A man in his late fifties sat across from me last spring, holding a printout from a health fair. His PSA was "high," the paper said, and he'd spent two sleepless nights convinced he had cancer. He didn't. But that number had hijacked his week, and no one had taken the time to explain what it actually meant.
That conversation happens more often than you'd think. So let's slow down and talk about PSA testing the way I'd explain it to you in my office here in Los Angeles — what it measures, what it doesn't, and how to think clearly about the result.
What is PSA testing and what does it measure?
PSA testing is a simple blood draw that measures prostate-specific antigen, a protein made by the prostate gland. It's one tool I use to screen for prostate cancer and to monitor prostate health over time.
Here's the part the health-fair printout left out. PSA is made by normal prostate tissue, not just cancerous tissue. So the number can rise for plenty of harmless reasons.
An enlarged prostate, a recent infection, vigorous cycling, even ejaculation in the day or two before the test can nudge it up. A "high" PSA is a signal to look closer — not a diagnosis.
Who should get a PSA test, and when?
Most men should start the conversation about PSA testing somewhere between ages 50 and 55, though I move that earlier — often to 40 or 45 — for men with a higher risk. That includes Black men and anyone with a father or brother who had prostate cancer.
I say "conversation" on purpose. The decision to test isn't automatic. It depends on your age, your family history, your overall health, and honestly, how you feel about chasing down a borderline result. Some men want every data point. Others would rather not start down a path of repeat tests and biopsies for something that may never have caused harm.
There's no single right answer. There's a right answer for you, and that's the kind of thing I'd rather sort out together than hand you on a brochure. It fits naturally into a comprehensive physical exam, where we can weigh it against everything else going on with your body.
How do I know if my PSA result is dangerous?
A single elevated PSA is rarely dangerous on its own — what matters more is the trend over time and the full picture. One number out of context tells me very little.
What I pay attention to:
- Whether your PSA is climbing test over test, or just sitting at a stable, slightly-higher baseline
- Your age and the size of your prostate
- Anything recent that could have falsely raised it — a urinary infection, a long bike ride, a recent catheter
If something looks off, the next steps are measured, not dramatic. Often that means simply repeating the test in a few weeks after ruling out an infection. Sometimes it means a referral to a urologist for further evaluation, which I help arrange and follow through on so you're never left to figure it out alone.
What if my PSA comes back normal?
A normal PSA is reassuring, but it isn't a lifetime guarantee, which is why we keep an eye on it over the years. Prostate cancer can occasionally be present even with a normal number, and PSA can drift up slowly with age. That's the whole point of tracking it across visits rather than treating any one result as final.
I think of PSA the way I think about cholesterol testing — one thread in a larger pattern of preventive care. Prostate health doesn't live in isolation. It sits alongside your blood pressure, your weight, your sleep, and the rest of the picture we build together over time.
The honest takeaway on PSA testing
PSA testing is genuinely useful when it's used thoughtfully and interpreted with context. It has caught cancers early enough to treat. It has also sent men into needless worry over numbers that turned out to mean nothing.
The difference is almost always the conversation around the test — someone who knows your history, can explain the result in plain language, and won't rush you toward a biopsy you may not need. That's the part I care about most.
If you're wondering whether PSA testing is right for you, or you've gotten a result that left you uneasy, I'd genuinely like to hear from you. Reach out to my office and we'll talk it through, no printout required.