When to do a prostate biopsy for an elevated PSA-Well….that depends.

• A lot of what folks do depends on “who they are.”  The anxious patient may want to pursue a biopsy the first time it is elevated. The idea of waiting a couple a weeks and maybe a course of “empiric” antibiotics is something they don’t want to do. Another “calmer” type patient might wait months or as I have seen,”I’ll just repeat it at my yearly Doc.”
• It is always reasonable to repeat any lab value that is elevated. With the PSA, a two-week interval with or without antibiotics is something I commonly recommend.
• If there is a history of prostate cancer in the family that would make one more inclined to do a biopsy.
• The rectal exam trumps the PSA…so i the PSA is high and you are questioning the results and you want to repeat it…to most urologists, if the PSA is normal and the rectal exam has an abnormality, a biopsy is usually recommended.
• If your rectal exam is normal and your PSA is abnormal, say in the 4-10 range and the PSA has been about the same for years…you might not consider a biopsy.
• It is my opinion that a persistently elevated PSA should warrant a biopsy at least once. This then rules out prostate cancer and now gives the patient a baseline of “his” normal PSA.
• It is not unusual at all for some patients to have a high PSA and not have cancer.
• There are lots of reasons for an elevated PSA besides cancer and that is what makes the question tricky.
• Since there are some prostate cancers that are aggressive and the PSA is not elevated or only minimally elevated..this is what makes the situation tricky.
• It is best in all things medicine to consider all factors….i.e. a man 80 with a PSA of 6 is different from a 55-year-old with the same value.
• Health issues important: In some patients we don’t do a biopsy because if we did and found cancer, in that particular patient we already know we wouldn’t treat it.
• Sometimes a Free and Total PSA is helpful. A low free PSA % means a higher likelihood of a positive biopsy.
• Read Lorenzo Squarf’s rationale for not pursuing a biopsy. (Search his name on this site.)

So if your life expectancy is greater than 10 years, you have a confirmed elevated PSA and have not previously had a biopsy…I’d recommend one. You may never need another.

Repeating after a period of time, even up to three months particularly if the rectal exam is normal, is even reasonable.  If it reverts to below normal the likelihood things are good. You still should keep an eye on it. Listen to the urologist, ask your GP his thoughts. Get a second opinion if it is important to you with another urologist. I wouldn’t put much weight into what a friend recommends. He may be smart but he will not know the specifics of your situation, rectal exam and etc.

I watched my PSA for about 6 months before biting the bullet. The Free PSA did it for me…mine was very low.

Take home message to the question: There is certainly no rush…you have time to repeat and consider your options and where and “who you are” in life before making the “prostate biopsy decision.” Always remember this…You are the boss. All doctors can do is recommend and you go along with your willing consent.