Elevated PSA Levels: Diagnosis and Treatment Options

Q: Elevated PSA Levels: Diagnosis and Treatment Options

Mr. <br>Wu： Hello, regarding prostate examinations, the best diagnostic methods are digital rectal examination (DRE) and transrectal ultrasound (TRUS). <br>The diagnostic capabilities of CT scans and MRIs are not superior. <br>Additionally, elevated PSA levels can be caused by ma

Elevated PSA levels?

Due to frequent urination and dull pain in the perineum and groin, I visited the urology clinic in September last year.
Blood and urine tests revealed a PSA level of 9.4, and a digital rectal exam showed no hard nodules.
The physician prescribed antibiotics (Dolcol) to be taken 500 mg twice daily.
After 7 days of treatment, my PSA level decreased to 6.7.
I requested the physician to perform a transrectal ultrasound-guided biopsy, which was done on November 10, with a total of 6 samples taken.
During my follow-up appointment on November 18, the physician indicated that all biopsy results were normal, and my prostate weighed approximately 47.5 grams.
I have been taking Foxate 200 mg twice daily and HARNALIDGE D 0.2 mg at bedtime.
After three months, I returned for a follow-up in February this year, and my PSA level was 6.45.
The physician advised me to have my PSA tested again in three months for monitoring.
In addition to regular PSA monitoring, including repeat biopsies if there are two consecutive increases, are there more aggressive diagnostic methods, such as MRI or CT scans, that could be beneficial? Currently, I still experience frequent urination, dull pain in the groin, and mild pain in the right testicle, making it difficult to sit for extended periods.
The symptoms gradually worsen from morning to night.
Is there a chance that prostatectomy could improve my current symptoms? Does a total weight of approximately 47.5 grams meet the criteria for a prostatectomy?

Mr. Wu, 50~59 year old female. Ask Date: 2011/02/17

Dr. Xu Weikai reply Urology

Mr.
Wu: Hello, regarding prostate examinations, the best diagnostic methods are digital rectal examination (DRE) and transrectal ultrasound (TRUS).
The diagnostic capabilities of CT scans and MRIs are not superior.
Additionally, elevated PSA levels can be caused by many factors, such as infections, constipation, diarrhea, sexual activity, older age, and enlarged prostate.
Due to the numerous influencing factors, multiple biopsy examinations are necessary for confirmation.
Furthermore, a test for free PSA can also serve as a clinical reference.
Moreover, the symptoms of benign and malignant prostate tumors are almost identical, making it impossible to differentiate based solely on symptoms.
When clinical symptoms are more severe, surgery can provide improvement.
The size of the prostate is not the primary consideration for surgery.
If there are any unclear points, feel free to ask again for further discussion and research.
This response is from Dr.
Hsu Wei-Kai, Director of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2011/02/17

More Info

Elevated PSA (Prostate-Specific Antigen) levels can be a source of concern for many men, particularly when accompanied by symptoms such as frequent urination, perineal discomfort, and groin pain. In your case, a PSA level of 9.4, which subsequently decreased to 6.7 after antibiotic treatment, indicates that there may have been an underlying infection or inflammation affecting the prostate. The fact that your biopsy results were normal is reassuring, but it does not completely eliminate the need for ongoing monitoring and evaluation.

PSA levels can fluctuate due to various factors, including infections, benign prostatic hyperplasia (BPH), and even recent sexual activity. Therefore, it is essential to consider these factors when interpreting PSA results. The decline in your PSA levels after antibiotic treatment suggests that inflammation or infection may have played a significant role in the initial elevation.

Regarding your question about additional diagnostic methods, while MRI and CT scans are valuable imaging tools, they are not typically used as first-line tests for evaluating elevated PSA levels. Instead, multiparametric MRI can be beneficial in certain cases, especially when there is a suspicion of prostate cancer after multiple PSA tests and biopsies. This imaging modality can help visualize the prostate and surrounding tissues, potentially identifying areas of concern that may warrant further investigation.

As for your ongoing symptoms, including frequent urination and groin pain, these can be indicative of chronic prostatitis or pelvic pain syndrome, which may not necessarily improve with prostatectomy (surgical removal of the prostate). The decision to undergo prostate surgery should be carefully considered, weighing the potential benefits against the risks, including urinary incontinence and sexual dysfunction. The prostate weight of 47.5 grams you mentioned is within the range that may be considered for surgical intervention, but the primary consideration should be the severity of your symptoms and the impact on your quality of life.

If your symptoms are significantly affecting your daily activities, it may be worth discussing with your urologist the possibility of surgical options or other treatments, such as medication adjustments or physical therapy aimed at alleviating pelvic pain. Additionally, lifestyle modifications, such as dietary changes, pelvic floor exercises, and stress management techniques, may also provide symptom relief.

In conclusion, while regular PSA monitoring is crucial, it is equally important to address your symptoms and overall well-being. Engaging in an open dialogue with your healthcare provider about your concerns, treatment options, and the potential impact of any surgical interventions will help you make informed decisions regarding your health. If your symptoms persist or worsen, do not hesitate to seek further evaluation or a second opinion, as proactive management is key to maintaining your quality of life.

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