PSA trending down but not normal

User

Posted 15 Nov 2024 at 15:10

Greetings.

Summary: 63 y/o Caucasian; No symptoms; regressing PSA results: 8.14 (7/29/24), 5.4 & 9%free PSA (9/3/2024), 4.65 (11/5/2024); negative DRE; concerned about prostate biopsy and is it necessary.

I had a routine PSA test the end of July 2024 and it showed my PSA was elevated to 8.14 ng/ml(H). I was having no symptoms but of course I was concerned. The doctor ordered a follow up PSA with %free PSA so a different lab was used and I had this test done in early September 2024. Results were 5.4 ng/ml(H) for the PSA and 9% (calc)(L) for the %free PSA (Alt Meth). Although the PSA decreased, he recommended I see a Urologist. The Urologist recommended a transrectal prostate biopsy but agreed to redo the PSA and did a digital exam. He said it felt normal. I went for my third PSA 4 days later (beginning of November) and the results of that were another decrease down to 4.65 ng/ml (H), but still not normal (below 4.0).

My issue is I'm struggling with whether to get the biopsy. I understand complications are rare, but they're still present. I also understand that other factors can contribute to the elevated PSA including constipation (I am), ejaculation (duh), and exercise (nothing strenuous but I do get winded).

I'd appreciate any input on my situation re my regressing PSA and my aversion to biopsy. Has anyone seen or experienced this and what was the outcome. I'm well aware any discussion does not constitute medical advice. Thank you for your help.

User

Posted 15 Nov 2024 at 16:44

Hi,

My first thought was it's a shame the second psa test was done at a different lab as the results might not be consistent. I also wondered if you're in the UK as we don't hear much about free psa tests. Did that influence your doctors decision? Also in the UK we'd have an MRI test before a biopsy.

As your psa is now 4.65, down from 8 in July and 5 and in September, and so isn't that much above the threshold I think I'd be holding off from a biopsy until a consistent rise happened. Although I'd be wanting to have more psa tests perhaps in a couple of months initially to see how it's trending.

Of course it's up to how you feel about the risk if you want early treatment if it's positive.

I'd also think any deviation caused by cycling or other activity would not be that significant, from what I've read it's only 0.1 or so.

All the best, Peter

User

Posted 17 Nov 2024 at 11:42

In the UK, you have to have an MRI scan before a biopsy (the MRI scans rule out the need for many biopsies).

Also, we don't do transrectal biopsies any more.

If PSA is dropping without any treatment, it's very unlikely (although not completely impossible) that the raised PSA which has dropped was anything to do with prostate cancer. Of course, that doesn't mean you haven't got prostate cancer.

You haven't started taking any medication containing Finasteride, Dutasteride, or a prostate supplement, have you?

Edited by member 17 Nov 2024 at 11:47 | Reason: Not specified

User

Posted 18 Nov 2024 at 22:06

I'm in the states. Pennsylvania. I think the free PSA did influence his decision somewhat. That's pretty much what I'm thinking re. wait and monitor vs. biopsy. Had the PSA not gone down, it would be a no brainer. I like the idea of an MRI, or anything that's not invasive for that matter.

Thank you for your input.

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