What happens after a PSA blood test? Understanding the next steps after a raised PSA test result

A raised PSA result can be worrying – and it often brings an immediate question to mind: what happens next? 

The PSA blood test is the best first test for prostate cancer, but it can’t diagnose the disease on its own. A raised PSA level doesn’t automatically mean you have cancer; it can also be caused by non-cancerous conditions. 

But it can be a sign that further tests, such as MRI scans or biopsies, are needed to build a clearer picture of what’s going on. It’s often the first step in what’s known as the ‘diagnostic pathway’.

That can sound daunting, but knowing what happens next can make it feel more manageable. So we’ve broken down what each stage of the diagnostic pathway involves, and the vital role the PSA test plays.  

The PSA blood test measures the amount of prostate specific antigen (PSA) in your blood.  

PSA is a protein naturally produced by the prostate. It’s normal to have a small amount in your blood, but a raised PSA level could be a sign of prostate cancer or other prostate-related conditions.

What does a raised PSA level mean?

This is one of the most common questions men ask after getting their results. 

The answer isn’t always straightforward. PSA levels vary from man to man, so what’s ‘normal’ for one may not be for another. 

However, as a general guide, most men have a PSA level under 3ng/ml (nanograms per millilitre). If your level is higher than this and you don’t have symptoms of a prostate problem, your GP will likely refer you onto the next step of the pathway. For most men, this means having an MRI scan. 

If you do have symptoms of a prostate problem, your GP will look at your PSA levels alongside other factors before deciding whether you need more tests. One of those factors is age, as there are different thresholds for men at different ages.  

This means that you’d usually only be referred onto the next step of the pathway if your PSA level was higher than the threshold for your age, if there’s been a significant change since your last test, or if the GP has other cause for concern. 

If your PSA level is raised and your doctor thinks further checks are needed, the next step will usually be an MRI scan. 

MRI scans use magnets to create a detailed picture of your prostate and the surrounding tissues.  They help doctors look for anything unusual and decide whether more tests are needed. 

During the scan, you’ll lie on a table that moves into the MRI scanner, which is shaped like a donut or long tunnel. You may be given an injection of dye so the doctor can see images clearer.  

An MRI scan can help doctors decide if you need a biopsy. If the scan doesn’t show anything unusual, you’re unlikely to have prostate cancer that needs to be treated. 

For some, this means you may be able to avoid having a biopsy altogether. Instead, your doctor may recommend regular PSA blood tests to monitor your prostate and check for changes in the future. 

If the MRI does show an area that needs closer inspection, your doctor may recommend a biopsy. The scan images can help doctors decide which parts of the prostate need to be checked more closely.  

A prostate biopsy involves using a thin needle to take small samples of tissue from the prostate. These are then checked for cancer. 

Before the biopsy, you’ll be given an anaesthetic to numb the area. This should stop you feeling any pain. 

There are two main types of biopsy: 

Your doctor will explain which type is most suitable for you.

If cancer is found, your doctor will use your results to understand how quickly it’s likely to grow. This will guide decisions about treatment – and in some cases, whether treatment is needed straight away at all. 

If no cancer is found, your doctor may still monitor you with future PSA tests to keep an eye on any changes.  

And if your doctor still has concerns, they may recommend repeating some of the tests. 

Positron emission tomography (PET) scans are usually used to check if the cancer has come back after the treatment, but may also be used during diagnosis. 

A raised PSA result can be worrying, but it’s important to remember that it’s not a diagnosis of prostate cancer – it's the starting point for further tests and clearer answers. 

The process can feel complex at times. But having a better sense of what your results could mean – and what usually happens next – can help you feel more informed and more in control of what happens next. 

For some men, the diagnostic pathway will involve repeat PSA tests, an MRI scan, and sometimes a biopsy. Each step helps doctors build a clearer picture so you can get the right care and support, at the right time, and move forward with confidence.