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    Rising/Falling PSA over 18 years. What to do?
    rwpeti posted:
    Over 18 years my PSA is:

    1.4, 2.6, 4.3, 3.4, 4.6, 3.7, 4.7, 7.1, 4.8, 7.4, 5.5, 7.6, 5.8, 6.7, 7.1, 8.3,

    6.7, 8.6, 10.0, 7.4, 7.7, 6.5, and last week 11.0.

    I'm 73.5 and had two neg biopsies. It's been up and down for 18 years.

    I've no problem symptoms in this time. Told my prostate is about 5x the

    normal size (85.5 cc) but no troublesome symptoms. Seeing Urologist

    next week.

    What should I do? All opinions appreciated.

    Thanks rich P
    Basir U Tareen, MD responded:
    This is often a challenging dilemma and makes both patients and urologists a little uneasy when the PSa is rising consistently in the face of negative biopsies. We have all certainly seen men with large prostate volumes have these kinds of numbers. We have also seen this type of PSA pattern in men with prostate cancer that took several biopsies to find.

    One simple, yet elegant solution I will often consider is starting a 5 alpha reductase inhibitor such as Finasteride or Dutasteride. I often find that in men with elevated PSA from benign causes the reduction in PSA is more than 50%. This is not a bad idea in men with glands larger than 50g who are symptomatic from BPH. If the PSA is rising despite being on one of these meds a more aggressive search for disease may be warranted (ie, extended biopsy under anesthesia, MRI, etc.)

    Best of luck.
    ctfchuck replied to Basir U Tareen, MD's response:
    I had robotic removal of my prostate about 8 years ago. My PSA after surgery was always 0.01. The last blood work I had registered at 0.26 and a follow up was 0.20. I have been taking oxycodone for extreme back pain for about 1 year. Could the oxycodone affect the rise in my PSA level?
    Basir U Tareen, MD replied to ctfchuck's response:
    I don't know of any relation between oxycodone and PSA. The definition of "PSA recurrence" differs from institution to institution (some use .10, some use .20 and others .40). Bottom line is that someplace in the body there are cells producing PSA. This can sometimes be from benign tissue not taken at surgery (seminal vesicles, vasa, etc.) or in some cases represents a recurrence of disease -- either in the are of where the prostate used to be (local recurrence) or away from the area of surgery (lymph nodes, etdc. -- distance recurrence).

    Another factor to consider is the lab. Some labs will do an ultrasensitive PSA (to the one-hundreth of a point) and others will not be so precise.

    Regardless, you need time and to follow the PSA. If it continues to rise this suggests a recurrence and then the question will become whether it is local or distant. (fast rise suggests distant).

    If the PSa stays the same over time, this suggests PSA from benign tissue and is typically not worrisome.

    Good luck.

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