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Prostate Cancer

Increasing PSA with Negative Biopsies

03/12/2008

Question:

About 4 years ago I was found to have an elevated PSA and normal DRE (maybe a little fullness on one side). I`m otherwise healthy. I do have symptoms of BPH. Over these 4 years my PSA has risen into the 15 range where it`s stayed for about 2 years. I`ve had 5 biopsies done, with ever increasing number of specimens, all of which have been negative. I also took a long course of antibiotics with minimal change in my PSA. I`m afraid I`ll be having biopsies every 6-12 months for the rest of my life! What else can be done? Thanks

Answer:

It certainly sounds as though you are being followed very closely. We know that some people have elevated PSA's that are not due to cancer. A few things that can be done, is to follow your PSA velocity or the rate of change of your PSA. If it is >0.75 over one year that would be a reason to do a biopsy. Also, a percent free PSA can be checked, and if your percent free PSA is <11, it would be another indicator for a biopsy. If you were to require another biopsy, I would make sure that they do a transition zone biopsy as well, and maybe even a transurthral biopsy of the prostate, which is not normally sampled by a transrectal biopsy. A transurthral biopsy is not typically done, however, given your situation it may be indicated.

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Response by:

Lee E Ponsky, MD Lee E Ponsky, MD
Associate Professor of Urology
School of Medicine
Case Western Reserve University