Hi, I Am A 62 Year Old Man. My PSA

Posted on Sat, 2 Mar 2019

Question: Hi, I am a 62 year old man. My PSA started going up 10 years ago. It went up to 26. I had a biopsy done and it came back negative. We monitored it and it went up and down but stay about the same. Last year it went up to 45. I had an MRI done and it did not show anything definite but there were two areas that were suspect. So had another biopsy done and they took a larger number of samples. It all came back negative. Just last month my PSA jumped to 78. My urologist now wants to do the TURP procedure to get some samples inside the prostate. This seems like a pretty drastic procedure. I'm not sure I want to have it done. They have not check out my hormone levels at all. Wouldn't that be a good thing to have done to see if my hormones are out of balance which may cause a rise in my PSA. Are there any other methods to check to see if I have prostate cancer? Thank you for your time, I really appreciate it.

Answered by Dr. Dr. Michelle Gibson (1 hour later)

Brief Answer:
testosterone can be tested but not commonly done

Detailed Answer:
HI, thanks for using healthcare magic

It is understandable to be concerned re a surgical procedure.

In terms of hormones, the main hormone that one may think has the potential to influence PSA, would be testosterone.
In some men who receive testosterone replacement therapy there is a slight increase on a yearly basis.

A study released in 2017 and published in a journal called Current Urology confirmed that there is an association with this hormone (testosterone) and the PSA, though it is weak.

If your levels are very very high, then they may be impacting on the PSA results.

There are some new techniques that are currently being developed such as shear wave elastography (this is a new ultrasound technique), it is supposed to the helpful re diagnosis if changes in the prostate but it is a new technique.
The TURP, though invasive , may give the best indications of what is happening with the prostate but you can discuss your options with your doctor.

I hope this helps, feel free to ask any other questions

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Michelle Gibson (9 hours later)

Can you have a PSA as high as 78 just from an enlarged prostate that has BPH?

Answered by Dr. Dr. Michelle Gibson (8 hours later)

Brief Answer:
it would have to be very large

Detailed Answer:
HI

If the prostate is very very large then it is possible.

In addition to the new ultrasound technique mentioned, there are also some very new blood tests that are being investigated.
Like the new ultrasound technique there are not routine as yet eg prostate specific membrane antigen, human glandular kallirein-2

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar