Suggest Treatment For Fluctuating PSA Level

Posted on Mon, 17 Nov 2014

Question: This is a follow up question to issues I discussed a month ago. About a month ago I went to have a check up and my psa levels came back at 3.4 which was double when I had the test 6 months earlier. Then the PSA was 1.5. I was sent to a urologist who determined I should have a biopsy done. Reluctant to do this I had a 2nd doctor review my information. He determined I should wait 3 to 4 weeks and redraw the blood. I did so this week and the psa came back 2.0 with a free psa of 11%. This doctor is wanting to retake the test again in 30 days and see if the free psa gets any better. The first doctor is still wanting to do biopsy even after the psa came back at 2.0. I have had a dre test which was good and had a ultra sound done this week that came back fine but did see some enlargement. I DO NOT want to have the biopsy unless absolutely necessary but do not want to risk anything either. What is your advise?? My father had prostate cancer at 70 years old and did recover from it. I am currently taking testosterone shots but have not been taking for the last 3 weeks. The 2nd doctor wants me to resume the testosterone shots tomorrow. I also started taking prostate supplements a few weeks ago which has saw palmetto.

Answered by Dr. Dr. P. T. Patil (2 hours later)

Brief Answer:
I still emphasize not to go for Prostate Biopsy.

Detailed Answer:
Thanks for writing again .I can understand your concern over your low free PSA level. I would state that it is very confusing stage for consultant and patient as regards the need for prostate biopsy in such situations .

Many a times we use other criteria for making decisions whether to go for prostate biopsy is what is called as Prostate Density. This is ratio of Total PSA divided by volume of Prostate as determined by Trans Rectal Ultrasound Scanning examination .(Normal value is 0.15.) Any level above this range is considered to be ideal for taking a decision for doing Prostate Biopsy.

Since your PSA are within normal range I still think that you should wait for two months more and repeat your Serum PSA levels and Trans Rectal Ultrasound Scanning and take the decision based on the results at that particular time.

Hope I have answered your query . Please feel free to ask if you have any more questions I shall be happy to help you.
Thanking you with Regards.
Dr.Patil.

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