about 25% of cases in the 4–10 range return to the normal range just by retesting.

Q. What if the level is still high after retesting while following all three conditions?

A. In the past, a biopsy was performed immediately. However, international guidelines have recently changed.

The new standard is to perform a prostate MRI before a biopsy.

Using the MRI, a score called PI-RADS is assigned to suspicious areas.

The score ranges from 1 to 5; if it is 3 or higher, a targeted biopsy is performed by aiming specifically at that area.

This is done alongside a conventional biopsy, including the areas identified by the MRI.

Since MRI interpretation has limits and some cancers are not visible on imaging, combining both methods is the most standard international practice.

Q. Is a prostate MRI available locally?

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

At Gangneung Asan Hospital, urologists and radiologists collaborate to interpret the results and determine the need for a biopsy.

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

Please remember these three things!

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

Second, perform a PSA retest after 2 to 4 weeks while following the necessary conditions.

Third, if it remains high upon retesting, proceed with an MRI first, followed by a detailed examination including a targeted biopsy if necessary.

Don’t worry alone while searching the internet; consult a specialist at a nearby urology clinic.

By following the correct sequence, you can reduce both unnecessary worry and unnecessary tests.