I am 58 years old.18 months ago my showed a PSA of a 3.2 with a ferquent very urge to urinate. The PCP referred me to a urologist. He performed several DRE's, ultrasound exams, took urine samples. My prostate was enlarged - not significantly so. He performed a Thermal Destruction Of Prostate Tissue for the frequent urination ten months ago. Frequency of urination improved. In 18 months I saw the urologist for and almost each time he has taken blood for a PSA. It's ranged from 2.1 to a 4.2. One result that was a 5.0 about six months ago. It fluctuates back and forth though. A month ago the urologist took blood for a PSA and digitally stimulated the prostate to increase the volume of sperm in the urine. He then took a urine sample and told me that it was a special test to determine if I had a genetic predisposition to prostate cancer. Last month he told me that the result of the genetic test came back negative and the PSA was a 4.1. He also measured the volume of urine output and that seemed much better.
He told me that it was his opinion that I have him perform a biopsy on my prostate (through the rectum with the sonogram unit for the samples) at the end of this month. His rationale is that my PSA values have a wide range as I mentioned, a 2.1 to a 4.2 with a single result of a 5. The only other thing that I can add is that my sister has had surgeries and radiation for breast cancer about 20 or more years ago (she is well now) and my mom had passed away from lung cancer. Please, please respond - I am out of my mind with worry.
The internet sites I've checked indicate that my range, at my age, is fairly normal to borderline. Is this correct? Is a biopsy on the prostate absolutely necessary in my case? I am really scared out of my wits. Also, my urologist isn't going to use a topical anesthetic on the prostate prior to the biopsy and I am sure it will be unbearably painful to have it done. Am I correct? (please be honest with all of your answers.
Thank you for your question. There seems to be several things packed into your question.
With respect to your PSA levels. A variation of 2.1 - 5.0 over a short period of time could be caused by varying degrees of BPH, prostatitis, and prostate cancer. Also, the differences could be caused by lab variation. Finally, if blood is drawn after a DRE is performed, this could also elevate the level of PSA in the bloodstream.
Age-specific PSA levels tend to underdiagnose, misdiagnose really, prostate cancer in men as they get older. Continued elevated PSA levels should move you in the direction of a prostate biopsy.
Thank you for your question.
Ash Tewari, MD
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Mike, first don't worry about the biopsy..I had one done a few months back..maybe little uncomfortable but really nothing. Went to lunch with my wife right after. My PSA is up and down also..went from 2.0 to 4.6..then they did a biopsy and I was diagnosed with cancer. Got two more opinions and those two said NO you do not have cancer but my PSA will need to be monitored. My last PSA a few weeks ago was 3.0. Please get more than one opinion...its crazy what you are told.
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