PSA going up

Really cant tell you what do to, but my DRE was always fine and it was a PSA that went up to3.7 that caught my PCP's eye and then she made the referral to a URO. I told him I wanted to wait until the next PSA a couple of months later and it was then over 4, so it was the PSA that let to the biopsy and eventual tx. for PCa. good luck and I hope it is just a blip like the last one was for you.

Michael

1. There is the free PSA blood test:

Low free PSA may indicate prostate cancer. High free PSA along with other factors may indicate that you have BPH and no need of biopsy.

The free PSA test measures the proportion of free PSA to bound PSA in the total PSA in your blood sample. It's called this because PSA-f circulates in the bloodstream "unbound," without a carrier protein.

2. PSA density: This is a ratio of psa to prostate volume:

Divide the PSA test number by the size of the prostate gland found during the transrectal ultrasound to find the PSA density. For instance, if a patient has a PSA test of 6.0 ng/ml and a prostate volume of 40 ml, divide 6.0 by 40. The lower the number, the better. If I remember, a density of .12 or lower is good.

Post Edited (robertcool) : 1/23/2012 9:57:19 AM (GMT-7)

One of my friends was recently diagnosed with PCa after multiple negative biopsies. A specialist finally found it with the aid of some kind of imaging. Turned out to be on the far side of the prostate where the biopsy needles usually don't reach.

It might still be an experimental procedure.

I have had similar numbers in a similar time frame. Been through 3 biopsies, to include a color Doppler ultrasound and saturation biopsy,all negative. My numbers have just jumped Yet again so I am likely headed for another biopsy. If needed I will opt for another saturation biopsy for more definitive results.

I would request a PCA3 urine test along with a free psa before making a biopsy decision. The slow consistant rise in psa is a red flag, but your doubling time is about 4 years which indicates if cancer is found it will most likely be the slow growing non agressive type.
Dr Strum stated in his 45 years of dealing with prostate cancer diagonistics he has never seen a case where a slow consistant increase in psa and a doubling time of under 10 years did not eventually lead to a diagonosis of PC.
If the 2nd biopsy is negative then in the future you should look at getting a color doppler ultrasound or a saturation biopsy.
Greg and DRB,
I know the frustration you are going through. I had 10 years of rising psa and 13 biopsies and an MRIS, all negative. 99% of the doctors you will deal with just don't have the knowledge or experience in Dxing abnormal cases. It finally took a medical dective, a noted prostate oncologist, and another expert CDU interventional radiologist to discover the extent of my cancer.
There are very rare cases of psa leak that cause high psa, but psa usually levels off at some point. The most common cause of multiple negative biopsies with a consistantly rising psa is cancer in the transition zone or anterior which normal trans rectal biopsies just can't adequately reach. I saw the CDU screen that clearly showed the tracks of my previous 26 core biopsy that went all around a 2.5cm tumor without hitting it.
JohnT

Thanks everyone for the replys, I have read them all and will discuss all of the options with the urologist.