PSA 4.9, Age 71; Biopsy?

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Per the title, my PCP stated via the online portal:

*"...mildly elevated PSA, recommend patient discuss possible biopsy with urologist". *

From various sources, I've noted PSA levels up to 6.5 ng/ml is considered normal for my age group. Is a biopsy invasive?

I should note I am a hypochondriac in a big way.

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  • Edited

    Yes it is invasive. Biopsies are taken from the prostate via the anus . I suggest you wait a month or more and then have your PSA levels checked again . If the levels are rising fast (a bit subjective I`m afraid as so many variables) then it might be wise to have an MRI scan on your prostate if possible ..that can give a good indication as to there being cancer or not. I had Turp two years ago and it appeared I would have had biopsies in a matter of fact way with follow on checks regularly which all create stress and worry. It turned out I did need Turp but I did not have cancer and biopsies were totally unnecessary.

    If your psa levels are not rising fast then hold off. It is not the actual levels per se that are important but it is the speed (or not) at which they are rising that is more of an indicator as to there being a problem or not.

    Are you peeing ok.? If not that might mean you need to get you prostate checked but it doesn`t have to be via biopsies.. MRI scans give very reliable results and are 95% accurate as to showing any abnormalities on the surface of your prostate and also if it is enlarged.

    If you are peeing ok then wait not rush onto what I call the conveyer belt of unnecessary treatments..

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  • Edited

    As GInAndPlatnic correctly writes: wait a month or more and check the PSA again.

    In addition I suggest

    1. Go back to the same lab for the follow up PSA check in 6 weeks
    2. If the PSA has risen by a good percentage, say a third or more, then go for a MRI
    3. Ensure the MRI is a 3T MRI as these are the most detailed
    4. Nobody should go from one PSA check straight to an invasive procedure such as biopsy without having undergone a non invasive scan.

    Good luck.

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  • Edited

    Completely agree with the above.

    Elevated PSA by itself is not a concern. If the trend is for PSA rising steadily - get an MRI.

    In 10 years of my monitoring before the surgery I was pressed hard into a biopsy, never had it and as it appeared - it would be unnecessary in my case.

    If an MRI suggests tumours - a biopsy may be considered, but even so it should be US or MRI guided for precision.

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  • Edited

    Thanks for all the great info and advice. One thing I don't understand is everyone knows PSA increases with age and according to what I read, up to 6.5 ng/ml is normal for my age group (71). My PSA was 4.9 ng/ml. However, there appears to be no consideration for this fact within the medical community as it relates to process and next steps. In other words, anything in excess 4.0 ng/ml is "High" and since X=Y, that's it, end of story.

    Thanks again.

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    • Edited

      There are many things you can take away from this forum. If I may suggest, one is the most important: the PSA number of itself means nothing. It is the trend that matters. For instance if the number doubles in a year then it's likely that there is cancer.

      It is possible to have a PSA of 1,000 and NO cancer as it is to have a PSA of 3.1 like me and HAVE cancer.

      For the moment don't worry. Have the follow PSA test say 6-8 weeks from the first test and take it from there.

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  • Posted

    You also have to take the size of your prostate into account. The bigger the prostate the higher the PSA. The PSA density should be less than 0.1. Prostate density is PSA/Prostate size in grams or centimeters. You can get the size from a TRUS, Trans Rectal Ultrasound Scan or from an MRI. If your going to get an MRI, get a 3 Tesla MRI, with and without contrast, so that it would show any cancer nodules. Have the MRI looked at by a prostate cancer specialist, not a generalist.

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  • Posted

    Three months later, age 72, following a subsequent blood test, Total PSA increased from 4.9 to 7.5, Free PSA 1.43 for a ratio of 19.1% .

    Disappointing to me. Advice/comments welcomed.

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