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Prostate Cancer

Increasing PSA with Negative Biopsies



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


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