Does Raised PSA Levels Indicate Need For Prostate Biopsy?

Posted on Sat, 27 Sep 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Sat, 27 Sep 2014 Answered on

Tue, 21 Oct 2014 Last reviewed on

Question : I am a 51 year old male. My father had prostate cancer and in April 2014 my psa level was 1.5. This week my blood work came back and my psa was 3.4. My internal medicine doctor referred me to an urologist and this doctor is wanting to do a prostate biopsy. I have been taking weekly testostorone shots for about 2 years now and I am very nervous about this biopsy. A friend of mine is wanting me to get a 2nd opinion from from another urologist who specializes in testorone therapy and sees raised psa levels all the time. Please give me your thoughts and concerns. Thanks

Answered by Dr. Dr. P. T. Patil (3 hours later)

Brief Answer:
No need for prostate Biopsywith PSA of 3.4

Detailed Answer:
Hello
Thanks for query .based on the facts that you have posted and report of your Serum PSA. which is 3.4 is well within normal limits .

I shall be happy if you can post me few more details to make comments on your problem .
1) Has your Urologist carried out DRE Digital Rectal Examination and noticed any hard nodule in prostate.?
2)Is Ultrasound Scanning of the abdomen done if so What is the size of the prostate?
3) Do you have any voiding urinary symptoms ?

Ideally we advice biopsy of the prostate only when Serum PSA is above persistently high above 4 or when a hard nodule is palpated in prostate .

With your PSA below 4 I personally do not think that you need to go for biopsy of Prostate.

Hope I have answered your query ,Please feel free to ask if you have more questions .I shall be happy to address the same.
Thanks and Regards.
Dr.Patil..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (4 hours later)

he did the digital exam yesterday and found everything normal but his concern was that I went from 1.5 to 3.4 since april of 2014. Scan has not been done. I do get up during the night to urinate 1 or 2 times. when you say persistently high do you mean more than one test that comes back high? Again I am taking testosterone injections 1 day per week. thanks

Answered by Dr. Dr. P. T. Patil (18 minutes later)

Brief Answer:
Read Detail answer bellow

Detailed Answer:
Hello
Thanks for follow up.
By persistent raising levels of PSA I mean that if your serum PSA done at regular interval of every month above higher side of normal range of 4 show raising trend..
hen one has to suspect cancer of the prostate which is to be ruled out by doing Prostate Biopsy

Variation in normal values(1-4ng) is not significant at all and does not need any active intervention . I do not think any reason for you to go for invasive procedure of Prostate Biopsy.

Your urinary symptoms could be due to UTI or Prostatitis which can be dealt with taking antibiotics .
Thanks and Regards.
Dr.Patil.

V

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (6 hours later)

So your thoughts that the urologist had that the psa had doubled in 5 months should be of no concern. It went from 1.5 to 3.4?

Thanks

Answered by Dr. Dr. P. T. Patil (11 hours later)

Brief Answer:
PSA is still below normal value.

Detailed Answer:
Hello
Thanks for follow up.
Though PSA level has increased from 1.5 to 3.4 it is still within but it is still within normal range .It can get raised with mild infection of prostate itself and not necessarily due to cancer of prostate.

Please repeat serum PSA every month for 3-4 consecutive months and if it shows raising trend then think of going for invasive procedure of Prostate Biopsy to rule out cancer of prostate and to allay your anxiety.
Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar