A man in his late fifties sat across from me last month, holding a printout he'd found online. His PSA had come back "slightly elevated," and by the time he reached my office he was certain he had cancer. He didn't. But that worry — the leap from one number to a diagnosis — is one I see all the time.
So let's slow it down. PSA testing is one of the most common, and most misunderstood, tools we use to keep an eye on prostate health. Done thoughtfully, it can catch a problem early. Done without context, it can send a perfectly healthy man down a rabbit hole of anxiety and unnecessary procedures. In my practice here in Los Angeles, I spend as much time explaining what a result doesn't mean as what it does.
What is a PSA test, and what does it actually measure?
PSA stands for prostate-specific antigen, a protein made by the prostate gland that shows up in your blood. A simple blood draw measures it. That's it — no scan, no needle in an uncomfortable place, just a vial of blood like any other panel.
Here's the catch. A higher number can mean prostate cancer, but it can also mean a lot of harmless things: an enlarged prostate (very common as men age), a recent infection, vigorous exercise, or even a recent bike ride. The test tells us the prostate is doing something. It doesn't tell us what. That's our job to sort out together. You can read more about how I order and interpret it on my PSA testing page.
When should I start getting PSA tests?
For most men, the conversation starts somewhere around age 50 — earlier if you have a family history of prostate cancer or you're Black, since both raise the risk. There's no single right answer that fits every man, which is exactly why I treat this as a discussion, not a checkbox.
Some men want every screening available. Others, knowing the trade-offs, decide to skip it. Both can be reasonable. What matters is that you understand the upside (catching aggressive cancer early) and the downside (chasing slow-growing changes that may never have caused harm). I'd rather you make an informed choice than an automatic one.
My PSA is high — does that mean I have cancer?
No, an elevated PSA does not mean you have cancer — most men with a high reading turn out not to. I can't say that strongly enough, because the fear is real and usually out of proportion to the odds.
When a number comes back higher than expected, I don't panic and I ask you not to either. Often the next step is simply repeating the test, since a single value can be thrown off by timing or a recent infection. We also look at the trend over time, which tells me far more than any one snapshot. A few things can nudge a result upward:
- An enlarged prostate (benign prostatic hyperplasia)
- A urinary tract infection or prostate inflammation
- Recent ejaculation, cycling, or a long flight
If the pattern genuinely concerns me, that's when I bring in a urologist.
How does specialist referral work if I need one?
If your numbers warrant a closer look, I coordinate a referral to a trusted urologist — often through my colleagues including Cedars-Sinai — and I stay in the loop the whole way. You're not handed a phone number and left to fend for yourself. I help you understand what the specialist recommends, whether that's continued monitoring, imaging, or a biopsy, and we decide on the next move together. That kind of specialist referral and coordination is one of the real advantages of having a primary care doctor who actually knows you.
How prostate health fits into the bigger picture
Your prostate doesn't exist in isolation, and neither does the rest of you. The same visits where we check PSA are the ones where I'm watching your blood pressure, your cholesterol, and your overall risk. Prostate screening lives alongside other age-appropriate checks — it's a close cousin of colon cancer screening, another quiet test that catches problems before symptoms ever show up.
I often tell patients that good prostate care is mostly unglamorous: show up, get the blood drawn, talk through the result, repeat. The men who do best aren't the ones who worry the most. They're the ones who keep a steady, boring rhythm of checkups and let me handle the interpretation.
If you're a man over 50, or younger with a family history, and you're not sure where you stand, I'd genuinely like to talk it through with you. Bring your questions, even the ones that feel silly. You can reach out here and we'll figure out the right approach together — at a pace that feels right for you.