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PSA 6.5 biopsy negative
rlb624 posted:
In two years, my PSA elevated from 2.25 to 6. In March I had a prostate biopsy and all 16 samples were negative. My PSA results today elevated to 6.5. I am 62 years old and in realtively good health. What might be the best course of action, as I am considering monitoring only at this time? Is there a chance the PSAis picking up "signals" from other parts of my body?
az4peaks2 responded:
Hi rib, - It certainly is reassuring that your Biopsy was negative for Prostate Cancer (PCa). Unfortunately, traditional patterned but "random" Prostate Biopsies cannot totally rule out PCa as they find only about 80% of existing PCa cases on an initial attempt.

"Standard" needle biopsies of the Prostate, today, take about 12 tissue samples in a random, but patterned, manor with any additional samples representing either "suspicious" areas seen on the UltraSound images used to guide the Biopsy device location or compensation for an unusually large volumed Prostate gland.

Since the SAMPLES are exactly what they are called, "samples" they do not NECESSARILY represent a totally accurate reflection of the either the amount or the aggressiveness of the Cancer tumor(s) present in the TOTAL prostate. They do, however, (4 out of 5 times) reliably establish the PRESENCE of PCa, if it exists. A subsequent second Biopsy rounds these "positive" (PCa identified) findings to about 90% of existing cases eventually found. The remaining 10% take 3 or more Biopsies to be eventually identified.

Some reasonable assumptions can be made after two or more serial Biopsies are found to be negative (no PCa identified) and to a lesser extent even after an initial negative biopsy. These are (1) that any PCa that might have been missed, is not likely to constitute a widely spread PCa volume within the Prostate itself. (2) Due to #1, it is substantially less likely to presently constitute an advanced PCa, thus increasing the chances of successful treatment and "cure".

However these are assumptions and NOT GUARANTEES, so follow-up monitoring and other possible diagnostic endeavors may be employed to further enhance such findings. Therefore, it should be recognized that "positive" Biopsy results alone are much more "certain" as to the presence of PCa, than "negative" findings are indicative as to its non-existence.

There are other causes for elevated PSA readings, if that was the sole cause for your Biopsy, particularly Prostatitis (Infammation) and/or BPH (Benign Prostate Hyperplasia (or Hypertrophy) so PCa may not be the cause of your elevated PSA. Follow-up may be able to better identify the most likely cause. That will be the most beneficial time to determine your next step in action.

If the decision is to take conservative monitoring action, you should have a formal plan to regularly evaluate diagnostic results and act accordingly to what they tell you is appropriate at the time. I would strongly suggest that you acquire copies of your diagnostic results, for your records, including PSA results and your Biopsy Pathology Report, for future comparison of results and clarification of possible causes.

Good luck! - (aka) az4peaks

Good luck
rlb624 replied to az4peaks2's response:
Thank you very much for the feedback.
Basir U Tareen, MD responded:
To me this rise is somewhat worrisome. If this is a "benign rise" it should come down closer to your original 2.25 range. Its very possible that is from some type of inflammatory process, resolving prostatitis, etc.

One option is to consider using a 5 alpha-reductase inhibitor (proscar or avodart) to see how much the PSA decreases. Ideally should be at least 50% although in your case if your PSA rise is from a benign cause I would bet it would come down even more.

I would definitely re-check the PSA once or twice over the next few month and if it still elevated you may also want to consider an MRI at an institution that does a high volume of prostate MRIs.
jameshodge responded:
The PSA value is not a magic number that immediately tell you what is wrong. That is why testing like the doctor here recommends is necessary and I hope you can find a doctor that will help you get the best diagnosis by the safest methods. Remember that you can develop a healthy prostate with the right diet and supplements like I've been reading in Super Beta Prostate reviews .

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