psa and biopsy

Hello,  First post. However, i have been here many times.

February of this year I had an 8 core biopsy, results were negative. I just had my follow up psa and it is up. I see my Urologist in a couple of weeks and I know he’s going to want another biopsy. Only blood work done up to this point is the standard psa blood test. Suggestions? Go along with my second biopsy? Request psa free test? No family history to my knowledge. Mother, Father and Grandparents died young. Seems as if I already know many of you, any information you can provide is appreciated.

Thank You

Age 52

PSA History:  7/05 1.36

                     1/09 3.34

                     12/09 4.20

                     1/10 4.90 (8 core biopsy negative results)

                     5/10 6.62

Its been 4 months since your biopsy, not too soon if you and your dr sure another is warranted. My last two biospies were barely 6 weeks apart, the dr saw suspicous "shadows" in the scan, and on the 3rd one, only took cores there, and came up 7 of 7 positive. He doesnt think your PSA rise is related to any kind of prostate infection?

I think a color doppler may also be a test to consider. Appears to be a big help in these hard to find situations with rising PSA and negative biopsy.

Welcome!  My experience with a biopsy wasn't in the top ten things I enjoyed doing, so I (and the AUA) think you might want to think hard about rushing into another one. The fact is that far too many biopsies take place.   This is not my own personal shoot-from-the-hip, Ready-Fire-Aim conclusion.  This is the conclusion of the American Urological Association (AUA). The AUA's " Prostate Specific-Antigen Best Practice Statement:  2009 Update " says that in addition to PSA and DRE results, doctors should take these into account before proceeding to biopsy: free and total PSA (complexed PSA) patient age PSA density PSA velocity family history ethnicity prior biopsy history Before proceeding to biopsy, a variety of factors can influence PSA and should be considered in the interpretation of results...especially at low, but abnormal levels (in the 5-6 ng/mL range). PSA tests are not very " specific "; that is, they may indicate prostate cancer or they may indicate a number of other non-cancerous causes.  The PSA rise you have experiences has more of a signature for infection than for prostate cancer; it still could be due to PC, but that would be very atypical.  That being said, even if it is due mostly to infection, if the doctor looks hard enough it will be likely that he will find some cells which are naturally developing into cancerous shapes—as it does with age for ALL men. My specific recommendations:  1.  Get yourself intimate with the free online AUA document referenced above to make yourself an informed, empowered patient...avoid "shooting-from-the-hip."  It can be found at:  http://www.auanet.org/content/media/psa09.pdf?CFid=658649&CFTOKEN=15265454&jsessionid=84301aded42bfce88a3d743f7f76175f4a2f 2.  Request that your doctor seek to eliminate all doubt that the PSA rise is due to infection or other non-cancerous causes. 3.  Request that your doctor perform a complexed (free and total) PSA test.  Numerous medical studies have assessed the use of complexed PSA as an alternative test to total PSA for early prostate cancer detection. The majority of studies report an increased specificity and thus a decrease in the number of unnecessary biopsies utilizing complexed PSA in the total PSA  range of 2.5 to 6.0 ng/mL...right in your range.  One can easily search and find more info on “free PSA ”, but here’s a briefing: PSA exists in the blood in two forms:   one bound to plasma proteins (complexed) and the other in the free state ; total PSA is the combination of both.   Benign prostate tissue contains more free PSA than prostate cancer tissue.   Patients with prostate cancer tend to have lower free/total ratios, whereas men with benign disease have higher free/total ratios, except in the case of prostatitis.   Using the ratio of free/total PSA will reduce the number of biopsies in men with PSA levels between 4 and 10 ng/mL. So, despite all this, while biosies aren't in the top ten list, it is likely that someday another one will be in your future...sorry, it's just the reality .  Hopefully, some of these points will lead to other, simpler but informative tests being done FIRST to really conclude where another biopsy is warranted or not, but the sad reality is that prostate cancer is a naturally occurring outcome of men aging .  Now that you've had one, I would agree with Tudpock that next time you should have the 12 or 16 sample version...once they are in there, they might as well make the most of your and their time! best wishes... Post Edited (Casey59) : 5/22/2010 8:00:02 AM (GMT-6)

Thank you for all the suggestions, that’s why I came here. I will talk to my urologist about all your recommendations at my next scheduled appointment on June 8th. I will post update following that appointment. I forgot to mention that between the 12/09 and 1/10 psa I took a thirty day supply of cipro. Urine was collected and tested on both occasions (not sure for what), was told it was good. Thank you again, I will keep you posted in a couple of weeks. God bless you all.