คุณควรทำอย่างไรถ้าคุณมีการตรวจเลือด PSA สูง?

อัปเดตล่าสุด: 18 พฤษภาคม 2026

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PSA (Prostate-specific antigen) is one of the most common laboratory tests included in elderly male health screening packages. Many men who receive a high PSA result come to my office concerned about prostate cancer. This article explains what a high PSA actually means and what steps to take next.

• ศูนย์โรคทางเดินปัสสาวะ โรงพยาบาลกรุงเทพ ทำนัด Online 02-310-3009 bhquro@bdms.co.th
• โรงพยาบาลสมิติเวชศรีราชา ชลบุรี 088-022-1445

The current standard definition of an elevated PSA is a value above 4 ng/mL. However, a high PSA absolutely does NOT mean prostate cancer. PSA is produced by all prostate tissue — anything that stimulates or disrupts the prostate can raise PSA levels.

Common causes of falsely elevated PSA (pitfalls to exclude first)

• Recent sexual activity — ejaculation within 24 hours before the blood test significantly elevates PSA. Always abstain for 24 hours before testing
• Recent heavy exercise — an hour of bicycling or jogging can raise PSA values; levels return to baseline within 48 hours

When prostate cancer is still suspected after excluding false positives, careful patient counseling is essential. The definitive diagnostic test — TRUS-guided prostate biopsy — is invasive, and I use every available method to avoid unnecessary biopsy:

• PSA Velocity — serial PSA measurements assess the rate of change. A rise greater than 0.75 ng/mL per year suggests possible cancer
• Free PSA to Total PSA ratio — PSA circulates in two forms. In prostate cancer, Free PSA is relatively low. A Free PSA ratio below 10% indicates approximately 50% cancer risk
• MRI Prostate — now the standard imaging modality before biopsy, with over 90% cancer detection rate confirmed in the literature. MRI can identify suspicious areas and guide targeted biopsy, avoiding unnecessary sampling

The key message: prostate cancer is typically a non-aggressive disease with a favorable natural history. We will use every method available to minimize unnecessary biopsy. However, when biopsy is truly indicated, do not delay — early detection saves lives. If you are wondering whether you should undergo prostate cancer screening, see this article.

Frequently Asked Questions About High PSA

What does a high PSA mean and does it always indicate cancer?

No — a high PSA (above 4 ng/mL) does not mean prostate cancer. PSA is produced by all prostate tissue and rises with any prostate stimulation or inflammation. Common causes of falsely elevated PSA include recent ejaculation (within 24 hours), heavy exercise, urinary tract infection, prostatitis, and BPH (benign prostatic hyperplasia). A high PSA is a signal that requires further evaluation, not an automatic cancer diagnosis. Your urologist will systematically exclude false positives before recommending biopsy.

What tests are done before deciding on a prostate biopsy?

Before recommending biopsy, a urologist will typically use: PSA velocity (rate of change over time — a rise >0.75 ng/mL/year is concerning), Free PSA to Total PSA ratio (below 10% Free PSA suggests ~50% cancer risk), and MRI prostate (over 90% cancer detection rate, identifies suspicious regions for targeted sampling). These tools help risk-stratify patients and avoid unnecessary biopsy in low-risk cases while ensuring biopsy is directed and accurate in high-risk cases.

How should I prepare before a PSA blood test?

To ensure an accurate PSA result, abstain from sexual activity (ejaculation) for at least 24 hours before the test. Avoid heavy exercise such as cycling or jogging for at least 48 hours before testing. Inform your doctor if you have any active urinary tract infection, are taking 5-ARI medications (Dutasteride or Finasteride, which lower PSA by 50%), or have had any recent urological procedures. These factors all affect PSA and must be accounted for in interpreting your result.

If you have received a high PSA result and would like specialist evaluation, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. นัดหมายปรึกษาแพทย์.

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