A single prostate-specific antigen (PSA) test is not enough to confirm prostate cancer, according to a urologist who spoke with TODAY.com. Dr. Firas Abdollah of Henry Ford Health told the outlet that an elevated reading is only the starting point of a screening process, not a diagnosis in itself.
The PSA test measures the amount of a protein called PSA in the blood, and it is the screening tool most men receive when they and their doctor decide screening is appropriate. An abnormal result is generally one that comes back higher than normal.
Why it matters
Prostate cancer often produces no noticeable symptoms while it is in its early stages, which is why screening carries so much weight. Because the disease can grow quietly, waiting for symptoms to appear can mean losing the window when treatment is most straightforward. At the same time, an abnormal PSA number can have causes that have nothing to do with cancer, so the result has to be interpreted rather than acted on in isolation.
Abdollah's central point, as reported by TODAY.com, is that one test cannot stand alone. He described a PSA reading as a single snapshot of a person's overall health. The number is useful information, he said, but it is not absolute — it functions as an early signal that something in the body may need a closer look.
What a PSA number can and cannot tell you
According to Abdollah, a normal PSA level falls between 3.5 and 4 nanograms per milliliter. People with prostate cancer typically show a level above that range. The American Cancer Society, cited in the TODAY.com report, says that when a PSA reading climbs above 10, the chance of having prostate cancer is about 50%. The report also notes that only about 15% of people with prostate cancer have a PSA below the normal range.
Those figures cut in two directions. A high number raises concern but does not settle the question, and a normal number does not rule cancer out in every case. Abdollah told TODAY.com that in rare instances a person with prostate cancer can have normal PSA levels, while someone else can have an elevated reading for reasons unrelated to cancer. Among the possible non-cancer causes the report lists are a medication the person is taking, a prostate infection, a recent medical procedure, or even a recent bike ride.
That range of explanations is why the test is treated as a clue rather than a verdict. An elevated result tells a doctor that further investigation is warranted; it does not tell the doctor what is actually wrong.
What happens after an abnormal result
When PSA results come back abnormal, the report says patients should expect additional screening. Because prostate cancer tends to be silent and slow-growing, the next step is usually a referral to a urologist for a closer examination.
Abdollah told TODAY.com that these referrals make up most of the patients he sees in his clinic, and that many arrive surprised. He said patients often tell him they feel nothing and believe nothing is wrong. His response, as described to the outlet, is that symptoms are usually a poor guide to prostate cancer, and that many people with the disease have no significant symptoms at all. That absence of warning signs, he said, is precisely why screening with PSA is used to catch problems early.
From there, the path depends on the individual. Abdollah said he sometimes schedules a biopsy, a procedure in which a small sample of the prostate is taken and examined under a microscope for cancer cells. According to the report, a biopsy is more likely when a patient's PSA is especially high.
For other patients, he takes a different approach: another PSA test, typically scheduled for the following year, to track whether the number changes over time. That monitoring period allows a doctor to watch for movement before ordering a biopsy for a cancer that may not be present, may not be spreading, or may not exist at all.
The distinction matters because the two paths carry very different consequences. A biopsy is an invasive step, and the report frames the decision to order one as a judgment call rather than an automatic response to a single number. For patients whose readings are not dramatically elevated, repeat testing over time can supply the context that one test cannot.
The takeaway for patients
The report's practical message is that a PSA result should be read as one data point in a larger picture. An abnormal reading is a reason to continue screening, not a reason to assume a cancer diagnosis. A normal reading, meanwhile, does not eliminate the possibility of disease in every patient.
Abdollah's guidance to TODAY.com was direct: one test is not sufficient. What follows an abnormal result — a biopsy, a repeat test next year, or another form of monitoring — is a decision made with a urologist based on the size of the elevation and the patient's overall situation.
Patients who receive an unexpected PSA number can expect their doctor to look deeper rather than draw an immediate conclusion. The next step for most is a conversation with a urologist about which form of follow-up testing fits their results.
