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Prostate Cancer

Increase in PSA with Negative Biopsies

12/10/2007

Question:

I have had 5 Biopsys all have come back negative for prostate cancer. My PSA has gone from 3.5, 7 years ago to my latest of 10.3. My last biopsy was done when my PSA was at 7.3 1 year ago. 3 months after my last biopsy my PSA was 8.8. 8 months later it is 10.3. Are 5 biopsies enough or should I keep on getting biopsies as my PSA elevates. I am 58 yrs.

Answer:

Sorry for missing this one.

According to your information you do seem to have a significant rate of rise of PSA (PSA velocity) over the last year, though it has not doubled. The concern with such a situation is whether this rise is due to prostate cancer. In a scenario as yours where several previous biopsies have been negative, the decision as to when to rebiopsy is not clearly defined and is usually made in relation to the existing clinical circumstances. One thing to rule out would be other causes of PSA rise such as urinary infection. It would also be important to note the digital rectal prostate exam findings and whether there has been any interval change in this. A free/total PSA ratio is another test which can sometimes help in such situations where a ratio <0.25 is more suggestive of malignant disease (these values are again variable).

If you decided to proceed with a biopsy, I feel it would be worth performing a saturation biopsy (samples a significantly larger area of the prostate than a standard biopsy) and a biopsy of the transitional zone of the prostate (if this has not been done already). I am not sure what the indications for your previous repeat biopsies were, but but rate of rise is an important factor that should be considered besides the absolute PSA value.

I would recommend that you have a detailed discussion with your urologist regarding the above mentioned issues as there is no one right answer to this situation. I hope the information above helps you make a informed decision along with your physician, regarding further biopsy.

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Response by:

Krishnanath  Gaitonde, MD Krishnanath Gaitonde, MD
Assistant Professor of Clinical Urology
College of Medicine
University of Cincinnati