The subjects which people search for and then ultimately end up on this blog are very informative. Castrasted monks is a popular one. Another is prostate humor and famous people with prostate cancer. I have addressed these previously.
The issue of a man being told his PSA is high and then he has a biopsy that does not show cancer is also commonly searched. “High PSA negative biopsy.” What does this mean? Does it mean that you had a unecessary biopsy or that the PSA is a terrible test, or that your urologist subjected to torture for monetary gain alone?
Well, it means that for some reason you produce more PSA than the “average bear.” (That’s Yogi speak.) The chances are that your particular PSA is the norm for you and that you will never develop prostate cancer. If you were my patient, however, I’d advise a twice a year rectal exam and PSA. The kicker is that your PSA is abnormal and for that reason it and your prostate has to be monitored. In my twenty odd year career, I have seen the patient with a high PSA and negative biopsy progress to a positive biopsy in less than 10% of the time. On only one occasion have I seen the resultant positive biopsy be of an aggressive form. In this particular case, the patient had had three biopsies over five years for a PSA of 15 and the resultant biopsy showed a small amount of Gleason’s 8 prostate cancer. The Gleason’s 8 confirms that this was not an incidental finding of a non aggressive cancer. Here’s the kicker as well, the cancer may have been unrelated to the elevated PSA.
So high PSA and negative biopsy is a good thing. You can be critical of having had a test that did not result in cancer, but until we get a better more sensitive marker its the best we have. Of the other causes of a high PSA is sex the night before the PSA, a large prostate, that you just produce more, Padgett’s disease, certain meds, and lab error.
The upshot to the question-you are off the hook for now, but will need to be monitored to be sure there isn’t a prostate cancer that is responsible for you PSA is present but not sampled by the biopsy. Remember we usually take only 12 small cores so the possibility of “missing or not sampling” a cancer is possible.