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What Causes Elevated PSA Levels?
Question: I am 60 yo healthy male, no family history prostate CA, negative DRE, and PSA spiked from 1.6 to 2.1 to 2.8 over the last 3 years. % freePSA was 10% each time. Should I rule out Cat IV prostatitis? Then active monitoring or biopsy?
Brief Answer:
No need to worry. Just monitor your PSA.
Detailed Answer:
Hi, dear.
I have gone through your question. I can understand your concern.
Your PSA level is increased from 1.6 to 2.8. But its still not very high. PSA is the marker for prostate cancer. But prostatitis and benign prostatic hyperplasia also leads to slightly high PSA.
You should monitor your PSA level regularly. If it is still increasing then you should go for biopsy of prostate.
Right now biopsy is not required.
Consult your doctor and plan accordingly.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
No need to worry. Just monitor your PSA.
Detailed Answer:
Hi, dear.
I have gone through your question. I can understand your concern.
Your PSA level is increased from 1.6 to 2.8. But its still not very high. PSA is the marker for prostate cancer. But prostatitis and benign prostatic hyperplasia also leads to slightly high PSA.
You should monitor your PSA level regularly. If it is still increasing then you should go for biopsy of prostate.
Right now biopsy is not required.
Consult your doctor and plan accordingly.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you Dr. Sanghvi for your prompt reply. I am a practicing DDS so we can talk technically. Since I am asymptomatic I am wondering how to empirically treat and rule out Cat IV prostatitis.
Regarding lab tests, how about running a pro-PSA which tracks PSA precursors and is appropriate for PSA scores between 2 and 10? Also the PCA3 urine test as another approach?
Thank you and I value your opinion.
Regarding lab tests, how about running a pro-PSA which tracks PSA precursors and is appropriate for PSA scores between 2 and 10? Also the PCA3 urine test as another approach?
Thank you and I value your opinion.
Brief Answer:
I will explain you everything in detail.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern. As you say you are practicing DDS we will talk technically.
Cat IV prostatitis is asymptomatic prostatitis. We suspect only on the basis of histopathological evidence or due to slightly high PSA level. Generally no/any treatment is required for Cat IV prostatitis. However you can take a trial of antibiotics and anti inflammatory drugs.
Pro PSA is the precursor of PSA. Pro PSA correlates more with prostatic carcinoma when level of PSA is between 2 to 10. Pro PSA does not rise significantely in BPH or prostatitis. So Pro PSA level is helpful to avoid unnecessory biopsy when PSA level is between 2 to 10.
PCA3 is genetic marker of prostate carcinoma cells. This cells shed in the urine and PCA3 can be detected in urine. Those with having high value of PCA3 has high chance of positive biopsy for prostate cancer. If PCA3 is low then biopsy can be delayed or avoided.
So overall very small number of cases with PSA level between 2 to 10 having prostatic carcinoma. But very small risk is there. You can go for Pro PSA or PCA3 to decide whether biopsy is needed or not.
Hope I have answered your all questions. If you still have any doubts then feel free to ask me. I will be Happy to answer you again.
Thanks for using health care magic.
Wish you a very good health.
I will explain you everything in detail.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern. As you say you are practicing DDS we will talk technically.
Cat IV prostatitis is asymptomatic prostatitis. We suspect only on the basis of histopathological evidence or due to slightly high PSA level. Generally no/any treatment is required for Cat IV prostatitis. However you can take a trial of antibiotics and anti inflammatory drugs.
Pro PSA is the precursor of PSA. Pro PSA correlates more with prostatic carcinoma when level of PSA is between 2 to 10. Pro PSA does not rise significantely in BPH or prostatitis. So Pro PSA level is helpful to avoid unnecessory biopsy when PSA level is between 2 to 10.
PCA3 is genetic marker of prostate carcinoma cells. This cells shed in the urine and PCA3 can be detected in urine. Those with having high value of PCA3 has high chance of positive biopsy for prostate cancer. If PCA3 is low then biopsy can be delayed or avoided.
So overall very small number of cases with PSA level between 2 to 10 having prostatic carcinoma. But very small risk is there. You can go for Pro PSA or PCA3 to decide whether biopsy is needed or not.
Hope I have answered your all questions. If you still have any doubts then feel free to ask me. I will be Happy to answer you again.
Thanks for using health care magic.
Wish you a very good health.
Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
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