Elevated PSA and PHI: Next Steps for Prostate Health

Elevated PSA levels, PHI > 36?

Hello, doctor.
I have been under follow-up for over a year.
My PSA levels were 4.2 a year ago, then 4.1 after 3 months, 3.6 after another 3 months, and recently 4.6 after 6 months.
Additionally, my self-paid PHI is 40.5, which is greater than 36.

1.
The doctor recommended an MRI, but it did not show any lesions.
What should I do next? Is a biopsy necessary?
2.
Also, in the past month, I have been experiencing irregular sharp pain in my pelvis, perineum, groin, and buttocks, with the left side being more pronounced.
I feel like I might have prostatitis.
Can chronic prostatitis cause PSA and PHI levels to exceed the standard? Furthermore, can these levels remain elevated for such a long time?
3.
Is chronic prostatitis potentially curable? I have seen treatments using energy wave vibrations in the perineal area that can improve prostatitis symptoms for a period.
Are these effective? Can I perform perineal massage myself to reduce the pain?
Thank you for addressing my questions.

Sam, 40~49 year old female. Ask Date: 2023/09/30

Dr. Li Xinyi reply Urology

If there is a family history of prostate cancer, such as a father with a related history, it is advisable to consider a biopsy more proactively.
Otherwise, if the PSA level is slightly elevated but the MRI does not show any potential lesions, close monitoring may still be an option.
Additionally, your symptoms could be indicative of prostatitis, so it is recommended to discuss with your clinician whether oral antibiotics should be used for treatment, as some patients have experienced a reduction in PSA levels as a result.
It is important to discuss the details with your primary physician, as they are more familiar with your condition.

Reply Date: 2023/09/30

More Info

Understanding elevated PSA (Prostate-Specific Antigen) and PHI (Prostate Health Index) levels can be quite complex, especially when considering the various factors that can influence these markers. Based on your situation, let's break down your concerns and provide some insights.

1. Next Steps After MRI: Given your PSA levels have fluctuated over the past year, with the most recent reading at 4.6 and a PHI of 40.5, it is understandable that your physician has recommended an MRI. The MRI is a useful tool for visualizing the prostate and can help identify any suspicious areas that may warrant further investigation. Since the MRI did not reveal any lesions, the next steps can vary based on your physician's assessment and your overall health. If there are no significant findings and considering your age (36), your doctor may suggest continued monitoring rather than an immediate biopsy. However, if there is a family history of prostate cancer or if your symptoms persist, a biopsy may still be considered to rule out malignancy.

2. Impact of Chronic Prostatitis on PSA and PHI: Chronic prostatitis can indeed elevate PSA levels. Inflammation of the prostate can lead to increased permeability of the prostate gland, causing PSA to leak into the bloodstream. This condition can also affect PHI levels, as PHI is calculated using total PSA, free PSA, and [-2]proPSA. Chronic prostatitis can persist for extended periods, and it is not uncommon for PSA levels to remain elevated during this time. If you are experiencing pelvic pain, discomfort in the perineum, or other symptoms associated with prostatitis, it is essential to discuss these with your healthcare provider. They may recommend a course of antibiotics or other treatments to manage the inflammation.

3. Management of Chronic Prostatitis: Chronic prostatitis can be challenging to treat, and while some patients experience significant relief from symptoms, others may find it more persistent. Treatment options vary and may include antibiotics, anti-inflammatory medications, alpha-blockers, or physical therapy. The use of energy wave therapy (such as shockwave therapy) has shown promise in some studies for alleviating symptoms of chronic prostatitis, but results can vary from person to person. Self-massage of the perineal area may provide temporary relief for some individuals, but it is crucial to approach this with caution and ideally under the guidance of a healthcare professional.

In summary, your elevated PSA and PHI levels warrant careful monitoring and possibly further investigation, depending on your symptoms and family history. Chronic prostatitis can significantly influence these markers, and addressing the underlying inflammation may help normalize your PSA levels. Always consult with your healthcare provider for personalized advice and treatment options tailored to your specific situation. Regular follow-ups and open communication with your doctor are key to managing your prostate health effectively.

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