My APS is high: what does that mean and what should I do?
Updated: 2 days ago
A high PSA level does not necessarily mean you have prostate cancer. Approximately one in four abnormal results actually indicates cancer, according to the Canadian Cancer Society. The others are often explained by an enlarged prostate, inflammation, or simply by the conditions of the blood test. The correct course of action is to repeat the test and then consult a urologist who will determine if an MRI is necessary.
Here's what your result means, what can make it go up, and the steps to take.
What exactly is APS?
PSA (prostate-specific antigen) is a protein produced by the prostate gland. A small amount normally passes into the bloodstream. The PSA test is a simple blood test that measures this amount in nanograms per milliliter (ng/mL).
The PSA test is not a cancer test. It's a prostate test. Anything that irritates, enlarges, or stimulates the prostate can increase the result.
What is a high APS?
There is no magic number. Doctors often use a guideline between 2.5 and 4.0 ng/mL, but this threshold varies depending on your individual situation:
Age : PSA naturally increases with age, as the prostate enlarges.
Prostate volume : a large prostate produces more PSA, without there being cancer.
Changes over time : this is often the most important factor. A stable APS of 4.5 for five years is less worrying than an APS that goes from 1.5 to 3.5 in one year.
That is why a urologist always looks at your result by comparing it to your previous results, if you have any.
Causes of elevated PSA that are not cancer
Several common situations cause an increase in APS, sometimes significantly:
An enlarged prostate (benign prostatic hyperplasia, or BPH). Very common after age 50. It often causes frequent urges to urinate or a weak urine stream. Treatments such as Rezūm steam therapy are available to relieve these symptoms.
Prostatitis or a urinary tract infection. PSA levels may remain elevated for several weeks after the infection.
Ejaculation within 48 hours prior to the blood test.
A long bike ride or any effort that compresses the perineum.
A recent examination or procedure : urinary catheter, cystoscopy, biopsy.
Getting up at night to urinate? It's often a sign of an enlarged prostate. Read our guide: Getting up at night to urinate: is it the prostate and what to do?
Conversely, some prostate medications (finasteride and dutasteride) reduce PSA levels by about half. If you are taking these, tell your doctor: your result should be interpreted differently.
Signs that deserve more attention
Certain factors increase the likelihood that PSA may be masking cancer, and justify further evaluation:
an APS that is rapidly increasing from one year to the next
a father or brother who had prostate cancer
African or Caribbean ancestry
a known genetic mutation, such as BRCA2
an abnormality detected by the doctor during a rectal examination
a low free APS/total APS ratio (an additional test that your doctor may request)
What to do now: the 4 steps
Repeat the test. Wait a few weeks, avoid ejaculation and cycling for 48 hours beforehand, and treat any infection first. A decreasing result is reassuring.
Consult a urologist. They will interpret the APS based on your age, risk, and progress, perform an examination, and may request a free APS.
If doubt persists, undergo a prostate MRI. Multiparametric MRI identifies suspicious areas and assigns them a score from 1 to 5 (PI-RADS). A reassuring score often makes a biopsy unnecessary.
Perform a targeted biopsy, if necessary. If the MRI shows a suspicious area, the MRI-ultrasound fusion biopsy precisely targets that area. It can be performed through the perineum, which significantly reduces the risk of infection.
Should we be worried?
A high PSA level warrants monitoring, not panic. Prostate cancer is the most common cancer in men in Canada: approximately 1 in 9 men will develop it in their lifetime, and an estimated 30,400 new diagnoses are expected in 2025. However, many of these cancers are slow-growing.
Detected early, while still confined to the prostate, it responds very well to treatment. Many men don't even need treatment: they are simply monitored (active surveillance). Others may receive targeted treatment, such as NanoKnife focal therapy , which treats only the affected area without removing the prostate.
Frequently Asked Questions
Is an APS of 4 serious?
Not necessarily. A PSA level of 4 ng/mL is at the upper limit of commonly used reference ranges. In a 70-year-old man with an enlarged prostate, it's often normal. In a 50-year-old man whose PSA was 1.5 last year, it needs to be evaluated. The urologist interprets the figure based on age, prostate volume, and any changes over time.
How long should I wait before repeating the APS test?
It is generally recommended to wait a few weeks, and up to six to eight weeks after a urinary tract infection or prostatitis. Avoid ejaculation and cycling for 48 hours before the blood test. Have the test done at the same laboratory if possible, to ensure comparable results.
Can a urinary tract infection cause PSA levels to rise?
Yes. A urinary tract infection or prostatitis can cause PSA levels to rise significantly, sometimes above 10 ng/mL. The level usually returns to normal within weeks of treatment. This is why the test is repeated after recovery before proceeding with further investigations.
Do I need to have a biopsy if my PSA level is high?
Not automatically. Today, an MRI of the prostate is performed first. If it shows no suspicious areas and your risk is low, a biopsy can often be avoided. If the MRI shows a suspicious area, a targeted biopsy using MRI-ultrasound fusion can confirm or rule out the diagnosis.
Consult a urologist
Have you received a high or rising PSA result? Make an appointment at the Sioufi Urology Clinic. Bring your PSA results from recent years: the trend often tells you more than the latest number.
Also read: NanoKnife or surgery: how to choose after a prostate cancer diagnosis
Request a second opinion at the Sioufi Urology Clinic Have you been diagnosed with prostate cancer and would like a complete and independent review of your case before committing to treatment? Book an appointment with Dr. Sioufi — no referral, no waiting list, in Montreal or Châteauguay. Montreal (Westmount) | Châteauguay | sioufiurologie.com/nous-joindre |
