Raised PSA
What a raised PSA result means, and what happens next — assessment by a specialist urologist in Johannesburg.
A raised PSA is not a diagnosis
If a blood test has come back with a raised PSA, the first thing to know is this: a raised PSA does not mean you have prostate cancer. PSA (prostate-specific antigen) is made by all prostate tissue — normal, enlarged and cancerous — and many things can push it up:
- Benign prostate enlargement (BPH) — the most common reason
- Urinary or prostate infection
- Recent ejaculation or vigorous cycling before the test
- A recent catheter, cystoscopy or prostate procedure
- Prostate cancer
What happens next
The worst response to a raised PSA is to ignore it; the second worst is to panic. The right response is a structured work-up. At your consultation we will repeat and interpret the PSA properly — the trend over time often matters more than a single number — and examine the prostate.
Where indicated, the next step is an MRI scan of the prostate. A biopsy is no longer automatic: modern practice uses MRI to decide who actually needs one, and to target it precisely if so.
MRI, biopsy and staging
Prostate MRI
Where needed, the MRI is done close to home — at Life Wilgeheuwel or Johannesburg Surgical Hospital wherever possible. A normal MRI can sometimes spare you a biopsy altogether.
Targeted, transperineal biopsy
If a biopsy is needed, I do an MRI-guided fusion biopsy: the MRI images are fused with live ultrasound so that suspicious areas can be sampled precisely. The biopsy is taken transperineally — through the skin behind the scrotum rather than through the rectum — which carries a much lower risk of infection. It is done in theatre as a day case, so you are comfortable throughout.
Staging with PSMA PET
If prostate cancer is found and there is a risk that it has spread, a PSMA PET scan — the most sensitive scan currently available for prostate cancer — is done at Theramed at Johannesburg Surgical Hospital. The results guide whether surgery, radiation or another approach is best.
Who should have a PSA test?
Current international guidance supports offering PSA testing from around age 50 — and from around 45 if you have a family history of prostate cancer or are of African descent, as both carry a higher risk. Men with a known inherited risk, such as a BRCA2 gene mutation, may start from around 40. Testing is a personal decision, best made after discussing the benefits and downsides with your doctor.
If prostate cancer is confirmed, treatment is individualised — see Prostate Cancer Treatment for the options, from active surveillance to Da Vinci robotic surgery.
A raised PSA deserves a proper answer, not months of worrying. Call 011 794 3549 or email appointment@urology.joburg.
This information is general in nature and is not a substitute for a consultation.