Understanding Elevated PSA: Age, Prostate Weight & Cancer Risk

An elevated prostate‑specific antigen (PSA) level (e.g., 4.9 ng/mL) does not diagnose prostate cancer. PSA rises with:

• Benign prostatic hyperplasia (BPH)
• Prostatitis (inflammation/infection)
• Recent ejaculation, catheterization, biopsy, or vigorous cycling
• Age (PSA naturally increases)
• Prostate volume (larger glands produce more PSA)

Next Steps:

1. Repeat PSA after avoiding ejaculation/cycling for 48 hours.
2. Digital Rectal Exam (DRE): Assesses symmetry, nodules, consistency.
3. PSA Density: PSA ÷ prostate volume (from TRUS); >0.15 ng/mL² suggests cancer.
4. Multiparametric MRI: Identifies suspicious lesions (PI‑RADS score).
5. Targeted Biopsy: MRI‑fusion or systematic if indicated.

Shared decision‑making with a urologist balances cancer detection against overdiagnosis/overtreatment of indolent disease.