Increased PSA level

I would go ahead with surgical intervention.  I am just starting on this journey, but hoping to have the good luck like my dad had.  Prostate cancer runs in my dad's family.

Hi Andy

My hubby had the same problem as you.  He had been 'warned' about biopsies by family members but the reality was that it hardly hurt at all.  In fact, his words were 'a little uncomfortable but not as bad as the first DRA!'.  He ended up having HoLEP, where all the tissue that had been removed was checked for cancer cells, as opposed to the dozen or so with a biopsy, and all was clear.

It's a personal choice I suppose, all I can say is that my hubby (and the guy who went in before him) were not screaming in pain when they came out.  Good luck.

Hi Andy,

I've been on Combodart for 4 or 5 years now, following a routine 'well man' PSA test that came out at 9.6 (apparently at that time, late 40s, I should have been 3.8).

I had the standard 10 biospies, follwed by another 25, followed by another 65 by template - all clear of cancer (very unpleasant and arguably unecessary).

Since then my annual tests have been 3.8 and my GP tells me they double it to take into account the drugs but are really only looking for changes. Your change of 2.5 could be of concern BUT as I understand it there are a lot of things that can affect your PSA test results (recent orgasm, infection etc). Personally I would leave it for a month and have another test. If it's back up investigate further. If it's still down realx and programme in another test for 6 months time.

I've had a biopsy under local, which, whilst uncomfortable was no problem if you don't get embarassed easily. Cancer not found, but suspicious signs were. A couple of years later, a saturation (multi-sample) biopsy under general anaesthetic found definited cancer cells, but minimal number and completely contained. Worst aspect was an overnight observational stay in hospital, because I tend to get retention problems after a general. Personally I'd rather know what can be known, and I haven't needed treatment - just active surveillance with level psa scores at around 8. Now the enlargement is much more the problem, and because the cancer is well monitored, I've easily been able to live with it.

In my case the larger the prostate the higher the PSA. When my prostate was 35grams and my PSA just over 5.0 I had two clear biopsies about two years apart. By the time my prostate was 75 grams my PSA was over 9.0. After my PVP it went back down to 5.0 

My prostate regrew to 130 grams and my PSA went up to 8.0. I then had a Thulium laser procedure and the tissue sent to the lab was clear.

It is always your choice, not the surgeons/doctors.

I know surgeons who do not even ot psa tests any more - they are too unreliable.

Biopsies are very variable, and others have probably given you a decent range of experience.

I too would not have one done with your readings, especially where there was a drop. In the ranges, surgeons often do 'watchful waiting'.

I'd get at least one other opinion, preferably at a nationally recognised cancer centre. If you live in the UK, you can self-refer to either the Royal Marsdeon if you live in the South of England, Christies in the North.

OK Andy where to start.  I shan't bore you with the usual "been there got the tee-shirt" stuff but make some suggestions that you may wish to consider.

Bouncing PSA could be as you've already guessed down to infections and or the BPH but to remove the infection scenario from the equation, ask your GP to put you on a course of antibiotics with a follow-up PSA test. A reduction in PSA would suggest an infection and no reduction would point at something else.

Why have a biopsy that does have inherent risks when a state of the art 3T multiparametric MRI scan would give a far better picture of what is going on within the prostate. The advances in MRI scanning have improved significantly over the last 5 years and it is now possible to grade and stage prostate cancer on the results of a 3T MRI scan alone, not that you need to worry about such things at present.  If your consultant refuses to refer you for a 3T MRI it may be that the NHS Trust area you reside in doesn't have that facility or he is one of those Urologists that believe the biopsy route is the gold standard for diagnosis and won't open his mind to new and improved methods at arriving at a diagnosis.

If this is the case then insist that you be refered for an MRI and keep insisting and if he still refuses go back to your GP and ask to be refered out of the Trust area and into one that does have the facility and forward thinking Urologists.

If all else fails you can go private for a 3T MRI scan but you'll need to budget for around £300 and you will get faster peace of mind.

As for treatment, if its just BPH and the Tamsulosin begins to be less effective as the  years go by then see if Avodart can be prescribed to help reduce prostate volume, with surgery in the form of a HoLEP a few years down the line if and when medication starts to fail. HoLEP is a breeze, out the same day with no catheter and it can be done using a spinal anaesthetic (you can then watch your own rebore taking place on the big screen).

Finally and if and when PCa is discovered get yourself under the care of a top notch Prostate Cancer hospital like Addenbrookes which is a centre of excellence for all things urological. 

I can only emphasis you have the right to be refered to the hospital of your choice and although it may prove difficult to get that referal now that GPs have a tighter grip on the purse strings, it is your right and you should push hard to achieve it.  Good luck

Hi Andy, on advice from my urologist I had a 12 core biopsy. It was a bit embarassing but I was treated with care and consideration by the team at my local hospital. It was unfomfortable rather than painful. The results were not really conclusive so having six months checks.

Down side, I have regular pain and discomfort from this procedure. Hot baths, walking and ibuprofen releive it.

If I had known that i could have had a scan thats what i would have gone for ,Rogcal says you can have this as a private patient for about £300. Bet the information from it would have been more accurate.

All the best mate, but keep on top of this condition

Thank you all so much for your invaluable knowledge and advice. I am going to the consultants on Wednesday to discuss results from my PSA test done last week. I am going to ring the doctor tomorrow to get the PSA value so I have this before meeting the consultant. I am currently under Harlow Hospital and Epping Hospital, but useful to know that Addenbrookes has some specialism as i am only half an hour away. I will let you know how I get on. Without Forums like this we would be far less knowledgeable and less able to make informed decisions. Thanks Again.

highly recommend Addenbrookes, it's where my hubby had his HoLEP, Mr Tev Aho, lovely and brilliant man.

Andy, my pas got up to 9. I already had BPH 

My GP told me to see a urologist...that's when my problems started. He convinced me to have a 30core perineal biopsy. 

It came back clear, no cancer but I couldn't urinate properly anymore. Uro said it would right itself ...it didn't so went onto flomax. So I didn't have any issues before the biopsy but now I did. 

Anyway after a year of this I saw three other urologists. One wanted to do TURP, the other Holep, and the other (a woman) wanted to do open surgery on me, God forbid. I wasn't looking forward to a significant chance of incontinence and or impotence. 

Then I discovered Prostate Artery Embolisation (PAE) performed by an interventional radiologist. Long story short, I now pee like a horse and have better erections (30% of PAE patients report improved sexual performance).

I am in remission from Lymphoma. My oncologist tells me he refuses to have a PSA test as it leads to so much unnecessary treatment. I'm doing the same...no more PSA tests for me. 

A very large study showed no difference in long term mortality rates between men who had regular PSA tests and men who did nothing. 

In my opinion PSA testing is just a funnel pouring money into urologists pockets.

I just lost a former boss to prostate cancer after a 4 year 'battle'. Do not fool with this type of disease. Do whatever you can to stay alive. Being 'uncomfortable' and having to carry the "possibility' around are quiite different. I really do not understand some of the posts I have read on here, quite alarming in fact. To think that ejaculation is more important than making sure your health is taken care of is beyond me. Good luck and all the best.

May the flow be with you.