What do you think about this case

Hi Dr,

What do you think about the following case.

A health male in early 50's, with no family history of prostate cancer.  In his later forty's, annual exam showed PSA were in 1.3-1.4 level.  A most recant one, after 18 month of the last test, PSA somehow shot in higher lever ,  a couple of them were consider took right after DRE or other exam may course the elevated PSA.  Later repeat in a month showed PSA range 4 - 2.5 (a few days after DRE or test involved in a message of prostate).  

Dr consider infection, so he took a course of antibiotics. After that, the first repeat test show PSA is 1.8.  

What do you think about this case? IS infection?  If he is your patient, what will be your recommendation?  Will you still think biopsy is necessary?

Thank you in advance for your advise and help!

[Stephen Liroff, MD]

Some urologists routinely give a course of antibiotics to their patients with elevated PSA's. If the value drops to a normal level and stays there, I do not see the need for a biopsy. I would continue to follow you with a PSA in three months and if it is normal and has not risen significantly, I would check it again yearly. This all assumes that your rectal exam is normal. If either the speed of rise of your PSA, the absolute value or the rectal exam are abnormal, then I would recommend a biopsy.
S.A.Liroff, M.D.

[blueskyabq]

Hi Dr Liroff,

Thank you so much for your response!

Is a 6 Mo follow up PSA test too long?

If PSA will not be the same low level, but up to 2.5 level, what to do?  Will another course of antibiotics needed?  Do any tests can diagnose of the infection or inflammation?  BTW, DRE is normal and slice enlarged.

Also, in the case of PSA <4, has fPSA test any value?

Thank you in advance for your time and help!

[Stephen Liroff, MD]

I tend to repeat at 3 months, but there is no scientific basis for this choice. PSA kinetics are the thing to watch now. If your PSA is increasing rapidly (faster than 0.7 per year) then you are at increased risk that this is due to a Ca. Also, there are age related PSA values. A PSA of 3.5 in a 53 year old is a bit high. So, if you are consistently on the high end, a biopsy should be considered.
I would not get a percent free psa at this point.
If your psa jumps again, I would not be in favor of a course of antibiotics. I would repeat the test a few weeks later, not having had an orgasm for at least three days (also, not truly a scientifically chosen time, but it is related to PSA half lives).
S.A.Liroff, M.D.

[blueskyabq]

Hi Dr Liroff,

Thank you so much for your promptly response, it is greatly appreciated.

May I have one more question for you. This is about a urology test called PCA3-D, it suppose will be used to see the likely of postage CA.  Based on the Lab report, if PCA3-D < 35, it is negative.  

My question is if the test result is 6 (very low), is it means he can have a peace of mind? How useful or accurate of this test, and how it should be used?  And is there any limitation for it should be used in the certain range of PSA (like %free PSA only be used when PSA=4-10).

Thank you again.  Your responses are always the great help!