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An elevated PSA can be alarming—but it doesn't always mean prostate cancer. Before recommending a prostate biopsy, there are several important clinical steps that can improve diagnostic accuracy, reduce unnecessary procedures, and help patients make informed decisions. 

 In this episode of UroNurse, host Vic Senese, RN, BSN, FAUNA, reviews the essential evaluation every clinician should consider after discovering an elevated PSA. Learn how to confirm an abnormal PSA, identify reversible causes of elevation, evaluate patient risk factors, understand the role of PSA density and PSA kinetics, determine when prostate MRI is appropriate, and recognize when additional biomarker testing may help guide clinical decision-making. This evidence-based discussion also explores shared decision-making with patients, current best practices, and practical tips that can help clinicians avoid unnecessary biopsies while identifying patients who may truly benefit from further evaluation. Whether you're a urology nurse, nurse practitioner, physician assistant, primary care provider, resident, medical student, or urologist, this episode provides practical guidance you can apply in everyday clinical practice. 

Topics Covered:

• Causes of an elevated PSA
• Confirming an abnormal PSA result
• Repeating PSA before biopsy
• Digital rectal examination (DRE)
• PSA density
• PSA velocity and PSA kinetics
• Risk factors for prostate cancer
• Family history and genetic risk
• Multiparametric prostate MRI
• MRI before prostate biopsy
• Biomarker testing (4Kscore, PHI, ExoDx and others)
• Active surveillance considerations
• Shared decision-making
• Current prostate cancer evaluation guidelines
• Reducing unnecessary prostate biopsies
• Best practices in prostate cancer detection

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*The expert's opinions in this communication are personal and not representative of any organization. They are for informational purposes only, not official guidance. Viewers are advised to use their judgment, seek additional advice, and take responsibility for any actions based on these opinions.