Elevated PSA Levels: When to Consider a Biopsy?

PSA (Prostate

Hello Doctor: My husband is 33 years old.
His PSA levels have been over 8 in two consecutive blood tests, with a one-year interval between the tests.
He visited a doctor in November last year and took medication for four weeks, but his PSA levels remained over 8, with an increase in the decimal portion.
Should he undergo a biopsy for further evaluation? He usually enjoys eating fried foods and consumes few vegetables; could this have an impact? Additionally, does a biopsy affect sperm count, and could it indirectly impact fertility? Thank you for your response.

chiouya, 30~39 year old female. Ask Date: 2007/05/07

Dr. Xu Weikai reply Urology

Hello, PSA is currently a valuable tool for screening prostate cancer, but it is also often overused.
In your husband's case, a PSA level of 8 is slightly elevated.
It is recommended to go to a larger hospital for a retest and to request further analysis of the PSA, which means distinguishing the overall PSA into values related to cancer and those not related to cancer.
By examining the proportions, it can provide a clearer understanding of the possibility of cancer.
There are many factors that can affect PSA levels, including sexual activity within the last 24 hours, constipation, diarrhea, prostate massage or examination, and prostatitis, among others.
Therefore, these factors must be ruled out before determining the likelihood of cancer.
Of course, a biopsy is a more direct way to obtain preliminary answers.
Note: If the biopsy result is malignant, it is definitely cancerous; if it is benign, it only indicates that the sampled tissue is benign, and it cannot completely rule out the possibility of malignancy.
Furthermore, biopsies carry a certain degree of complications that need to be carefully considered.
Generally, I would recommend a biopsy as a last resort.
Currently, most outpatient clinics measure total PSA, which does not separate the cancer-related portion.
However, some larger hospitals can perform this type of screening, allowing for a more precise subdivision of PSA through a blood draw.
In other words, fewer patients would need a biopsy.
I hope this explanation is clear and understandable.
Best regards, Dr.
Hsu Wei-Kai, Director of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2007/05/07

More Info

Elevated PSA (Prostate-Specific Antigen) levels can be a source of concern for many men, especially when the values are consistently high. In your husband's case, with PSA levels consistently above 8, it is understandable to consider further evaluation, including a biopsy.
PSA is a protein produced by both normal and malignant cells of the prostate gland. While elevated PSA levels can indicate prostate cancer, they can also be influenced by a variety of other factors, including benign prostatic hyperplasia (BPH), prostatitis (inflammation of the prostate), recent sexual activity, and even certain medical procedures. The fact that your husband has had elevated levels over a year and after treatment for potential prostate issues suggests that further investigation is warranted.

The decision to proceed with a biopsy is typically based on several factors, including the PSA level, the rate of increase in PSA over time, the results of a digital rectal exam (DRE), and any imaging studies that may have been performed. In general, a biopsy is recommended when PSA levels are significantly elevated (usually above 4 ng/mL, but especially concerning at levels above 10 ng/mL) and when there are other clinical indications of potential prostate cancer.
In your husband's case, with PSA levels consistently above 8 and increasing over time, a biopsy may be necessary to rule out or confirm the presence of cancer. It is important to discuss this with a urologist who can provide a comprehensive evaluation and recommend the best course of action based on your husband's specific situation.

Regarding lifestyle factors, diet can indeed play a role in prostate health. A diet high in saturated fats, such as those found in fried foods, may be associated with an increased risk of prostate issues, including cancer. Conversely, a diet rich in fruits, vegetables, and healthy fats (like those found in fish and nuts) is generally recommended for overall health and may help in managing PSA levels. Encouraging your husband to adopt a healthier diet, along with regular exercise, can be beneficial not only for his prostate health but for his overall well-being.

As for the concern about a biopsy affecting sperm count and fertility, it is important to note that while a prostate biopsy is a relatively safe procedure, there can be some risks associated with it. Most men do not experience significant long-term effects on fertility following a biopsy. However, there can be temporary effects, such as discomfort or bleeding, which may affect sexual function in the short term. It is crucial to discuss these concerns with the urologist, who can provide more personalized information based on your husband's health and the specifics of the biopsy procedure.

In summary, given your husband's elevated PSA levels, it is advisable to consult with a urologist to discuss the necessity of a biopsy and to explore lifestyle changes that may positively impact his prostate health. Regular monitoring and open communication with healthcare providers are key to managing any potential health issues effectively.

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