53 Male with PSA 6.2

My last annual physical producd a total PSA result of 3.5.  Previous annuals exam for total PSA test were 1.4, 1.8, 2.3 respectively.  DRE's have all been normal.  My primary care physican referred me to a Urologist who suggested and performed a biopsy.  Results were negative.  At a 6 month follow-up with the Urologist, my PSA was 6.2.  I was put on antibiotics for two weeks and repeated the PSA after 1 month.  Awaiting the results.  

All PSA tests performed during my annual physicals were done after a DRE.  I've read numerous articles since that indicate DRE's can cause a spike in a PSA.  I was I told to refrain from sex 48 hours prior to a PSA test.  Also can spike PSA test from what I've read.  The Urologist never suggested or mentioned a tPSA, cPSA or fPSA nor tested my total PSA himself before doing the biopsy.  After the recent 6.2 Total PSA and round of antibiotics, I insisted on a fPSA.

All the information I've obtained came from internet articles and posted discussions.  My primary physician nor my Urologist have volenteered any helpful information or options that would have made this experience less stressful.

My question is... does this sound normal or familiar?  Is this a common experience?  Is it noromal to only perform Total PSA tests when other tests are available?  Are the other tests so unreliable that any additional information they might yield simply add noise to the ultimate need for a biopsy.  Also I've read that PSA test all assay differently but I haven't been able to determine how much of a difference the results can vary?  Perhaps you can address and comment on some of my concerns.

[blueskyabq]

PSA velocity is important.  If PSA increase 0.75/year, then need to pay attention (some Dr use 0.35 if the total PSA is < 2.5).

Also, prostate density is important, too.  If a person have enlarged prostate, then he will have higher PSA than a person who has small prostate.  Since you did biopsy, did the Dr measure your size of prostate?  Some people have benign prostate enlargement, which will also results higher PSA.

Also, fPSA is most used to distinguish if elevated PSA is cancer related or other abnormal conditions of prostate if total PSA is in the range of 4-10.

PSA test right after DRE will be higher than it should be , should be avoid.

Sometimes PSA is higher than it should be for "unknown" reason.  If you feel it is not actual, repeat again.

I hope that after antibiotics, your PSA will drop.  I think some people just have not very obvious symptom as infection, but it did.  I don't know why nowadays, Drs are not try very hard to do some proper tests to rule out any other reasons which caused elevated PSA like infection or inflammation, but just order to do biopsy, then after biopsy end up negative then back to antibiotics.  Even worse, some Drs will not happy for the patient who got information form internet or other sources.  Of course, we respect to the Dr, but we also need to make informative decision.  

There are also a couple of books are written by famous urologist, they are worth to find more information, look at amazon.com.  

1. Dr. Patrick Walsh's Guide to Surviving Prostate Cancer, Second Edition (Paperback) - for prostate cancer

2. Complete Prostate Book: What Every Man Needs to Know (Paperback) - for all prostate diseases, includes the prostate problems which may also elevate PSA

Good luck on your PSA result, and keep us posted.  

Best regards.

[PP9616]

Thanks for your response and information.  I received a phone call today from my Urologist with my tPSA and fPSA results.  tPSA = was 8.5 and fPSA = .13.  I must say worse news than I anticipated.  The test performed was the Mayo Clinic Free PSA.

He recommended a saturated biopsy as the next step.  I somewhat agreed but suggested we repeat both the PSA that is run in his office and the Mayo Clinic test.  I also intend to have a PSA done from my Primary Care physician.  I feel like I've been given several different PSA tests from different manufacturers and haven't had a consistent source from which to make a informed decision.  

[blueskyabq]

Do you mean tPSA=8.5 and fPSA=0.13? or fPSA=1.3?

If fPSA=0.13, that is very low.  If fPSA=1.3, that means %fPSA=15%, still not too good with tPSA=8.5.

But, please keep calm, you need to assure that the test result is actual and stable, because your informed decision will based on the test results.  Some times PSA shoot very high for "unknown" reasons.  

I think you can ask to repeat test to see if this recent test results were the true value. You may feel more comfortable for the next step if the repeated test show the PSA and fPSA at the same level.  And you can seek second option before make decision.

I had been asked why sometimes PSA tests seems not actual, I was told that some factors will affect the results like sample degraded, contaminated...I also knew some people go step further, that is when test, send 2 samples out and test in the 2 different labs, to see if the results show the same level.

I know there is the test called PCA3-D which can tell the low or high likelihood of prostate cancel or biopsy.  Please talk to your urologist about how this test will help.  Please be aware, do PSA, fPSA tests before do PCA3-D (it will affect PSA test result if do it after in a short time).

In the "Complete Prostate Book: What Every Man Needs to Know" book, there is a section describes in details about biopsy including saturated biopsy.  It looks like that your previous biopsy was sextant systematic biopsy? As I read, the saturated biopsy will unlike to miss any spots, so if that will be the next step you will go, hope that will be one for good - have a solid diagnosis.

Do you know that you can post a question to a Dr?  From "Forums", choose either "urology" or "urology cancer", may be an expert will answer your question and give you good advise.

The best regards.

[raymond583]

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