Private raised psa clinic in London, same-day urology.

What else raises PSA

• Benign prostate enlargement — the commonest reason by far, and simply part of ageing
• Urine infection or prostatitis — can raise it substantially for weeks
• Ejaculation within 48 hours
• Vigorous exercise, particularly cycling, within 48 hours
• Catheterisation, cystoscopy or a recent prostate examination
• Constipation, and anal intercourse

Because of this, a single raised result is usually repeated after several weeks, avoiding those triggers, before anything else is decided. A great many raised results settle on retesting.

The numbers

These are referral thresholds, not diagnostic lines. What often matters more is the trend over time, the free-to-total ratio, and PSA density — the level relative to prostate size on scanning. A man with a large prostate and a PSA of 6 may be at lower risk than one with a small prostate and a PSA of 4.

If a biopsy is needed

• It is usually done through the perineum (transperineal), which carries a much lower infection risk than the older route through the rectum.
• Blood in the urine and semen afterwards is common and can last weeks. Semen may look rust-coloured for a month or two.
• Results are given as a Gleason score or grade group, describing how aggressive the cells look.
• A negative biopsy does not always end the matter; PSA monitoring usually continues.

If cancer is found

Prostate cancer covers a very wide range, from disease that will never cause harm to disease needing prompt treatment. Many men with low-risk cancer are offered active surveillance — regular PSA, examination and scans, with treatment only if things change. This is not being denied treatment; it is avoiding the side effects of treatment for a cancer that may never need it.

Where treatment is indicated, options include surgery, radiotherapy and hormone treatment, each with different side-effect profiles around continence and erectile function. These are worth discussing in detail rather than deciding quickly.