Urology · University Urology, PC · Knoxville, TN
Elevated PSA
An elevated PSA result can be concerning, but it does not automatically mean cancer. Understanding what your PSA means — and what to do next — is what a urologic evaluation is for.
What Is PSA?
Understanding Your PSA Result
PSA (prostate-specific antigen) is a protein produced by prostate cells. It is measured with a simple blood test and used as a screening tool for prostate cancer. However, PSA is not cancer-specific — it can be elevated for many reasons.
What raises PSA besides cancer?
Enlarged prostate (BPH), prostatitis (prostate infection or inflammation), recent ejaculation, prostate procedures, urinary tract infection, and vigorous bicycle riding can all elevate PSA without cancer being present.
What PSA level is concerning?
There is no universal threshold. PSA must be interpreted in context: age, prostate size, PSA velocity (rate of rise), PSA density, and prior PSA history all matter. A urologist interprets PSA in full clinical context, not in isolation.
An elevated PSA does not mean you have prostate cancer
Only about 25% of men referred for biopsy due to elevated PSA are found to have prostate cancer. The goal of evaluation is to determine whether biopsy is necessary — and if so, what kind. Many men with elevated PSA are monitored without biopsy.
Evaluation
What Happens After an Elevated PSA
Urologic consultation
Your urologist reviews your PSA history, performs a digital rectal exam, and assesses your risk factors. Many men need no further workup beyond monitoring.
Reflex testing
Additional blood tests such as free PSA percentage, PSA density, 4Kscore, or PHI (Prostate Health Index) can help determine whether biopsy is warranted — often avoiding unnecessary procedures.
Prostate MRI
Multiparametric MRI of the prostate identifies suspicious regions and guides targeted biopsy. At University Urology, MRI findings directly inform biopsy planning — improving accuracy and reducing unnecessary sampling.
Prostate biopsy (if indicated)
If biopsy is recommended, we offer both transperineal and transrectal approaches. Transperineal biopsy has a significantly lower infection risk and is our preferred approach for most patients.
If cancer is found
Our fellowship-trained urologic oncologists provide a full range of treatment options including active surveillance, robotic prostatectomy, focal therapy (HIFU/NanoKnife), and coordination with radiation oncology.
Our Specialists
Prostate Cancer Specialists at University Urology
Our fellowship-trained urologic oncologists manage elevated PSA and prostate cancer from initial evaluation through treatment and surveillance.
Urologic Oncology · Focal Therapy
Dr. James M. Bienvenu
HIFU, NanoKnife, robotic prostatectomy, MRI-guided biopsy
Urologic Oncology · Department Chair
Dr. Wesley M. White
Robotic prostatectomy, advanced prostate cancer, clinical trials
Robotic Surgery
Dr. Jonathan W. Angelle
Robotic prostatectomy, prostate cancer surgery
Common Questions
Frequently Asked Questions
My PSA went from 2 to 4 in one year. Is that bad?
PSA velocity — the rate of rise over time — is an important factor. A rise of more than 0.75 ng/mL per year is generally considered significant. Your urologist will review your full PSA history to put this in context.
Do I need a biopsy?
Not necessarily. Many men with elevated PSA are managed with additional blood tests, repeat PSA monitoring, and prostate MRI before any biopsy decision is made. The goal is to biopsy only when there is sufficient reason — and to do it accurately when it is needed.
What is the difference between transperineal and transrectal biopsy?
Transperineal biopsy accesses the prostate through the perineal skin rather than the rectum, which carries a lower infection risk. Transrectal biopsy is performed through the rectal wall and is also a well-established approach. University Urology performs both. Your surgeon will recommend the approach that is most appropriate for your situation. See preparation instructions for transperineal biopsy or transrectal biopsy.
What is focal therapy and am I a candidate?
Focal therapy (HIFU or NanoKnife) treats only the tumor within the prostate, preserving surrounding tissue and reducing side effects compared to whole-gland treatment. University Urology is the only program in East Tennessee offering both modalities. See our focal therapy page for candidacy criteria.
Elevated PSA? Get a Specialist Evaluation.
Our urologic oncologists interpret PSA in full clinical context and build a personalized plan — not a one-size-fits-all response.