Fluctuating psa. Going for 2nd biopsy

I'm grateful to have a place to vent. Be 60 in April very healthy,runner,just a dysfunctional prostate. Psa started a slow rise about 5 years ago. Nothing concerning to urologist . At 3.0 back in 2012. History of bph and prostititis. In 2013 psa 7.9 redone week later dropped to 7.1 dr also said right side of gland felt firm. Had 12 core biopsy which showed normal. Since then psa went 5.7 then 4.6 then 3 months ago I had an inflammation and it shot up to 7.1. Just reached 2 yr mark since biopsy and psa dropped all the way back to 4.3. Dr sAys it's time for another biopsy since level remains above 3.5. My mind is racing with the unknown. Even though I've had a firmness on one side of prostate doc says Ive had that. Also I'm confused how my psa is going back down if I have cancer. Any help would be appreciate. I admit I'm confused and worried...thank you for listening. Doctor also gave me the option of waiting since my psa had dropped but would prefer another biopsy since its been 2 years since last check

You are showing the classic pattern of relapsing prostatitis. With PC, PSA doesn't go back down, it only goes up. Does it respond at all to antibiotics? It's possible to have both PC and prostatitis, and BPH too. There's an inexpensive blood test that can help distinguish called PHI. Click here for details. There's also a urine test called PCA3 that may provide a clue, but it is more expensive and check that your insurance covers it first. If the biochemical markers are negative, you may want to wait before another biopsy. If they are positive, you may want an mpMRI-targeted biopsy next time.

- Allen

My one hope is that since my numbers are back to 4.3 I've read that if you have a cancer they do not go down but continue an upward trend. Hoping for the best will have 2nd biopsy in 2 weeks. Firm right side of prostate also has me worried. Dr.said that has been the same ,nothing new, only doing 2nd biopsy because 2 years have passed.thank you for all the responses and support.

Here's my saga.

in 2004 at 54 my PSA was over 4 and I had a 6 sample biopsy. No cancer. PSA tests until 2014 were under 4.00 and then a spike in 2014 to over 7 with GP (Dr Weiner). at that time i was taking 5mg of Finesteride. I went to the urologist who performed the 2004 biopsy but he had lost my records. I stopped the Finesteride and engaged other urologists Dr. Licht and the head of urology at the University of Miami to get two opinions concurrently since Dr Licht had no confidence in lab used by GP. I was looking for consistency in lab results and patterns over time. Results from both doctors dropped to 4.xx from 7. and then to 3.11. Most recent PSA score was 5.1 and i declined a biopsy. i have an appointment today 10/19/15 at U of M and an appointment in Nov '15 with Dr. Licht. of course U of M wants to perform a fusion biopsy but i am not a fan of prostate biopsy. never quite felt the same after 2004 biopsy and my cousin spend a week in hospital with a nasty infection after an in office 12 sample biopsy.

I am a 5 year survivor of base of tongue cancer (stage four local metastasis - curable) and not afraid of watchful waiting. I know the quality of life issues from cancer treatment since i have very little saliva and taste is degraded, but this was the price of victory. I dont want to add the side effects of prostate treatment. I suffer urination issues helped by a daily dose of Flomax generic. I suspect the fluctuating PSA is due to chronic prostatitis but doctors are always looking for cancer and so far they rely on biopsy. I also know from cancer treatment that doctors have different levels of knowledge. I fired the first team of head and neck cancer specialists who wanted to remove my infected lymph nodes. The second opinion radiation oncologist recommended radiation only twice daily for 8 weeks. odds were 85% for cure and 80% to save salivary gland in line of fire. Salivary gland didn't make it but i did.

Today i wanted to learn about other men's experiences with fluctuating PSA. I'll relate my sojourn.

8/10/2015 5.1 licht
11/14/2014 3.11 licht
4.xx university of miami
6/14/2014 4.xx licht
5/23/2014 7.11 weiner
2/24/2012 1.73 weiner
10/27/2009 2.25 weiner

i thought this thread was about fluctuating PSA and my experience over 12 years of fluctuating PSA is relevant to all those making decisions. I dont want another biopsy. Doctors err on the side of caution. their enemy is cancer and quality of my life is subordinate. I'm not looking for help in making my decisions and this will be my last post.

U of M urologist recommended 4k score test followed by MRI. the 4k score will rate the possibility of aggressive cancer and the MRI will show the presence of lesions. If 4k score is less than 25 and no lesions are found then no biopsy. if 4k score is greater than 25 then or MRI shows lesions then fusion guided biopsy will be performed using the MRI results to target lesions or suspect areas for sampling.

ezbleed,
I have nothing against the 4Kscore other than its cost. You can get PHI instead for free (Unlike 4Kscore, it is covered by insurance) and has much the same accuracy.

The nice thing about the fusion biopsy is you can take it one step at a time - only going ahead with the biopsy if the mpMRI reveals something suspicious.

- Allen