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No semen and high PSA

Posted 15 Aug 2021 at 21:06

Hi guys,


My dad is 68 years old. and recently had a slow rise in PSA. 


3.7 Feb 2020

3.6 Nov 2020

4.8 Mar 2021

biopsy  May 2021

9.4 AUG 2021


The biopsy came back negative however he still to this day has no semen when he ejaculates. Another worrying sign was he took a blood test two weeks ago and his PSA jumped to 9.4.

Is this normal? Is been a few months and he still has no sperm. And his PSA jumps to 9.4.

But his biopsy did come back normal. 





Posted 15 Aug 2021 at 23:32

Retrograde ejaculation is possible you can Google it and find it is not a problem in itself, but one has to wonder what the cause is.

What kind of biopsy was it? Trans rectal ultra sound TRUS is not very good at finding cancer, transperineal biopsy is more likely to spot cancer. Did he have an MRI scan? 

There is a possibility the high August psa is a result of the healing process from the biopsy. What has his urologist got to say about the rise in psa? 

I think I would be happy to have another psa test in October and see if psa has came down, if it has I would blame the rise on the biopsy. 

Ignoring the August test, his PSA is still rising at 30% per year. I presume he is on Active Surveillance, and this will have to continue until his PSA stabilises or they find cancer. 


Posted 16 Aug 2021 at 00:12

He had TRUS. Now that i google it, I wonder why they didn't go with transperineal biopsy. 

No MRI. 

Posted 16 Aug 2021 at 09:57
OK Bob,

Going forward, get your Dad sorted for an MP-MRI scan, followed up with a transperineal biopsy, if his clinicians think it’s appropriate.

Don’t waste everybody’s time with another, now largely discredited, TRUS biopsy, as there are guys here who have had three inconclusive ones, only to have a fourth transperineal biopsy which confirmed their prostate cancer.

Bear in mind that 60% of men in their sixties have some cancer in their prostate, and most will die with it, blissfully oblivious, rather than of it.

If your old man is confirmed with PCa, bear in mind that is an additional risk factor for yourself!

When you reach fifty, insist on regular PSA tests, and don’t let your GP palm you off with some leaflet or flannel about ‘You have no symptoms, why do you need a test?

Best of luck to Papa.

Cheers, John.

Posted 16 Aug 2021 at 12:24


Are you in the UK, treatment / investigation can vary from country to country ?

Thanks Chris



Posted 16 Aug 2021 at 14:16
I am in the USA
Posted 16 Aug 2021 at 15:04


An article I read the other day seemed to say the TRUS biopsy is still the most commonly used type of biopsy in the USA. 

Thanks Chris


Posted 16 Aug 2021 at 15:15

OK USA may be different. In the UK we have the NHS and they tend to follow national guidelines. About half of NHS hospitals have bought the new transperineal equipment and the other half are still using the old TRUS equipment which will almost certainly be abandoned within a few years. 

Now-a-days an MRI is usually done before biopsy which can hi-light suspicious areas. The biopsy needles can then be directed at the area of concern. TRUS usually use about 12 samples, and with no MRI to help guide things, the chances of hitting a small tumour are not very high, but if it is a large tumour it may be found.

With the transperineal biopsy about 40 samples are taken so nearly four times as much chance of hitting the tumour. Doing an MRI just now would not be much use the prostate needs to heal from the first biopsy, give it a few months, and then consider the options Bollinge suggests.

Of course cost may be a factor, in this country we pay for the NHS out of high taxes, but at least it is there when we need it, and we have already paid for it.



Posted 16 Aug 2021 at 21:20

MRI before biopsy is still not common in the US, because insurance often won't pay for an MRI scan until you've had a positive biopsy.

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