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Tuesday, March 11, 2014
Prostate PSA 35. Does it mean cancer?
Over past 3 years my PSA has gone up from 11 to 17 then 28, then dropped to 17 and now up to 35. I have had 3 biopsies in that period all negative. My urologist told me it makes no sense - digital exam is prostate is noral like that of a 20 year old. I am now 69 years old. He wants me to have another biopsy - I do not. Under these facts is it likely I have prostate cancer or is there another cause. Thank you.
The situation is of concern for prostate cancer. Other causes of elevated PSA include inflammation or enlarged prostate. One method of increasing the specificity of the PSA is the serum free PSA which is reported as a percent of total. The lower the percent, the greater the risk of prostate cancer. Unfortunately, this is not perfect. Other methods of investigation include MRI of the prostate with spectroscopy, but this is offered in only a few centers at this time (University of Cincinnati is one of them; others include Massachusetts General and University of California at San Francisco).
Later in this year, investigators will present new methods of detecting prostate cancer that will provide greater specificity (correctly identifying prostate cancer with the hope of eliminating unnecessary biopsies). However, we are uncertain at this time when these screening methods will be generally available. In the extreme, PSA's can increase through the 30 ng/ml range before prostate cancer is detected.
I have had one patient who underwent multiple biopsies before prostate cancer diagnosis was made. My partner described a patient who underwent more than 10 biopsies without prostate cancer diagnosis, but when the prostate was removed, it did contain prostate cancer. There is much uncertainty with current methods, and work goes on to decrease this uncertainty.
My advice at this time would be to get the serum free PSA and, based upon your risk profile, decide what risk you are willing to tolerate (the risk of prostate biopsy vs. the risk of undiagnosed prostate cancer).
James F Donovan, Jr, MD
Professor of Surgery
Director of UC Urology
College of Medicine
University of Cincinnati