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I am a urologist trained at AIIMS Delhi and Oxford. I see men panic over PSA results all the time, and I also see men dismiss genuinely worrying numbers because their doctor did not explain things clearly. This post is my attempt to fix that.

What is PSA?

PSA stands for Prostate Specific Antigen. It is a protein produced by both normal and abnormal prostate cells. A blood test measures how much of it is circulating in your body. It is not a cancer test. It is a prostate health marker. That distinction matters enormously.

What is a normal PSA level?

There is no single universal cutoff. Here is a rough age-based guide:

Under 50: below 2.5 is generally normal

50 to 59: below 3.5

60 to 69: below 4.5

70 and above: below 6.5

These are guidelines, not hard rules. A 45-year-old with a PSA of 3.8 needs attention. A 72-year-old with a PSA of 5.1 may be fine if it has been stable for years.

What raises PSA besides cancer?

This is the part most men are not told.

Benign prostatic hyperplasia (BPH), which is just an enlarged prostate, is the most common reason for elevated PSA. Prostatitis, meaning prostate infection or inflammation, can push PSA very high, sometimes to 20 or 30. Ejaculation within 48 hours before the test can raise it slightly. A urine infection can raise it. Even vigorous cycling the day before can affect it.

So if your PSA comes back elevated, the first question is: has your doctor ruled out infection and inflammation?

What actually matters: velocity and density

A single PSA number in isolation tells you less than most people think. What matters more is:

PSA velocity: how fast is it rising? A rise of more than 0.75 per year is concerning regardless of the absolute number.

PSA density: your PSA divided by your prostate volume on ultrasound. A density above 0.15 warrants further investigation even if the absolute number looks borderline.

Free to total PSA ratio: if your PSA is in the borderline zone (4 to 10), a lower free PSA percentage increases the likelihood of cancer. Below 10 percent is more worrying. Above 25 percent is more reassuring.

What should you do if your PSA is elevated?

Step 1: Repeat it. One elevated reading means very little. Wait 4 to 6 weeks, avoid ejaculation and vigorous activity for 48 hours before, and repeat.

Step 2: Rule out infection. If there is any chance of prostatitis, treat it first and retest.

Step 3: If it is persistently elevated, ask for a prostate MRI before agreeing to a biopsy. A multiparametric MRI can identify suspicious areas and help avoid unnecessary biopsies. Many men are still being sent straight to biopsy without an MRI first. That is outdated practice.

Step 4: If an MRI shows a suspicious lesion (PI-RADS 4 or 5), a targeted biopsy of that specific area is far better than a random 12-core biopsy.

Who should get PSA testing?

Men at average risk: discuss with your doctor starting at 50.

Men with a first-degree relative who had prostate cancer: start at 40 to 45.

Black men: start at 40, as the risk is significantly higher.

The bottom line

PSA is a useful tool when interpreted correctly. It is not a binary pass or fail. An elevated number is a starting point for investigation, not a diagnosis. And a normal number does not guarantee everything is fine if symptoms are present.

If your doctor just says your PSA is high and refers you straight to biopsy without discussing MRI, velocity, density, or free PSA ratio, it is completely reasonable to ask for those things or seek a second opinion.

Happy to answer questions.

India has one of the highest rates of kidney stones in the world. The "kidney stone belt" stretches across Rajasthan, Gujarat, Punjab, Haryana, UP, and Bihar. Peak season for stone attacks in these states is April to July. This is not a coincidence.

Why summer specifically triggers kidney stones:

The mechanism is straightforward. In 45 degree heat, you can lose 2 liters of water just sitting in a poorly ventilated room, and far more if you are outdoors or working manually. If you are not replacing this through water intake, your urine becomes highly concentrated. When urine is concentrated, the mineral content crosses the solubility threshold and crystals begin to form. This is the starting point of a kidney stone.

Who is most at risk in Indian summer:

- Outdoor workers: farmers, construction workers, delivery people, traffic police

- Anyone living without consistent air conditioning

- People who rely on sugary drinks, lemon soda (nimbu pani with sugar and salt), or packaged juices to hydrate (these are not adequate substitutes for water)

- Those who fast during Navratri or other religious observances without increasing water intake

- Anyone who has had a stone before. Recurrence risk is 50% within 10 years even with stone treatment

The most dangerous misconception in Indian households:

Many families believe that drinking cold water in summer can cause illness, so they restrict water intake or boil and cool it to room temperature before drinking. The temperature of the water does not matter for stone prevention. What matters is the volume. You need to be drinking enough that your urine is pale yellow or clear, not dark or orange.

What to drink:

- Plain water is best. Aim for 3 to 3.5 liters per day in peak summer, more if you are outdoors.

- Nimbu pani (fresh lemon in water) is genuinely protective. The citric acid from lemon converts to potassium citrate in the body, which is a proven stone inhibitor. Just use minimal sugar and salt.

- Coconut water is acceptable and beneficial due to its potassium content.

- Avoid colas and packaged drinks: phosphoric acid in colas directly promotes stone formation, and the sodium and sugar in most packaged drinks worsen your urinary chemistry.

When to see a urologist urgently:

- Severe pain in the back or side (flank), especially if it comes in waves

- Pain radiating to the groin or inner thigh

- Blood in the urine (can be visible as pink/red or detected on a dipstick test)

- Fever above 38 degrees with any of the above (this is a medical emergency - infected obstructed kidney can become life-threatening within hours)

For those in NCR (Gurgaon/Delhi), I see patients at a urology practice here. But honestly, the most important thing is that you know when to go to any urologist and what to ask for. If you have recurrent stones, ask specifically for a 24-hour urine metabolic test. Most urologists in India do not routinely order this test. It will show exactly which imbalance in your urine chemistry is causing your stones.

Ask any questions in the comments.

Every summer I see a spike in kidney stone presentations in my practice. This is not a coincidence. There is a well-documented seasonal pattern to kidney stone formation, and if you are a stone former, understanding this can genuinely prevent your next episode.

Why does summer increase stone risk?

1. Dehydration is the primary driver. In hot weather, you sweat more and if you don't increase fluid intake proportionally, your urine becomes more concentrated. Concentrated urine means more minerals in a smaller volume of water, which increases the chance of crystal formation. A simple test: if your urine is dark yellow, you are already behind on hydration.

2. Higher Vitamin D exposure. Sunlight increases Vitamin D production, which in turn increases calcium absorption from the gut. More calcium absorbed means more calcium excreted in the urine, which directly increases calcium stone risk. This is particularly relevant if you already have hypercalciuria.

3. Hot outdoor work or exercise without adequate hydration. People who work outdoors or do physical activity in summer heat can lose 1-2 liters of sweat per hour. If this isn't replaced, urine output drops dramatically. Stones form in low-volume, highly concentrated urine.

4. Dietary changes in summer. More BBQs, more animal protein, more sugary drinks, fewer vegetables. Animal protein increases urinary uric acid and calcium excretion while also reducing citrate (your natural stone inhibitor).

What can you specifically do in summer to reduce your risk:

1. Set a urine color target. Pale yellow = well hydrated. Dark yellow or amber = drink now. This is more practical than counting glasses.

2. Increase daily intake to 3+ liters on hot days or exercise days. This is above the usual recommendation and necessary when you are sweating.

3. Add a squeeze of fresh lemon to your water twice a day. The citric acid becomes potassium citrate in the body, which inhibits calcium crystal formation. This is actually evidence-based, not folk remedy.

4. Reduce sugary drinks and sodas. Fructose from these increases uric acid production. Phosphoric acid in colas directly promotes stone formation.

5. Time your exercise for cooler parts of the day (early morning or evening) and drink before, during, and after.

6. If you are taking Vitamin D supplements, particularly high doses, discuss this with your doctor during summer. A review may be appropriate.

Who should be most vigilant:

- Anyone who has had a stone before (your risk of recurrence is 50% within 10 years without metabolic correction)

- Anyone with a family history of stones

- People in hot, dry climates (India's stone belt includes Rajasthan, UP, Bihar, Haryana, Punjab)

- Those with jobs involving outdoor work or exposure to heat

- People with high protein diets or low vegetable intake

If you are not sure what type of stone former you are, a 24-hour urine metabolic test at the end of summer would give you a very clear picture of what specifically needs to be adjusted in your chemistry. This is the single most useful test for recurrent stone formers.

Feel free to ask any questions in the comments.