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Fluctuating PSA

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Posted 2/23/2021 2:24 PM (GMT 0)
I am 48 years old. My PSA has been fluctuating. Do I need biopsy ?
Date PSA
1-Jul-15 1.3
9-Nov-18 1.57
8-Feb-19 1.66
27-Dec-19 2.15
6-Feb-20 3.39
11-Feb-20 4.7 Blood draw after DRE
20-Feb-20 2.78
22-Feb-20 1.8
27-Feb-20 2
23-Oct-20 2.2
16-Jan-21 3.19
23-Jan-21 3.5
Posted 2/23/2021 2:39 PM (GMT 0)
Hi ashu and Welcome to the Forum!

It should be a urologist who makes that call together with your input (do you have a uro?). Do you have BPH? Increased PSA from it can complicate the picture, as can other, non-malignant, prostate conditions. There are some tests further tests that can be run to help with the biopsy decision, such as looking at the ratio of percent free PSA to total PSA, and the prostate health index (phi).

I trust all your PSA test were done at the same lab (?). This is the best way to avoid discrepancies between labs and test methods and ensuring that any rise is actually yours.

Given what looks appears to be a large increase from your 2020 values, a 3T MRI may be in order. It can help identify and grade lesions seen on a 1 to 5 scale for how suspicious they appear on the imaging (generally any lesion graded 3 to 5 warrants a biopsy); however, a baseline biopsy can be a good even if nothing is seen on MRI if your uro has reason to want to rule out prostate cancer.

Having a first-degree relative with a history of PCa is another risk factor that should be considered.

I, too, had a slowly increasing, but fluctuating PSA, but my fluctuations were much smaller than yours. I had many biopsies over several decades that were all negative (until the last one). The recurring concern triggering these biopsies was that some of my PSA jumps were a bit higher than what was expected from BPH alone.

Given your PSA history, even if they show no cancer, a baseline MRI plus biopsy can be very helpful going forward. The bottom line from my layman's view is that your fluctuations are less of a concern than what appears to be an upward trend.

Djin
Posted 2/23/2021 4:24 PM (GMT 0)
Why do you repeat so many tests?
As Djin already emphasized, it's best to stick with one lab for consistency. There are some precautions many take prior to PSA testing: no sex, no bike riding although some feel there's no need for that. I would err on the side of caution.
I also support Djin's suggestion of getting another baseline test such as an MRI in addition to your PSA tests. Another prostate 'finger' test (DRE) would be a good thing as well.

Post Edited (Sr Sailor) : 2/24/2021 2:17:49 PM (GMT-7)

Posted 2/24/2021 6:23 PM (GMT 0)
Thanks Djin and Sr Sailor. Will consult urologist and request for MRI.
Posted 2/25/2021 2:15 AM (GMT 0)
Getting an mri is a good idea. I was on the borderline psa for a time, so got a prostate mri because of family history. It came back indicating lesions and then I went to a biopsy etc. So the mri can be very helpful before going down a more intrusive path. The mri isn't conclusive - suspicious stuff can prove to be something else, but a biopsy after that finding is necessary. Sr Sailor's comment on getting a dre is good too. If you go to a urologist it should be one of the things he/she does as it can be informative.
Posted 4/5/2024 2:05 PM (GMT 0)
Hello,

My PSA today 5th April is 17.5.
On 14-March-24 it was 4.4
On 22-March-24 it was 3.09.
For past few years it has fluctuated around 3.
Any idea what is happening ? I have an MRI scheduled coming week.

Thanks

Post Edited (ashu) : 4/11/2024 4:38:31 AM (GMT-8)

Posted 4/5/2024 3:18 PM (GMT 0)
Such a sudden rise usually means that you have an infection (prostatitis). But do check this out ASAP. The MRI should help in figuring out what is going on.
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