Rising PSA Levels: When to Seek Further Evaluation

PSA levels have been rising in recent years?

Hello, Dr.
Hsu.
My PSA levels have been rising over the past five years, starting from 9.7 and increasing to 14.3.
The doctor performed a digital rectal exam and a biopsy, which showed benign results with benign prostatic hyperplasia.
I continued to have follow-up visits, but my PSA levels have gradually increased.
Last July, my PSA reached 20.5, and I opted for an MRI and ultrasound fusion-guided prostate biopsy, which also returned benign results.
In October, my PSA was 22, and the doctor mentioned that it could be due to a bacterial infection, prescribing antibiotics.
When I returned for follow-up in December, my PSA had risen to 24.3, and blood and urine tests have consistently shown no issues.
I would like to ask if, despite the benign biopsy results, the continuous rise in PSA levels warrants further investigation, or if ongoing monitoring is sufficient.
Thank you.

Mr. Huang, 60~69 year old female. Ask Date: 2023/01/18

Dr. Xu Wencang reply Urology

Is there any abnormality in the MRI? A biopsy can be performed, and a transurethral resection of the prostate (TURP) or laser prostatectomy can be done, followed by pathological examination.

Reply Date: 2023/01/18

More Info

When it comes to rising PSA levels, particularly in the context of previous benign biopsy results, it can be quite concerning for patients. Your situation, where PSA levels have consistently increased from 9.7 to 24.3, despite multiple evaluations showing benign results, raises important questions about the underlying causes and the appropriate next steps.

Firstly, it's essential to understand what PSA (Prostate-Specific Antigen) is and how it functions as a biomarker. PSA is a protein produced by both normal and malignant cells of the prostate gland. Elevated levels of PSA can indicate various conditions, including benign prostatic hyperplasia (BPH), prostatitis (inflammation of the prostate), and prostate cancer. However, PSA levels can fluctuate due to numerous factors, including infections, recent sexual activity, certain medical procedures, and even physical activities like cycling.

In your case, the fact that multiple biopsies have returned benign results is reassuring, but the continuous rise in PSA levels is concerning and warrants further investigation. The increase from 20.5 to 24.3, especially after a course of antibiotics, suggests that there may be an underlying issue that has not yet been identified. While bacterial infections can cause PSA levels to rise, it is crucial to rule out other potential causes.

Given the persistent elevation of PSA levels, here are some considerations and recommendations:
1. Re-evaluation of Prostate Health: Since your PSA levels are rising despite benign biopsy results, it may be beneficial to conduct further imaging studies. Advanced imaging techniques, such as multiparametric MRI, can provide more detailed information about the prostate and help identify any areas of concern that may not have been visible in previous evaluations.

2. Consideration of Other Conditions: Conditions such as chronic prostatitis or BPH can lead to elevated PSA levels. If you haven't already, discussing the possibility of chronic prostatitis with your healthcare provider may be worthwhile. This condition can sometimes be difficult to diagnose and may require specific treatments.

3. Regular Monitoring: If further imaging and evaluations do not reveal any new concerns, a strategy of regular monitoring may be appropriate. This typically involves periodic PSA testing and clinical evaluations to track any changes over time. Your healthcare provider may recommend a specific schedule for follow-up appointments based on your individual risk factors and PSA trends.

4. Second Opinion: If you feel uncertain about the management plan or the interpretation of your PSA results, seeking a second opinion from a urologist or an oncologist specializing in prostate health can provide additional insights and options.

5. Lifestyle Factors: While lifestyle changes alone may not significantly impact PSA levels, maintaining a healthy diet, regular exercise, and managing stress can contribute to overall prostate health. Some studies suggest that certain dietary components, such as omega-3 fatty acids and antioxidants, may have a protective effect on prostate health.

6. Patient Education: Understanding the implications of PSA testing and the potential for false positives or benign conditions is crucial. Engaging in discussions with your healthcare provider about the significance of your PSA levels and the rationale behind recommended tests can help alleviate anxiety and empower you in your healthcare decisions.

In conclusion, while benign biopsy results are a positive sign, the continuous rise in PSA levels necessitates further evaluation. Collaborating closely with your healthcare provider to explore advanced imaging options, consider other underlying conditions, and establish a monitoring plan will be key in managing your prostate health moving forward.

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