Confused RE: PSA Readings

Approximately 3 years ago I was referred to a urologist for elevated PSA( 7.6. I am presently 61 years and no family history. My digital was unremarkable except for enlargement. Underwent biopsy with path showing no cancer, just atrophy and inflammation. 6 months later PSA continued to rise and free PSA borderline. Another biopsey and same path. Another 6 months and psa now over 12 and free at 12%. Third biopsey with same results. Another 6 months and PSA now decreasing to around 7 and free ath 11-12. No biopsey but 6 months later PSA now at 7 and free at 10%. Another 3 months and last vist PSA at 4.2 and free at 17%, almost normal. Still nothing on digital on any of these except enlargement. What is happening? Do I just keep watching and stop worrying? Thanks.

[HFHS M.D.-BL]

Dear Allan,

Prostate Specific Antigen (PSA) is a glycoprotein that is almost exclusively found in the epithelial cells of the prostate.  Circulating PSA is bound to alpha-1 chymotrypsin and A2MG.  The proportion of alpha-1 chymotrypsin-bound PSA is higher in the serum of men with prostate cancer than without.  Therefore, a higher free PSA is in theory better.  PSA is measurable in the serum and is usually less than 4.0ng/ml in normal men.  Levels greater than 4.0 are seen in men with benign prostatic hypertrophy (BPH), prostate cancer, and prostatic inflammation.


Since you have underwent three separate prostate biopsies that have all failed to identify a focus of cancer, your doctor would be supported by many urologists in only following you with periodic PSA measurements and rectal exams.  Your pathology report of inflammation and atrophy and your BPH on exam would be consistent with an enlarged prostate gland with an element of prostatitis.  This prostatic inflammation can be subclinical and give symptoms very similar to that of an enlarged prostate.  There are no hard and fast rules for urologists regarding complex cases as yours, but I believe that your physician would definitely be justified in following your rectal exams and PSA measurements.  Another biopsy would probably not be warranted unless another sudden rise in your PSA occurs.


This information is provided for general medical educational purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.  More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).


Sincerely,
HFHS M.D.-BL

[Robin]

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