high psa and normal prostate biopsy-what does that mean? well that you don’t have prostate cancer…maybe.

you have to be to do and you have to do to have- Zig Ziglar

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.

14 Replies to “high psa and normal prostate biopsy-what does that mean? well that you don’t have prostate cancer…maybe.”

  1. I recently had a PSA of 17 and so saw a urologist and he ordered antibiotics for a month and another test. Tested the same and so he performed a biopsy with the 12 small cores you mentioned. Biopsy came back negative for cancer. I should mention there have been no symptoms, no urination problems, nothing at all which I have read is very common.

    My urologist has recommended another biopsy in 6 months. My thought is to to have another PSA check in 6 months and if PSA is the same avoid the second biopsy until and if I ever see an increase from 17. What do you think? From What I have read the biopsy should be avoided unless necessary.

    Liked by 1 person

    1. Thank you for your blog! As one who recently tested at PSA 8.01, I will refer to it often. It’s the one which creates least hysteria and the most positivity. Super!


  2. I recently had a 36.6 PSA. I also have deep bone pain in my hips, long leg bones and pelvic area. Sometimes I cannot move my right leg due to what I think is a pinched nerve or other spinal pressure. My family practitioner diagnosed arthritis and put me on anti-inflammatories which have helped the pain. He suspected prostate cancer as well. My Urologist has determined Paget’s disease causing the pain based on a bone scan and a radiologist has confirmed. He also wants a prostate biopsy. Is there any correlation between high PSA’s and Paget’s if the pelvic and hip bones are involved with Pagets? (I am a white 54 year old male with no family history of prostate cancer or other illnesses. *100% healthy until this event.)


    1. I’m in the same position, but PSA just over 8 with hip pain controlled by ibuprofen. No family history, no symptoms, prostate leeks normal from the DRE. Just waiting on developments so I will follow your story if I may!


  3. No maybe for me. After several years of increasing PSA, 2 negative biopsies (8 and 20) and a diagnosis of prostatitis I ended up with Prostate cancer (2 small spots – Gleason 10 at the margin and 6 in the anterior of the prostate) last PSA before surgery was 25 and Gleason 10. Diagnosed after seeking a 2nd opinion (wish I had acted sooner) from another urologist because the 1st one was set on prostatitis. He had me do a saturation biopsy (grid the entire prostate) in the hospital – 9 of 42 cores positive. After removal via open surgery PSA still 11. All lymph nodes removed and frozen sections during surgery were negative. All insurance covered scans were negative. $3K non covered C11 acetate Petscan found cancer lighting up in prostate bed. Commenced casodex, lupron and radiation 12/11. PSA now less than .03. Plan is to continue 6 month lupron shots for 2 to 3 years. My conclusions are that no 2 cancer stories are the same, trust your doc but verify with 2nd opinions and keep a positive attitude.


  4. Had high PSA for 6 years..did 4 biopsy..no positive..different dr. on 5th and he really hurt me..didn’t do 6th year…7th year at 1st dr.and showed prostate cancer..did Cat scan and found large mass on 1 kidney..had it removed and was positve for cancer. Has mastisized..now on lungs and back of abdomin. Dr. insists prostate and kidney cancers are not related, but has to be a reason for high PSA. Shouldn’t more be done to find out why besides prostate biopsy or was my dr. negligent?


    1. The PSA is not perfect but once alerted there should be a more thorough means of finding the cancer if it exists. You and I are examples of this. Not sure on negligent part. Could be best practices during a time of continued ignorance regarding prostate cancer. I believe I just saw on this site a promising procedure for guys like us – A UCLA medical procedure using MRI and Ultrasound. Wish I had access to this.


      1. Thanks, I totally agree. More should have been done to find out why the high PSA levels were there.


  5. Lots of new info. I was diagnosed with Paget’s Disease as the cause of pain. Then I took 45 radiation treatments to kill prostate as cancer had spread outside gland. Surgical removal not suggested. Then a year later i took 15 more radiation treatments on right hip. No more pain. Paget’s covered cancer spread on film. A pet scan would have caught spread 3 years earlier. Now dealing with prostate cancer of bone in spine..shoulders..hips…most large bones. Just finished 3 chemo treatments of Taxotere. Ended up in hospital for 4 days with anal fissure and internal hemmorhoids from combo if chemo and radiation. Now off chemo. Taking Zytiga. No bad side effects. PSA at 270 but urologist says chemo killed many cells still in blood stream and not to be concerned. New blood tests in 2 weeks to see Zytiga results. Demand a Pet Scan early.


    1. Yes, demand PET scan. 6 years of biopsies on my husband’s prostate showed nothing till last one. Then dr. Did CAT scan and found his kidney had large mass. It had metastasized. He only lived one more year. PET would have told more.


      1. Very sad. C11 acetate petscan may have helped. I was lucky to have access in Tempe, az and my urologist was up to speed on these. Update on my situation is positive. Been off lupron for 6 months. So far so good as PSA is still less than .03. Medical oncologist recommended Zytiga and chemo as insurance. Insurance would not cover as I am not castrate resistant. $40k out of pocket cost. I opted for lose 50 lbs and hire a personal trainer to build muscle mass. Results have been outstanding regarding incontinence and increased muscle tone even though testosterone is still very low. Been reading a lot about exercise and diet. It’s all good news with nothing to lose. Just Do It!


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