So you have an elevated PSA? What does it mean? What should you do?

What is PSA?

PSA, or prostate-specific antigen, is a protein that is naturally produced by both benign and malignant prostate tissue.

PSA screening is a simple routine blood test that helps identify men who are at risk of having clinically significant prostate cancer.

Normal PSA levels should typically be less than 3.5. 

What causes an elevated PSA?

An elevated PSA means your PSA blood test results are higher than 3.5. So if your PSA is over 3.5, it’s important to undergo an evaluation to determine why it’s elevated PSA – whether it’s from benign causes or prostate cancer.

An elevated PSA can be caused by prostate cancer, but can also be due to a variety of non-cancerous factors as well. These include benign prostate enlargement (BPH), urinary tract infection or prostate infection (prostatitis), and urinary retention. Certain activities can also cause a temporary mild increase in PSA levels, such as having intercourse and riding a bicycle.

How do we evaluate men with an elevated PSA? Prostate MRI and MRI-guided 3-D Targeted (or “Fusion”) Biopsy have revolutionized the evaluation for men with an elevated PSA.

The increased awareness of prostate cancer as well as the understanding of the importance of early prostate cancer detection has caused a surge in the rate of screenings performed each year. This combined with the use of sensitive screening tests have led to an increase in the detection of prostate cancer at an early stage, when it is most curable.


Is a biopsy needed if my PSA is elevated?

It depends. It is important that benign conditions that can cause an elevated PSA are ruled out first. Beyond that, there are some other tests and innovative biomarker tools available that may help determine if a biopsy is indicated.

What are Biomarkers?

Biomarkers are blood tests that analyze levels of certain proteins in the bloodstream that are markers, or indicators, of prostate cancer. These tests, including the phi test, 4K score test, and PCA-3, analyze specific serum proteins including various fractions of PSA and prostate-derived kallikreins to better risk-stratify patients who need further testing.

What is MRI/Ultrasound 3-D Fusion Biopsy?

If an abnormality is detected on the MRI, we can now obtain a targeted biopsy of the suspicious region(s) with an MRI/Ultrasound 3-D Fusion Biopsy. This combines the tremendous anatomic detail of multi-parametric MRI with real-time ultrasound, allowing precise, image-driven prostate biopsies.

Standard TRUS Biopsy vs. MRI/Ultrasound 3-D Fusion Biopsy

A standard transrectal ultrasound (TRUS)-guided prostate biopsy is performed with ultrasound guidance.

The biggest challenge with a standard prostate biopsy is its inherent limited ability to detect cancer. The prostate is visualized on the ultrasound monitor, and needle core biopsies are obtained. Although the prostate is clearly seen via ultrasound, we are typically unable to actually identify any areas that might be suspicious for prostate cancer.

It’s therefore a “blind” or “random” biopsy, in which the urologist attempts to sample as much of the prostate as possible, hoping to hit the cancer if there is any.

Studies have shown that this standard technique misses 30-50% of cancers. A patient can have a clinically significant cancer that is completely missed on a traditional biopsy.

How is an MRI/Ultrasound 3-D Fusion Biopsy Performed?

A 3-D MRI fusion biopsy is performed with the patient lying on his left side, typically sedated. The urologist performs a transrectal ultrasound of the prostate.

The fusion software creates a 3-D model of the prostate and aligns it with the MRI images obtained previously.

The area of abnormality seen on the MRI can now be clearly identified on real-time ultrasound imaging, allowing a focused, image-driven targeted biopsy.

Who is a Good Candidate for an MRI/Ultrasound 3-D Fusion Biopsy?

Any man with an elevated PSA or a current diagnosis of prostate cancer may undergo a prostate MRI.  MRI/Ultrasound 3-D Fusion Biopsy is ideal for men with an abnormality identified on prostate MRI, providing very precise tissue sampling.

What are the Benefits of an MRI/Ultrasound 3-D Fusion Biopsy?

Where standard transrectal ultrasound (TRUS)-guided prostate biopsies have failed, the new MRI/Ultrasound 3-D Fusion Biopsy system succeeds. The benefits of fusion biopsies include:

  • The identification of prostate cancers that were often missed by traditional biopsy techniques
  • Ability to avoid unnecessary biopsies of normal areas of the prostate
  • Enhanced visualization of tumors, detailing both the exact size and location
  • Targeted biopsies with improved sampling
  • 3-D mapping of the prostate and any tumors
  • More individualized cancer treatment planning, including consideration for possible focal therapy
  • Accurate follow-up of men with prostate cancer on active surveillance

Sarasota Prostate Care offers the most advanced prostate cancer screening available. Utilizing MRI/Ultrasound 3-D Fusion Biopsy, we are able to precisely target suspected prostate tumors with minimal risk of side effects and no associated pain. and 3-D MRI-Guided Targeted Biopsy