Hi Jeff, you are asking exactly the same question I had when my OH started with PSA 290 last Sept. It seems really scary but as others have said you need to wait for the results to come through. For my OH at the first meeting with his urologist he was told he was 99% certain he had PCa and was put on bicalutamide for 4 weeks and 6 monthly injections of Decapeptyl which started last Nov as a palliative hormone therapy, followed by a bone scan (clear) and CT scan. He only had his biopsy this January 2023 with full diagnosis this March of Gleason 5+4 T3b N1 M0 and by then his PSA had fallen to 23 after 5 months on hormone treatment. His oncologist propses a curative aggressive treatment of chemo, RT and 3 years hormones, although my OH is declining the chemo he is at planning stage for RT. My view of the high PSA is that this indicates a higher risk which all needs to be determined by the series of scans, biopsies and tests. If my OH hadn't been started on hormones so quickly he could have had an MRI, which the oncologist prefers to have. She did mention that some people do seem to have higher PSA levels than others. So for now my OH's initial PSA of 290 did not mean metastases (he is late 70's and very fit too). Best wishes to you and your OH - this forum is really supportive so keep asking all your questions.