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Prostate Cancer

PSA Rise but No Biopsy

06/27/2008

Question:

My PSA over the last 2 years has been 1.93,1.50 and now 2.37. It rose .85 in one year. My urologist ordered a PSA profile. Results: Total PSA 2.47, free PSA .60 and FPSA/TPSA .24 . Narrative greater than .19 is suggestive of benign neoplasm.

My urologist says no need for biopsy now due to the free PSA and FPSA/TPSA levels being normal. I am almost 60 years old. He said my prostate is enlarged and that can cause the rise in total number. My urologist suggested a PSA Profile in 6 months and if a continued rise to consider biopsy then. Do you think this is wise and prudent? I am confused on the velocity issue? Thanks

Answer:

PSA velocity over 0.75 is generally considered abnormal. One could argue to do a biopsy because your PSA velocity was increased, however, it certainly is reasonable to recheck your PSA in 3-6 months with a percent free PSA. If your PSA continues to increase or percent free PSA decreases a biopsy would be appropriate at that time.

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Response by:

Lee E Ponsky, MD Lee E Ponsky, MD
Associate Professor of Urology
School of Medicine
Case Western Reserve University