My Doc says no biopsy. Need input.

My Uro is highly respected in NY and following me for two years. My father lived to 94 and had enlarged prostate no CA and prostatectomy at age 74. Sept 2014 my psa was 2.97 and free per cent 23. June psa 2.67 and percent 24.5 Just went mon for check and he called back today very casual stating psa 4.24 and per cent 17.5. He didn't seem concerned and said see me 6 mos. little concerned if need biopsy thank you

At your age you have in truth only just exceeded the upper end of range for most men of middle age. My suspicion is that he wants another point on the graph before he puts you through a biopsy, this is not unreasonable. Given your father's pretty good history he is probably being cautious but not over-reactive. Remember also that you can always ASK for a PSA at (say) 3 months from him or even your PCP.

Did you ejaculate within 24 hours of your test, did he do a rectal exam before drawing blood, do you ride bikes, horses, camels... All of these things can 'artificially' raise your PSA and should be avoided prior (except nobody ever tells us poor dumb men this).

If you want more information, you could ask for a Prostate Health Index blood test; this is considered more specific than PSA. It may take some hunting down as not every facility can conduct them. I believe that there is also one called PCA3?

Many folks arrive and often pass through here with Prostatitis (me likely included), my PSA went 1,4,2,8,8 in three months. So he may be considering that and looking to see if you exhibit the classic zig-zag pattern.

If he's a little too laid-back for your psyche, I might take matters into my own hands, schedule a PSA at 3 months, no sex, bike riding or the like for a few days beforehand and see what I get before jumping to biopsy (which isn't really the best day you'll ever have).

Along with a "Welcome and I hope you're just passing through" I will say that you have happened upon a rich resource of information, experience and support. A dozen guys will be along in a minute to tell me what I forgot and to help you.

Paul

Paul

Post Edited (Paul65) : 11/18/2015 10:39:33 AM (GMT-7)

Hello DrBill,

Welcome to the forum. Sorry you find yourself here but glad you found us. Hope we can help.

In general most doctors like to see a PSA of less than 4.0 and a free PSA percentage of more than 25%. A PSA of over 10 or a free PSA of under 10% are considered quite alarming. Your results are getting into the "concerned but not alarmed" part of the gray area for both tests. Since you are worried you might ask your uro about the Prostate Health Index test (PHI) -- another blood test which adds another biomarker to PSA and free PSA and appears to be quite a bit more specific for prostate cancer. Several studies have shown that it can successfully and safely be used to avoid many negative biopsies. Whether you would want to do the PHI at your next 6 month appointment or, maybe, pull it in to three months would also be up to you.

Thank you gentlemen for the advice. I just received a call from the doc. I have been on Androgel and he is waiting for my testosterone lab result back and states since Prostate and Breast are such hormone driven diseases he wants to see if this rise parallels with my results. Guess this makes sense since I have been on increased testosterone. Btw. I did have sex within 48 hrs of test.

Dr Bill,

It sounds like your doc is being informed and conservative. PC, even if it is there, is a slow-grower, and waiting six months is pretty standard. There are any number of things that can cause PSA to spike that are non-specific. One writer has labelled PSA as a 'check engine light' for your prostate. It means something is going on.

I'm sorry to provide a counterpoint, but I remain convinced that my NYC Uro's insistence on "you must have a biopsy if PSA goes over 2.0" was a meaningful contributor to my early detection. I freely admit that I'm in the "act fast and aggressive" camp (but he didn't know that), which is definitely not for everyone, but then I guess the whole point of this forum is to glean opinions from many people and then make a balanced and informed decision.

I remain extremely grateful for the advice, support and companionship that this forum provides. so a continued big "thank-you" to all.

I went for my 18 month post RP blood test this morning. The wait for the results never gets easier does it!

FWIW... I am about the same age, had a slow rise, and my Doc recommended a biopsy when my PSA was only 2.85. You can see the rest in my sig, but bottom line, PCa. Granted, very small amount of G6, and I opted for AS, but still...

DrBill, I tend to agree with Tudpock, I'd ask about a round of antibiotics.. The free psa drop is a bit concerning, but it's one reading. Definitely retest but maybe in a month rather than 3. If you don't see a change for the better in the readings I d ask for an MRI guided biopsy.
If you have as you say a "well respected" Uro, (would you be open to sharing his name, maybe some or one of us has had experience with him/her?) then they are probably thinking this already.
Good luck
And, I'm not a medical professional.

P.S. - once again, someone has grabbed onto a few words that were not even the point of the post put up, and turned a useful thread, important to a new and troubled member, into a thread focused on something not helpful to a new member looking for help..
I suggest we all ignore it from this point on and help Dr Bill as best we can.

Gentlemen , having experience with some forums i understand a post can go off the course but the information from everyone is invaluable to me at this stressful and anxious time. Since my last post my Uro called me back and his reasoning is the following- I have been a past user of sports performing drugs from 2008 until 2014. He explained to me that the two biggest hormone induced diseases, CA and benign, are breast and prostate. My spike on my last PSA he feels can be related to a rise in my testosterone levels. Two months ago when i was stable and 2.67 and my test level was 400,- he prescribed Androgel for me on his own due to years of taking it externally. I was basically "shut off "... So this week he drew my test level at same time and awaiting the result. He feels if my test level increased that this is proportionate to psa rise. If that is the case than he wants me to lower/stop the Androgel. of course this makes sense but i guess i am scared that my yrs of test/steroid use has created more of a prob down there... i have decided on my own what might be best is to just stop the testosterone gel and take NOTHING..Then retest in 30 days? or should i wait 60?? thanks again guys!!

I'm no expert on this issue, by far, DrBill. But what you are proposing and what Andrew said above, make a lot of sense to me.

I was on T injections for close to 2 years. My PSA slowly rose to 6.8 and at that point, my uro recommended a biopsy. When the results came back positive (3+4), my uro wanted me to stop my bi weekly shots. Two months later, my PSA dropped to 3.2. Had I opted to wait on the biopsy, I might have been inclined to blame the testosterone for the 6.8 and waited on the biopsy. I'm happy that things unfolded in the order they did. As you can see in my stats, my post surgical pathology came back with a Gleason 8 with EPE, but negative margins. Kinda feel like I may have dodged a bullet. Will have first PSA in Dec. Keeping fingers crossed!

Brokencrotch. As I read your story it makes me so happy that you caught something before assuming it was from a correlation with the T. However on the flip side if my levels of t decrease and so does my psa when I stop the Androgel then isn't it safe to take s more watch n wait before going for a not so pleasant and invasive biopsy procedure.

Dr. Bill, Most patients have little to no difficulty with biopsy. It's unpleasant, but not much more. I found the most painful part was the antibiotic shot in the butt cheek.