PSA Levels: When to Worry and When to Monitor

Q: PSA Levels: When to Worry and When to Monitor

Hello： For prostate cancer, all tests are references, and the key point is whether to perform a biopsy for confirmation and subsequent management (although a higher index may still have normal biopsy results). <br>The fluctuations in index levels can have many causes, such as sex

Hello Director Du, regarding the issue of the PSA levels increasing after one year?

Hello, Director Du.
Last May, my PSA level was 3.65, and my free PSA was 0.24.
The doctor at Beirong mentioned that my prostate was slightly enlarged (as my PSA was around 4.3 during a check-up a month prior).
Later, feeling uneasy, I opted for a self-paid MRI, which confirmed there were no tumors.
A year and a half later, just a few days ago, I returned to the hospital, and the doctor suggested checking my PSA levels again.
However, when I recently checked using the National Health Insurance mobile app, my PSA level has risen to 5.2.
I have been experiencing frequent urination over the past couple of years and started taking Tamsulosin three months ago.
Given the situation described above, should I continue to monitor my condition without excessive concern about the PSA levels?

Carlos, 40~49 year old female. Ask Date: 2020/10/01

Dr. Du Shixi reply Urology

Hello: For prostate cancer, all tests are references, and the key point is whether to perform a biopsy for confirmation and subsequent management (although a higher index may still have normal biopsy results).
The fluctuations in index levels can have many causes, such as sexual activity, digital rectal examination, or inflammation.
A rise from 3.65 to 5.2 over a year and a half at the same institution requires further monitoring.
My personal suggestion is to first make lifestyle changes, such as walking for 30 minutes daily, avoiding prolonged sitting, and maintaining a light diet.
After 1-2 months, retest to see if there is a decrease.
(Generally, a level of 4 is the threshold; levels above 4 have a higher chance of being concerning, while levels below 4 have a lower chance, though not impossible.
Being below 4 is relatively safer, and it is recommended to have regular check-ups without excessive anxiety.) As for the biopsy, you can refer to the following link: https://www.mil.mohw.gov.tw/?aid=509&pid=57&page_name=detail&type=17&iid=638

Reply Date: 2020/10/01

More Info

Understanding PSA Levels: When to Worry and When to Monitor
Prostate-Specific Antigen (PSA) is a protein produced by both normal and malignant cells of the prostate gland. PSA testing is primarily used to screen for prostate cancer and to monitor patients who have been diagnosed with the disease. However, PSA levels can be influenced by various factors, including age, prostate size, and even recent sexual activity or medical procedures.
In your case, you have experienced fluctuations in your PSA levels over the past couple of years, with a recent measurement of 5.2 ng/mL. This is indeed a notable increase from your previous levels, and it is understandable that you may feel concerned. However, it is important to remember that a single elevated PSA level does not automatically indicate the presence of prostate cancer.
The context of your PSA levels is crucial. You mentioned that you have been experiencing urinary frequency and that you have been prescribed Tamsulosin (often referred to as "Tamsulosin" or "Terazosin"), which is commonly used to treat benign prostatic hyperplasia (BPH) or enlarged prostate. BPH can lead to elevated PSA levels, as the enlargement of the prostate gland can cause increased production of PSA. Additionally, factors such as inflammation or infection of the prostate (prostatitis) can also elevate PSA levels.

Your previous MRI results indicating no tumors are reassuring. MRI is a valuable tool in assessing prostate health and can help rule out significant abnormalities. Given that your PSA levels have fluctuated and that you have a history of benign prostate issues, it may be reasonable to continue monitoring your PSA levels rather than rushing into invasive procedures like a biopsy.

The recommendation to monitor PSA levels is often based on the concept of "watchful waiting" or "active surveillance," especially in cases where the PSA levels are not significantly elevated and there are no other concerning symptoms. In your situation, since your PSA is still below the commonly accepted threshold for concern (usually around 10 ng/mL), and considering your MRI results, it may be appropriate to continue with regular follow-ups.

However, it is essential to maintain open communication with your healthcare provider. Discuss your concerns about the rising PSA levels and any symptoms you may be experiencing. Your doctor may suggest repeating the PSA test in a few months to see if the levels stabilize or continue to rise. They may also consider additional tests, such as Free PSA testing, which can provide further insight into the nature of your prostate health. The Free PSA test measures the percentage of PSA that is not bound to proteins in the blood, and a lower percentage can indicate a higher risk of prostate cancer.

In summary, while it is natural to feel anxious about rising PSA levels, it is crucial to approach the situation with a balanced perspective. Given your history and the current context, regular monitoring seems to be a prudent approach. Ensure that you maintain a healthy lifestyle, including a balanced diet and regular exercise, as these can contribute positively to prostate health. If you notice any new symptoms or if your PSA levels continue to rise significantly, do not hesitate to reach out to your healthcare provider for further evaluation and guidance.

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