Can someone explain PSA to me?

In 2012 my father went in to see his doctor because his prostate was swollen larger than a fist. He was really sick and in a lot of pain.

His PSA was 8.5 for 6 months so they did a biopsy which was negative. This was May of 2013.

He called today to say his PSA in now 10.5 and his doctor wants to talk about treatments options.

What does this mean? What are 'treatment options'? Does it sound like my father may have prostate cancer or may be leading up to it?

He refuses to do anymore biopsies. He's starting saw palmetto and regular walking.

He turns 65 this year.

It's ambiguous to me what the doctor means. There are also treatments for enlarged prostates that are not cancerous. I would ask for clarification from your dad or his doctor.
PSA can go up from enlargement (BPH ) , inflammation , infection or cancer. Good luck.
p.s. saw palmetto is not especially good.

A negative biopsy means the samples collected didn't contain any cancer. It doesn't say anything about the rest of the prostate that wasn't sampled. In other words, a negative biopsy simply means no cancer was found, not that he is cancer free.

Often a doc will try antibiotics to try to eliminate infection as a possible cause of the rising PSA. Did the doc put him on antibiotics?

There are 3 major diseases of the prostate: Prostatitis, Benign Prostate Hyperplasia (BPH), and cancer. You might want to look these up as the symptoms overlap.

A PCA3 lab test is sometimes used after a negative biopsy. It is a urine test done at the doctors office that shows the probability of cancer. Another option would be an MRI (either T1.5 or T3). This examines the prostate and identifies areas that look like they might be cancerous. Then, if any areas are identified as likely cancer, a biopsy is done that targets those areas.

Another helpful test is the free PSA test. It's a blood test that is simple to do.

I'm your father's age and had a similar experience. Rising PSA plus a small nodule on prostate. Urologist wanted to do biopsy. I ordered a free PSA lab test and asked my primary care doc to do a PCA3 test. Both showed a low probability of cancer.

Then I got my pc doc to do a referral for an MRI (urologist didn't want to give me a referral). Just had the MRI and no cancerous areas were identified, so no biopsy.

Post Edited (richh) : 1/17/2014 12:50:52 PM (GMT-7)

Hello Worried,

Sorry you have to be here but I hope we can help you. PSA is a chemical that is released into a man's blood stream by prostate tissue when there is something going on. As a man gets older his prostate tissue gets cranky and normally releases a bit more PSA and, at time his prostate keeps growing so there is more tissue to release PSA. So it's normal for the PSA to go up some as a man ages. Other things cause PSA to be released -- sex, bicycle riding, digital rectal exams, infections, and of course prostate cancer. Since your dad has a large prostate and had symptoms there is a possibility that his high PSA is because of his enlarged and possibly infected prostate. If that is the case then the doctor may be talking about drugs to shrink the prostate, to knock back the infection, and to make it easier for your dad to pee. He could also be talking about a minor surgery to remove some of the extra prostate tissue, again to relieve his symptoms and help him urinate more easily.

Then again, it could also be prostate cancer. With that PSA the doctors will want to keep an eye on him. I'm afraid, whatever is the case with him he is a bit beyond the Saw Palmetto stage. I'd get after him to go talk to the doctor again. Or you can get him to post here and I will get after him myself.

You said...
I'm really upset because his Urologist told him "there's nothing else we can do for you" last year after his negative biopsy. The plan was to just continue to do the monthly urine test and to check his PSA anually.

Chronic prostatitis is notoriously hard to treat. The doctor's "nothing we can do for you" is a blunt but factual observation of the medical state of the art in many cases. Since your dad's PSA has gone so high the doctor proabably wants to put him on one or both of two kinds of drugs -- one drug (such as Avodart) shrinks the prostate (and yes they do often grow as men age, like ears and noses) and the other type of drug would be antibiotics to see if he has an infection that is making his PSA go up. If neither nor both of those drugs make his PSA go down then the doctor will worry about prostate cancer.

I don't currently see any reason to be unhappy with your dad's doctor except, possibly, for a somewhat undiplomatic bedside manner.