Suggest Treatment For Increase In PSA Levels

Posted on Sat, 4 Jul 2015

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

Sat, 4 Jul 2015 Answered on

Sat, 25 Jul 2015 Last reviewed on

Question : Recently had my annual check up and PSA level had increased sharply...from less than 1 to 9. Saw specialist yesterday who said I didn't have BPH and the DRE was normal. I did have sex a couple of days before blood test, so he is redoing my PSA levels. Also have scheduled a biospy for July 23. Told me if the PSA level declines, would hold off any additional procedures. Seems like this is an early stage diagnoses but still a higher probability of some cancer. Am I looking at the correctly? If so, how aggressive should the treatment plan be and what is the outlook?

Answered by Dr. Matthew J. Mangat (38 minutes later)

Brief Answer:
Repeat PSA in 4 weeks.do a TRUS prostate and abdominal scan.

Detailed Answer:
Hello XXXX and welcome to HCM.
You have nothing to worry at present.Your next PSA must be checked with an interval of atleast 4 weeks.As an experienced Urologist, many patients' repeat PSA is normal.
A biopsy is done only if repeat PSA is above 4.Don't rush with a biopsy before the next PSA. However, you should have a TRUS (trans-rectal ultrasound ) scan of the prostate. This is to see changes within the prostate gland, which can't be felt with a DRE. If there are definite abnormalities in this prostate scan, then only the biopsy need be done before the next PSA. At the same time, an ultrasound scan of the abdomen will also be done as routine.
If you have any other queries, you are welcome to address it in my name.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Matthew J. Mangat (31 minutes later)

Thanks for the quick reply. Didn't know there could be big swings in PSA levels from test to test. My PSA levels have always been very stable in past tests.

Answered by Dr. Matthew J. Mangat (1 hour later)

Brief Answer:
PSA does fluctuate.

Detailed Answer:
Hi again.
You may find the next PSA to be within normal limits.
Anyway wait for the report, but carry out the scan tests.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

Follow up: Dr. Matthew J. Mangat (22 hours later)

Dr told me I didn't have BPH based strictly on the DRE. Could that change as a result of the TRUS examine.

Answered by Dr. Matthew J. Mangat (1 hour later)

Brief Answer:
DRE is only one assessment.

Detailed Answer:
Hi again.
BPH is diagnosed after doing a flow rate test with scoring of your symptoms,which you told the Urologist,and DRE,Ultrasound scan test( TRUS )with the blood reports including PSA, to know if there's any change within the prostate gland.
So, diagnosis is not based on a single test.
It's best to undergo the scan, for a proper approach to diagnosis.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Matthew J. Mangat (30 hours later)

Still waiting on my PSA retest results. Just wondering when a cancer first starts in the prostate does it show large increases in PSA levels. Going from .3-9.0 in one year is a bit unnerving. I would also like to understand the outlook for aggressive prostate cancer patients that have their cancers found quickly...has not spread.

Answered by Dr. Matthew J. Mangat (5 hours later)

Brief Answer:
high PSA is not cancer prostate.

Detailed Answer:
Hi again.
Don't worry about probabilities which don't exist.
A high PSA is above 10 on repeat readings. 4-10 is considered a grey area.
TRUS scan, helps to tell us where to direct biopsy, if the repeat PSA is again up.
Even if PSA is high, the biopsy is not 100% diagnostic of cancer prostate.
As an Urologist, i'm telling you, there are many cases where the PSA is elevated falsely, as in large prostates, prostate inflammations,pressure or manipulation of prostate before checking of PSA, etc.
The only test to confirm it is prostate biopsy.
So relax and contact me with the repeat PSA report.
wish you good health.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Matthew J. Mangat (33 hours later)

Have been able to schedule an appointment with Dr Catalona from Northwestern Hospital here in XXXXXXX He is written extensively on prostate cancer and came highly recommended by Heathcare Network....a private group that helps XXXXXXX business executives manage their healthcare issues and find resources. You have been a great help to me and I will keep you informed as to his findings. By the way I am a retired CEO of Rewards Network and a former ATT business unit president. Always have gad a great deal of stress to deal with, but feel like I am doing ok in working thru this issue.

Answered by Dr. Matthew J. Mangat (1 hour later)

Brief Answer:
you're welcome.

Detailed Answer:
Hi again.
Good to note you seem to be more relaxed now. Dr.Catalona is a familiar name, as we're both in the same profession. You can confirm with him, that PSA is only a tumor marker, which is not diagnostic of cancer prostate, but only suggestive.
Also, TRUS is far better to assess the prostate, than an Ultrasound abdomen.
Hope you feel free to contact me any time. Exercise relieves stress in a major way.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Matthew J. Mangat (1 hour later)

Just realized I did a 25 mile bike ride for the first time in 40 years on XXXXXXX 12...had my blood drawn on XXXXXXX 16. Prostate took Abigal beating over those 25 miles.

Answered by Dr. Matthew J. Mangat (17 minutes later)

Brief Answer:
good humor.

Detailed Answer:
Hi again.
Your sense of humor is enjoyable.
Please note, a bike ride and PSA aren't related.
Hope your spirit remains the same.
Wish you well.

Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar