Elevated PSA

Prostate-specific antigen (PSA) is a protein secreted by the prostate gland. A number of conditions, including prostate cancer, can cause a PSA level to rise. Our urologists are experts in the PSA blood test as a screening tool for prostate cancer and will discuss if the PSA test is right for you. 

What is considered an elevated PSA level? 

There is no “normal” PSA level. In the past, urologists considered 4 ng/mL or greater as elevated. However, our doctors consider additional factors, such as your age, family history, previous PSA levels and other health conditions. 
An elevated PSA does not mean you have prostate cancer. Other conditions that can cause a rise in PSA include: 

  • Infection or inflammation of the prostate gland, known as prostatitis
  • Enlarged prostate, also known as benign prostatic hyperplasia (BPH)
  • Recent urinary catheter placement
  • Urinary tract infection 

 You may be at increased risk for prostate cancer if you: 

  • Are between the ages of 55 - 70
  • Have a family history of prostate cancer
  • Are of African American descent 

Our urologists specialize in diagnosing and treating men who have an elevated level of prostate-specific antigen (PSA). A blood test to measure your PSA level is one way to diagnose prostate cancer. However, a rise in PSA level doesn’t mean you have prostate cancer. Other conditions that cause a rise in PSA are:
  • Infection or inflammation of the prostate called prostatitis
  • Enlarged prostate, also known as BPH (benign prostatic hyperplasia)


Men who are experiencing prostate problems typically have elevated levels of PSA, along with other symptoms, including:

  • Frequent or urgent urination
  • Difficulty getting a urine stream going
  • Feeling as though you are unable to empty your bladder completely
  • Pain when urinating or ejaculating
  • Fever and chills
  • Pelvic pain
  • Cloudy urine


The right diagnosis by an expert is important if your PSA level is elevated or you have any of the above symptoms. Our goal is to provide an accurate diagnosis as quickly as possible.

Your urologist may recommend one or more of the following tests:

  • Additional PSA tests
  • Digital rectal exam (DRE) 
  • Urine test
  • Imaging such as x-rays or transrectal ultrasound
  • Cystoscopy to look inside the urethra and bladder

UroNav System

If your urologist suspects you have prostate cancer, we offer the most advanced biopsy technology called fusion biopsy. Fusion biopsy uses imaging with both MRI and ultrasound to safely obtain tissue samples. 

Our urologists are experts in the UroNav system. We are one of only two centers in New Jersey with this state-of-the-art technology. This technology helps our urologists to determine the type and stage of prostate cancer and pursue the best possible treatments for you.

Advanced Testing

The PSA test alone cannot be used to diagnose prostate cancer. If your PSA level is elevated, we may recommend one or more of the following tests.

  • Biomarkers – Advanced blood tests including the Prostate Health Index (PHI) and the 4Kscore can identify markers for prostate cancer.
  • Advanced Imaging – As imaging technology for prostate cancer detection has improved, our urologists have stayed at the forefront of the field. Imaging such as 3-Tesla MRI creates 3D images of the prostate to identify suspicious areas.
  • Other Tests – Your urologist also may perform a physical examination. Additional blood and urine tests may be used to diagnose prostate cancer or rule out other urology conditions.

Prostate Biopsy

If your doctor recommends a prostate biopsy, we offer the latest imaging technology and the most targeted approaches.

  • Ultrasound-Guided Biopsy – Ultrasound-guided biopsies are performed under local anesthesia in a doctor’s office. The physician will insert an ultrasound probe into the rectum to visualize the prostate. The biopsy will be taken in one of two ways:
  • Transrectal Ultrasound-Guided Biopsy – The biopsy needle is inserted through the rectum.
  • Transperineal Ultrasound-Guided Biopsy – The biopsy needle is inserted through the perineum, or skin between the scrotum and anus.
  • MRI-Targeted Biopsy – You undergo an MRI of your prostate to identify specific areas for the urologist to target for biopsy. Our urologists are experts in using MRI-targeted biopsy to accurately determine the type and stage of prostate cancer. In the last decade, we have performed more than 1,500 MRI-targeted biopsies and have published and presented our outcomes at national conferences.

Leaders in Prostate Cancer Treatment

If the diagnosis is prostate cancer, you’ll find expert care from the team at the John Theurer Cancer Center at Hackensack University Medical Center. Our specialists provide you with the most advanced, proven, and effective treatment with the fewest possible side effects. Learn more about prostate cancer care at John Theurer Cancer Center 

Your doctor will determine the severity of your enlarged prostate or BPH (benign prostatic hyperplasia) and impact of your quality of life when developing a personalized treatment plan. If surgery is recommended, our urologists are skilled in the latest minimally invasive procedures. Treatment options include:

  • Medication: Your doctor may prescribe medications that relieve symptoms or reduce the size of your prostate.
  • Prostate artery embolization (PAE): We are pioneers in this interventional radiology procedure that reduces blood flow to the prostate to shrink it. 
  • Transurethral incision of the prostate (TUIP): Using state-of-the-art robotic technology, small incisions are made in your prostate to relieve pressure on your urethra.
  • Laser treatment: Using the GreenLight™ laser therapy system, pulses from a high-powered laser eliminate your overgrown prostate cells.
  • Transurethral needle ablation: A heated needle is used to destroy a portion of your prostate.
  • Prostatectomy: Typically performed only if the prostate is very large or if there are other complications, a prostatectomy is a robotic surgery to completely remove the prostate gland.
  • Urolift®: Urolift is a procedure that uses permanent implants to hold enlarged prostate tissue out of the way so it no longer blocks the urethra.

Prostatitis is usually caused by a bacterial infection. Your doctor may prescribe antibiotics to treat the condition.

Why Choose Hackensack Meridian Health for Urology Care


Hackensack University Medical Center has been ranked the #1 Urology Department in New Jersey for eight years in a row by U.S. News & World Report and is the only urology department in New Jersey that is nationally ranked.


Our urologists present their clinical research at national conferences and have published over a dozen original studies in peer reviewed journals in a variety of subspecialties.

Patient Experience

We specialize in a range of urologic disciplines including urologic oncology, infertility, stone disease, sexual dysfunction, female urology and pediatric urology.

Urology Singleport
Our Doctors

Our award-winning team of renowned surgeons, physicians, researchers and other health care specialists are able to provide exceptional urological expertise, advancements and cutting-edge technology to develop a highly-personalized plan for each and every one of our patients.


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If you are between the ages of 55 and 70 or have a family history of prostate cancer, you should have your PSA tested or discuss with a urologist the risks and benefits of yearly screening.

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