PSA Fluctuations

I am a 46 year old healthy, white man with no family history of prostate cancer. In 1999, my PSA was 1.6. In 2002, my PSA was 2.7. Last month, my PSA registered 5.0. I re-took the blood test a week later and the PSA was 5.5. I took antibiotics for 10 days and my PSA dropped to 3.4. So here are my questions:

1. Two different urologists have recommended my getting a biopsy given 1) the increasing scores over time and 2) the fact that 3.4 is still high relative to my age. Do you agree?

2. I took the latest reading (the 3.4)the day I finished my antibiotics. Is it possible that the scores could still be going down due to the antibiotics and therefore perhaps I should take another blood test before going ahead with the biopsy?

3. If I do have prostate cancer, is the score of 3.4 the more relevant one and thus I am perhaps more likely to have the cancer contained within the prostate and not spread?

4. Any other things I should be thinking about?

[Kevin Pho, MD]

To answer your questions:
1) The PSA is elevated to a borderline high level.  To give more clarity to the situation, you may want to ask for a free PSA level.  Lower free PSA levels are associated with cancer.  Given, that PSAs above 4 is considered abnormal, it may be worth being on the safe side and proceeding with the biopsy.  

2) Repeating another test may be another option.  As you may know, there are several reasons why the PSA can elevate.  Any type of prostatic irritation or infection can raise the PSA.  

3) Again, taking the free PSA level can give more clarity as to whether cancer is present.  However, the PSA test alone isn't enough to diagnose cancer - you would need a biopsy.

4) As mentioned abouve, prostate infection, inflammation, benign prostatic hypertrophy or perineal irritation can all elevate the PSA.  Biopsy is the best way to exclude cancer.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

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