Your PSA Came Back High. Here Is What "Just BPH" Actually Means.

A urologist explains why your number went up, why it will go up again, and what he now tells men after the good call.

Dr. Michael Hartwell, MDBoard-certified urologist, 24 years in practice. Updated November 2026. 8 minute read.

The 2 phone calls

I make both kinds every week.

The first one: "Your PSA came back elevated. We need you to come in." I know what that call does to a man. He does not sleep. He sits at the kitchen table at 2 in the morning reading survival rates. He does not tell his kids. He looks at his grandson at Sunday dinner and does math he has never done before.

Then the second call: "No sign of cancer. Your prostate is enlarged. A bigger prostate makes more PSA. That is all this is."

I have heard men cry on that call. I have seen wives collapse into the chair with relief.

And then, for most of my career, I would say: "Good news. It is just BPH. We will monitor it. See you in 6 months."

I am not saying that anymore. Because I know what happens in those 6 months.

Doug

Doug Moran is the man who changed how I make the good call.

Doug is 62. His primary care doctor flagged a PSA of 5.8 at a routine physical. Doug spent the next 9 days convinced he was dying.

He did not tell his wife Karen for the first 3 days. He sat at his desk at work and read about Gleason scores and staging and radical prostatectomy. He read about incontinence and impotence and he closed the laptop and went to the bathroom and stood there for a long time.

On day 4 he told Karen. She went quiet. Then she started making calls and building a folder.

The MRI was clean. I brought him in and told him.

"It is not cancer, Doug. Your prostate is enlarged. 47 grams. That is what pushed your PSA up. A bigger prostate makes more PSA."

Doug put his head in his hands. Karen cried. I gave them a minute.

Then Doug asked the question I have been asked hundreds of times: "So what do I do about it?"

And for 24 years I have answered that question the same way: "We will monitor it. Come back in 6 months."

Doug nodded. He took Karen home. And I went back to my office and sat down and thought about what I had just done.

I had told a man who spent 9 days thinking he was dying that he was fine. And I sent him home with nothing. No explanation of why his prostate was 47 grams. No explanation of what was making it grow. No explanation of what his next PSA would look like if nothing changed.

What I should have told him

Your prostate is 47 grams because of a hormone called DHT.

Your body converts testosterone into DHT. DHT docks onto your prostate cells and tells the tissue to multiply. That is why the gland grows. And that is why your PSA went up. A bigger prostate makes more PSA.

The word "just" in "just BPH" hides something. It hides the fact that the growth signal is still running. Right now. The DHT is still converting. Still docking. Your prostate is still growing. And when you come back in 6 months your PSA will be higher. Not because something went wrong. Because nothing was done about the reason it was high.

"Monitor it" is the profession's way of saying we will watch it get worse and intervene when it crosses a line.

7 months later

Doug came back. PSA 6.4. Up from 5.8. Prostate 51 grams. Up from 47.

He looked at me and said, "I thought you said I was fine."

He had started getting up twice a night. His stream had slowed. He had not connected any of this to the PSA scare because I had told him BPH and urinary symptoms were separate from the number that scared him.

They are not separate. They are the same gland growing for the same reason.

What I found

The drugs I could prescribe each miss something.

Tamsulosin relaxes muscle. It does not touch DHT. The prostate grows the same on it as off it.

Finasteride partially blocks DHT production everywhere in the body. It can reduce growth. But it comes with side effects I cannot justify for a man whose only problem right now is a gland that is quietly growing. Loss of drive. Difficulty with erections. Documented and real.

Saw palmetto. I know men buy this at CVS on the way home from my office. The NIH tripled the dose in a 369-man trial. 72 weeks. It could not beat a placebo.

There is a compound that works differently. It does not try to stop DHT from being made. It binds to the DHT molecules after they are already circulating. Wraps around them so they cannot dock onto your prostate cells. Called equol. Studied in Japan for decades. Published on PubMed.

And there is a second pathway. A protein called SHBG docks onto the prostate cell membrane and pulls DHT inside. Stinging nettle root blocks that docking site.

Two ingredients aimed at the same hormone from two directions. Neither one shuts down testosterone. Neither one requires a prescription.

What happened to Doug

I told Doug about equol and stinging nettle root at his 7-month visit. I handed him the PubMed references and told him to look it up himself.

Karen called my office 2 weeks later. She had read everything. She found a formulation with equol and stinging nettle root at the study doses. She ordered it.

Doug took it alongside nothing else. No tamsulosin. No finasteride. No saw palmetto. Just equol and stinging nettle root.

Week 2 his nighttime trips dropped from 2 to 1.

Week 4 he was sleeping through most nights. Karen told me. She was the one counting.

Week 6 his stream changed. He stopped planning bathroom stops before leaving the house.

His PSA dropped from 6.4 to 5.1. His prostate went from 51 to 44 grams. For the first time since the scare, both numbers went down.

Doug looked at me and said, "The number that scared me and the gland that caused it are the same thing."

I said, "They have always been the same thing. I just did not explain that to you the first time you sat in that chair."

What I tell every man after the good call now

The call ends differently. I still deliver the relief. But now I add something.

"It is not cancer. Your prostate is enlarged and that is what raised the number. But the reason it is enlarged is still running. If we do not address it the gland will keep growing and your PSA will keep climbing and we will be back here having a harder conversation."

Then I hand them the published references for equol and stinging nettle root. I let them decide.

1. Celebrate. You dodged the worst news a man can get. Take the steak dinner.
2. Keep every PSA check your doctor schedules. Nothing on this page replaces cancer screening.
3. Get your starting numbers. Your symptom score and how many times you are up at night, counted for a week.
4. Take Saika Prostate Intercept every day. 2 capsules, 1 in the morning and 1 later. Keep taking anything your doctor prescribed.
5. Rescore at 8 weeks. If the numbers moved, keep going. If they did not, use the guarantee.

Other men after the good call

You have 2 ways to spend the time until your next PSA

Saika Prostate Intercept

• 12 mg equol and 50 mg stinging nettle root per serving
• 2 capsules a day, 1 morning and 1 later
• Every dose on the label, no proprietary blend
• Runs alongside what you already take
• 60-day money-back guarantee, refunded the same day

See Saika Prostate Intercept

60-day money-back guarantee. Questions? support@getsaika.com

Questions men ask me