With the widespread use of PSA screening, many patients are found to have elevated blood PSA during routine physical exams. Many patients are very worried and struggle with whether or not to have a prostate puncture. If you do not have a puncture, you are afraid that you will miss the diagnosis of prostate cancer and delay the disease. The most important thing to do is to make sure that the PSA is high. Here I will answer several common questions. 1. What is PSA and does it mean that I have prostate cancer if it is elevated? PSA is a lipoprotein secreted by the prostate epithelium, but elevated PSA does not necessarily mean that you have prostate cancer. 2.When do I need a prostate puncture biopsy? If your PSA is elevated because you are elderly and your free PSA is low, with a ratio of free to total PSA less than 0.18, then you are more likely to have prostate cancer and need a prostate puncture biopsy. If your ratio is greater than 0.18, your prostate is large and your rectal evidence is normal, you can further do transrectal prostate ultrasound or prostate MRI, if both are normal, you can hold off on puncture and review it regularly. 3. How risky is prostate puncture? Prostate puncture is usually performed under the guidance of rectal ultrasound, which is not very painful and does not require anesthesia. It is very safe, and except for some people who have fever, other complications are rare, and the puncture will not cause prostate cancer to spread.