• So if your PSA comes high (more than four) the first thing is you should repeat the PSA in another more reliable lab.
  • If in the repeat PSA test report comes normal, then you don’t have to worry about the high PSA previously and you should just follow up by PSA every year.
• Now, if you do a repeat PSA and it again comes high, the first test is that you have to rule out urine infection.
  So, you should do a urine routine and a urine culture and make sure there is no infection.
• If infection comes in the urine test and your PSA is high, then treat UTI with antibiotics and then repeat the PSA after one month.
• so after 1month , three things can happen :
  • You have a high PSA and you have urine infection and you treat the infection and the PSA comes normal. In this case, you don’t have to do anything except further just do a repeat PSA every year.
  • Then another scenario is that the PSA is high and you do a urine test and there is no infection in the urine, in that case you have to do further testing because this could be a sign of prostate cancer!
  • the third scenario is you have treated the urine infection and you do a repeat PSA test and still the PSA is high it has come down from the previous value but still it is high in this case again you have to do further testing to make sure there is no prostate cancer.
• So now, if you are suspecting that the PSA is high and there is no infection and it could be prostate cancer the next important tests is digital rectal examination ( DRE) that is examination by experienced urologist and a prostate MRI.
  • DRE will make us feel if there are any abnormal nodules in the prostate which indicate prostate cancer and,
  • The MRI will show some abnormal areas in the prostate as well as it will tell us about the seminal vesicles about the lymph nodes and the bone of the pelvis. So, it will give us the full picture of the whole pelvis.
• The next important test is the prostate biopsy:
  • The prostate biopsy is done by putting a ultrasound probe in the rectum and we take 12 small pieces from the whole prostate and send it for testing. This test will tell us if there is cancer or not. It is a simple test, done as outpatient and patient can go home the same day. The biopsy reports come in 3-5 days.
• Now if after the prostate biopsy, report shows that there is no cancer congratulations!! 
• But you should stay in close contact with your urologist and repeat your PSA every six months to one year to make sure that the PSA is not rising and if the PSA is rising, you might need to do another biopsy.
• If the biopsy confirms that there is prostate cancer, Then we have to do further testing to Stage the cancer.
• The first test is a PSMA PET CT scan.
  • In the PSMA pet CT scan, we are able to do the exact staging of the prostate.
    We will know if the cancer is localized to the prostate or is the cancer going beyond the prostate- into the lymph nodes or into the seminal vesicles or into the bones or into the other organs.
    So we know the exact staging of the cancer.
• Now if the cancer on PET CT is localized or locally Advanced Prostate Cancer, but it is not metastatic, that means it is not going beyond the pelvis, so in this case the best treatment is robotic radical prostatectomy with pelvic lymph node dissection.
  • This is an advanced treatment, in which, by small holes and 3DHD magnified Vision we’re able to remove the whole prostate, seminal vesicles, lymph nodes
  • There is rapid recovery and minimal blood loss and
  • The patient is cancer free because the whole prostate is removed out to the body

So friends I hope you understood in this article, what to do if your PSA test value is high.

If you are also suffering from high PSA or you are wondering about the prostate biopsy or you want to know the prostate cancer treatment, you can contact me on email urodoc2011@gmail.com or WhatsApp number +919999059016