Does the PSA test detect prostate cancer?

The PSA (Prostate Specific Antigen) test is a screening method to look for possible prostate cancer (PCa). Many men think this test can detect prostate cancer (PCa). However, a high PSA does not necessarily mean cancer is present.

Rather, if PSA is higher than a normally expected range, it raises suspicion that PCa is present.

Here are PSA values considered normal by age*

*Note that PSA normally tends to increase with age because the prostate naturally enlarges.

Other things besides PCa can cause higher than normal PSA: benign prostatic hyperplasia (BPH); prostate or urinary tract infection; prostate stimulation within 48 hours before a blood draw (e.g. bike riding, orgasm, digital rectal exam); certain medications. Thus, the PSA test only registers prostate activity, which is suspicious for PCa but can mean other things as well.

Screening, or detection?

There is a difference between screening and detection. For example, a home screening test for a pest infestation is a noise in the wall. It could mean insects or rodents, but it could also be a possible leak from a water pipe in the wall. The next step is specific detection using additional tests like setting traps, looking for droppings under a sofa, or a damp wall or floor. Detecting evidence reveals the true source.

If a PSA is suspicious, how do you find out if it’s PCa?

Since the PSA screening test was developed in the mid-1990s, a suspicious PSA result was typically followed by a needle biopsy to find proof of PCa. However, there is a problem with this pathway.

Annually, one million biopsies are triggered by high PSA tests in the U.S.^[i] Yet, according to a 2012 news story, out of a million, “…about 240,000 new cases of prostate cancer are discovered each year. Thus, about 75 percent of biopsies are negative for cancer.” This means hundreds of thousands of men have an invasive biopsy when they don’t actually have PCa.

Therefore, a better way to detect PCa before a biopsy is needed.

Is there a better way to detect PCa before having a biopsy?

Thankfully, there is now a better way to detect PCa before jumping to biopsy. It is called multiparametric MRI PI-RADS plus PSA density (mpMRI PI-RADS + PSAD). The combination of mpMRI PI-RADS + PSAD is an accurate intermediate step between a suspicious PSA and a needle biopsy.

1. mpMRI of the prostate produces a high resolution, 3-dimensional portrait of the prostate gland anatomy. It is very accurate at revealing any area that appears to be PCa. The area is given a PI-RADS score from 1 to 5. The higher the score, the greater the probability that it is cancer. Any area that is PI-RADS 2 or greater should have a real time MRI-guided biopsy. This biopsy method uses the fewest needles yet provides the most accurate diagnosis to enable treatment planning.
2. PSAD (PSA density) is different from PSA, and it can be obtained from the same blood draw. It is calculated by dividing the prostate volume by PSA, which gives an additional number besides PSA alone. If PSAD is over 0.15, it can signal cancer and help rule out BPH or other condition.

Can mpMRI + PSAD determine if a biopsy is necessary?

Yes, combining imaging the PI-RADS score from mpMRI imaging with PSAD can show that a biopsy is needed. A 2025 study based on 45 PCa patients demonstrated that “… the combination of PI-RADS score and PSAD yields higher diagnostic accuracy for the detection of PCa (p < 0.001) than using the PI-RADS score alone.”^[ii]

Using this combination method to detect PCa has two main benefits.

1. The imaging reveals the location, probable aggression level and size of a suspicious tumor. Adding the PI-RADS score plus PSAD along with the visual information allows a real-time MRI-guided targeted biopsy with 2-4 needles rather than an ultrasound guided biopsy using 12 or more needles.
2. A huge number of unnecessary biopsy procedures can be avoided altogether if mpMRI PI-RADS + PSAD does not detect PCa.

Frequently asked questions

Q: Why should men have an annual PSA test?

A: An annual PSA test is a screening test for unusual prostate activity. It may not mean prostate cancer is present. However, since early prostate cancer has no symptoms, a suspicious PSA test is the earliest warning of something that needs further identification.

Q: If a PSA test is suspicious, is a needle biopsy the only way to prove it?

A: After a suspicious PSA test, an invasive needle biopsy is one way to determine if cancer is present. However, a less invasive method is to combine noninvasive multiparametric MRI, an imaging method to visualize any areas that appear cancerous, with a PSA density (PSAD) score. If imaging plus PSA indicates that PCa is likely the cause of the high PSA, a biopsy is necessary to diagnose the actual cancer cells.

Q: What’s the most accurate biopsy method?

A: The most accurate biopsy method is a real time (in bore) MRI-guided targeted biopsy. Since the cancerous area is seen in real time, a doctor can direct a minimum number of needles into the core of the area. This is the site likely to contain the most aggressive cancer cells, which is the key to matching treatment to the disease. This biopsy method uses the fewest needles to maximize diagnostic accuracy.

Content reviewed by Dr. Dan Sperling, M.D., DABR — updated August 2026.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Schmeusser B, Levin B, Lama D, Sidana A. Hundred years of transperineal prostate biopsy. Ther Adv Urol. 2022 May 21;14:17562872221100590.
[ii] Shetty A, Gadupati J, Bommineni B, Chikatla S, Krishnamurthy U, D R. Diagnostic Accuracy of Combination of Multiparametric MRI PI-RADS Score v2.1 and Prostate-Specific Antigen Density for Prostate Cancer Detection. Cureus. 2025 Mar 7;17(3):e80238.

About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.