To Biopsy or Not

[tbrd]

I just turned 50 and as part of a routine physical my doc ordered some blood tests, including PSA, which came back just over 7.  So we repeated it and it came back just under 7.  So i was referred to urology.  The resident said the prostate felt healthy to him on exam, but without further ado, the attending said I need to have a biopsy.  I'm reluctant to do this without investigating first other possible causes of the high PSA.  Do you think I'd be wise to stall having the biopsy and look for the answer elsewhere, UTIs or such, or do you agree with the attending that 2 PSAs of around 7 warrant biopsy?

[blueskyabq]

Hi Dr,

If a male with PSA in the range of 1.4 in later 40s and early 50s, last year tested in this range was about 18 Mo ago.  Recent test was about 2.6, with normal DRE and enlarged prostate (not actual prostate density test though).  

Is this situation concerned?  Need biopsy?  And with PSA<4, fPSA cannot help to distinguish if cancer related, what test you may recommend if it is your patient?

The Dr order him a course of antibiotics, but just the first time with medicine, feel very bad headache, is that normal, should continue to take the medicine?

Thank you in advance for your advice and help!

[Dr Santos]

Hi,

In addition to an elevated PSA level or an abnormality on digital rectal exmination or DRE, there are also relative indications for prostate biopsy in specific medical and surgical situations. Initial prostate biopsy should be done after considering other factors such as age, PSA velocity, percent free PSA, and recent prostatitis.

If the DRE is normal but the PSA is moderately elevated, a free PSA test may be done to look at the ratio of free to total PSA. This can help to distinguish between prostate cancer and other non-cancer causes of elevated PSA. Since the total PSA test can be elevated temporarily for a variety of reasons,  another PSA a few weeks after the first to determine if the PSA is still elevated.

However, the decision to perform a prostate biopsy is at the discretion of the urologist.  Some are aggressive in their treatment due to high incidence of understaging in prostate neoplasia.  If you are not comfortable with the idea of having a prostate biopsy, discuss the option above  with your doctor. Take care and keep us posted.