How to interprete your results

PSA or Prostate specific antigen is a protein in your prostate and semen. It goes up in three situations, either you have a urinary infection or inflammation, you have an enlarged prostate, or you may have prostate cancer (usually at a very early stage).

The PSA level relates to your current or future risk of prostate cancer. A PSA of <1 in a man aged 50-59, means your risk of prostate cancer now is very low, and in the future remains low, so re-testing in 5 years is reasonable, with a very low risk of missing any prostate cancer in the interim. If you are aged 60-69 years with a PSA <1, your risk of prostate cancer in your lifetime is extremely low, and no further screening is needed.

The PSA level relates to your current or future risk of prostate cancer. A PSA of >1 and <3 in a man aged 50-59, means your risk of prostate cancer now is low, but might increase over time, so re-testing in 2 to 4 years is reasonable, with a very low risk of missing any prostate cancer in the interim. If you are aged 60-69 years with a PSA >1 and <3, your risk of prostate cancer in your lifetime is low, but might increase over time, so re-testing in 2 to 4 years is reasonable.

When the PSA is above 3, it is important to assess for the possibility of prostate cancer present in men aged 50 to 69, as studies show that identification and treating prostate cancer at an early stage in this age group, does reduce prostate cancer mortality.

MRI is a safe (no radiation) scan that can visualise the prostate and can identify prostate cancer if present in 85 to 90% of the time when it is present. So, it rarely misses any prostate cancer. A normal scan can be reassuring for many men. If a cancer is present, it can usually be identified and then a biopsy later can be targeted to the abnormality. However, MRI scans can also pick up lesions that look like cancer but are not, so some men have biopsies that do not show cancer. However, it is currently the best scan we have to detect prostate cancer and can show signs of early spread as well as other helpful findings.

The chances are low. Most men with a high PSA do not have prostate cancer. Elevated PSA levels are most commonly due to an enlarged prostate or an inflammatory condition, prostatitis.

MRI scans are used to identify and assess lesions (possible cancers) in the prostate. There are 3 assessments (or sequences) performed to assess the prostate, T1 weighted, T2 weighted and Diffusion weighted (DWI). Whereas T1 and T2 images locate an abnormality, the DWI images allow us to grade the lesion as to the risk that it harbours, what is called, clinically significant prostate cancer (cancer that is likely to be a threat to your health in the future).

The system used to grade the lesions is called PIRADS and the lesions are graded 1 through to 5. The risk of clinically significant prostate cancer is PIRADS 1 or 2 (<10%), PIRADS 3 (30%), PIRADS 4 (50%), PIRADS 5 (80%). Biopsies are usually performed in PIRADS 4 and PIRADS 5 lesions, and can be considered in PIRADS 3 lesions, particularly if the PSA is too high for the gland size (called the PSA density).