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PCA3/PSA/fPSA variability
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PCA3/PSA/fPSA variability

From 5/2008 to 5/2009 my PSA went from 2.5 to 5.  I was referred to a urologist who put me on Cipro for 4 weeks. DRE negative.  PSA down to 4.5.  3 months later up to 4.8.  On another antibiotic for 4 weeks.  PSA climbed to 5.5.  Biopsied.  Saw the "prostate of a 65 year old" on ultrasound.  Negative.  3 months later PSA to 7.7.  Free PSA 12.  PCA3 2.1.  I am a 53 year old Jewish male with BRCA2.  Next step?  Another biopsy?  Another round of antibiotics?  Current doc suggest another biopsy?  What are your thoughts?

Thanks in advance for your response.
Tags: PSA, PCA3, fpsa
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Thank you for your question. Elevated PSA levels are not specific to prostate cancer, but can be an indication of other prostate conditions (BPH, prostate cancer, prostatitis). Often times this serves as a point of confusion, as all conditions may be present in some individuals. A rising PSA of 7 is indicative of malignant disease and should be repeated in 6-12 weeks. A mapping or saturation biopsy may also be warranted based on repeat PSA findings.

There is some literature suggesting that BRCA2 mutations are associated with an elevated prostate cancer risk.

Based on these findings, I think it would be prudent for your condition to be closely monitored with repeat PSA and possibly biopsy.

Ash Tewari, MD

http://www.cornellroboticprostate.org

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