Brief Answer:
Detailed answer and explanations given below

Detailed Answer:
Hi,

PSA levels are not very sensitive or specific in diagnosing prostate cancer and has the tendency to increase with time, which might also be the reason why you have it higher with time.

There are different recommendations from different medical authorities and they mostly don't agree on the importance of using PSA and PSA values should be used together with risk factors the patient has for prostate cancer and not just alone.

I would say that if digital rectal exam is normal and the biopsy has shown no cancer then very likely you don't have prostate cancer but just need to have the regular follow up with your doctor and annual check of the PSA levels. It is thought that free PSA (f%PSA) might be more reliable than just PSA in screening for prostate cancer.

There are a few situations that might increase PSA and effect the result:
- ejaculation, avoid ejaculation 48 hours before PSA test
- prostate massage
- acute bacterial prostatitis
- urinary retention
- prostate surgery (the last 4 can keep PSA increased for weeks to months)

To conclude i would say:
- PSA is not very sensitive of specific in detecting prostate cancer
- it should be evaluated together with other clinical information like family history for prostate cancer, race (black people are more at risk), age (increases with age) and other conditions
- you might talk to your doctor about having f%PSA instead of just PSA test as it is thought to be more reliable
- being aware of factors above that might increase PSA will help avoid false positive test results
- if biopsy is normal and digital rectal exam is normal then very likely you don't have prostate cancer
- it is best to continue the recommendations of your doctor and regular check ups as recommended

Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Zotaj Antoneta, General & Family Physician

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