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Urology (Expert Forum)
PSA Readings
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
PSA Readings
by Alan__0, Jul 05, 1998 12:00AM
I am a 59 year old in good health. About 2 years ago my PSA level went ,in a year, from below 4 to 7.6. I went to a Urologist who did a Ultrasound and biopsy. Path results negative, report said atrophy and mild prostatitis. Next 6 month check PSA continued to rise above 11. Another biopsy with same results on pathology. Next checkup at 6 months PSA up to 12.5. Third biopsy; same results. Last check in June PSA went down to 7.9 and free PSA went from 9 to 13%. Can anyone suggest a theory to explain what might be going on? The only drug I take during this period is Tegretol for Trigeminal Neuralgia. More recently also started taking Lipitor. Would appreciate any thoughts on my fluctuating PSA level. Mnay thanks.
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Dear Allan,
It seems like you have been well exposed to the elevated PSA and negative pathology on ultrasound guided prostate biopsy arena/dilemma. The reason I say dilemma is because as urologists there is no clear cut answer as to how many ultrasound guided biopsies need to be done for progressively elevating PSA before we decide enough is enough and to call it quits. One can conceivably perform a biopsy every 6 months (for a long time) and still not obtain any evidence for cancer. In fact, the yield of a positive biopsy for prostate cancer is less and less as each subsequent biopsy is performed . On one hand, one is happy not to obtain cancer, but on the other hand the question of the elevated PSA pops back up and at one point one needs to either repeat a biopsy, or ignore the elevated PSA. As you can probably tell, it can be frustrating not only for the patient, but also for the physician who feels responsible to the patient.
It’s important to first realize that prostate cancer is not the only reason that a PSA test is elevated. Other causes include a urinary tract infection, prostatitis, and BPH (enlargement of the prostate that occurs with aging). However, prostate cancer is the most worrisome possibility and this is why an ultrasound guided prostate biopsy is performed. As you probably know, the prostate biopsy only samples a portion of the prostate and does not tell us about whether there may or may not be cancer in the other adjacent cells which were not biopsied. Therefore, it’s somewhat of a judgment call.
Based on the story you describe it sounds like you may have chronic prostatitis as evidenced by your prostate biopsy. This would explain the fluctuating PSA level. It is important that you still have your PSA level followed by your urologist and follow his/her recommendations.
More individualized care is available at the Henry Ford Hospital and its urban campuses by calling (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians’ notes and lab test results that you may be able to obtain. These will help us greatly.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Wish you the best,
Sincerely,
HFHS-M.D. J.J
*Keyword:PSA
--------------------------------------------------------------------------------------------------------------------------------
Dear Allan,
It seems like you have been well exposed to the elevated PSA and negative pathology on ultrasound guided prostate biopsy arena/dilemma. The reason I say dilemma is because as urologists there is no clear cut answer as to how many ultrasound guided biopsies need to be done for progressively elevating PSA before we decide enough is enough and to call it quits. One can conceivably perform a biopsy every 6 months (for a long time) and still not obtain any evidence for cancer. In fact, the yield of a positive biopsy for prostate cancer is less and less as each subsequent biopsy is performed . On one hand, one is happy not to obtain cancer, but on the other hand the question of the elevated PSA pops back up and at one point one needs to either repeat a biopsy, or ignore the elevated PSA. As you can probably tell, it can be frustrating not only for the patient, but also for the physician who feels responsible to the patient.
It’s important to first realize that prostate cancer is not the only reason that a PSA test is elevated. Other causes include a urinary tract infection, prostatitis, and BPH (enlargement of the prostate that occurs with aging). However, prostate cancer is the most worrisome possibility and this is why an ultrasound guided prostate biopsy is performed. As you probably know, the prostate biopsy only samples a portion of the prostate and does not tell us about whether there may or may not be cancer in the other adjacent cells which were not biopsied. Therefore, it’s somewhat of a judgment call.
Based on the story you describe it sounds like you may have chronic prostatitis as evidenced by your prostate biopsy. This would explain the fluctuating PSA level. It is important that you still have your PSA level followed by your urologist and follow his/her recommendations.
More individualized care is available at the Henry Ford Hospital and its urban campuses by calling (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians’ notes and lab test results that you may be able to obtain. These will help us greatly.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Wish you the best,
Sincerely,
HFHS-M.D. J.J
*Keyword:PSA
