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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes elevated PSA levels?

Answered by
Dr. P. T. Patil


Practicing since :1971

Answered : 10116 Questions

Posted on Mon, 6 Jun 2016 in Urinary and Bladder Problems
Question: I have a question regarding my prostate issue. I am a 67yr. old male in good health.In XXXXXXX of 2015 I had a 12 core biopsy (all negative) after my PSA slowly XXXXXXX from 2.0 to 4.18 over 3 to 4 yrs. Since I was on Testosterone replacement therapy my Urologist thought it would be a good idea for the biopsy. While biopsy was pretty painless i had blood in urine and semen for 3 weeks. I then returned to him in Nov. 2015 and my PSA skyrocketed to 8.6. I had an MRI on Dec. 11th. Prostate volume was 85cc and it indicated one PIRADS 3 area but noted no definitive abnormality. This Feb. my PSA had dropped to 5.5, my free%PSA was 33% and my Prostate Volume density was below .10. My Urologist now wants to do a MRI guided biopsy which given my Feb. test results I am not inclined to do. I came off Testosterone Therapy in Feb. and it has been a nightmare since. Not sleeping well, no appetite, no energy, no morning erections and no sex since that time. When I was on testosterone, everything was great!! Is it normal for a PSA to drop if cancer present?? Do I have any options available to me or am I going to be held hostage in getting this MRI guided biopsy?? Your thoughts please...............
Answered by Dr. P. T. Patil 24 minutes later
Brief Answer:
Your going through very confused stage .

Detailed Answer:
Thanks for your query ,based on the facts that you have posted it appears that you have recently your serum PSA (5.5)which is higher than normal range of 4 .

I shall be happy if you can post me few more details to help me in making comments on your problem.
1) Has your Urologist carried out Digital Rectal Examination and noticed any hard nodule in prostate making him suspicious about cancer of Prostate ?
2) Have you done Trans Rectal Ultrasound Scanning (TRUS) and what are the findings ?.

Since your prostate biopsy done in Nov (Three months back )was negative recent rise in PSA level could be due to enlarged prostate with secondary infection .

In a given situation If you were happen to be my patient I would put you on course of antibiotic for one months and repeat PSA levels at regular interval of 4-6 weeks and if there is persistent rise in PSA level I would think to go for Prostate Biopsy.

Please note that Prostate cancer is very slow growing cancer and patient never dies due to cancer of prostate itself but due to other major illness . Hence there is no hurry taking drastic decision of doing prostate biopsy immediately .

Hope I have answered your query ,please feel free to ask if you have more questions , I shall be happy to help you .
Thanks and Regards.

Above answer was peer-reviewed by : Dr. Deepak
Follow up: Dr. P. T. Patil 1 hour later
The last time (don't remember date) he did a rectal exam he told me my prostate was large but soft with no nodules.

I think you have some timing/facts wrong. I had the 12 core biopsy back in XXXXXXX of 2015. When my PSA soared in November I had a MRI done on December 11th. That MRI showed a PIRADS 3 area in the Central gland. Last February, my PSA was down to 5.5 from 8.6 and the two other blood tests were positive in my opinion. 33%FreePSA and Prostate Volume Density below .10.

In general, does PSA ever go DOWN when cancer is present??

Not sure about the about Ultrasound scanning. I think he used ultrasound when he did the 12 core biopsy. I was told the MRI would be the most accurate way to assess my prostate. So that is what we did.

How do I convince him to try the antibiotic route?? He is hell bent on the MRI guided biopsy on the on suspicious area plus without that I am screwed regarding using testosterone.

Should I talk to a second Urologist in my area??

Answered by Dr. P. T. Patil 30 minutes later
Brief Answer:
I can not comment on opinion of some one .

Detailed Answer:
Thanks for follow up .It is unlikely that PSA goes down with cancer in situ .

If possible there is no harm in taking second opinion of other Urologist . As such Urologist in U.S are used to take drastic decision to go for biopsy immediately where as in XXXXXXX we have conservative and go slow approach . Sorry if I sounded rude but it's just an opinion based on my several years of expertise..

Thanks and Regards.
Above answer was peer-reviewed by : Dr. Arnab Banerjee

The User accepted the expert's answer

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