I am 61 and in good health. I have longstanding BPH and have been followed with yearly digital exams and PSA. My PSA has been up and down over the years with Free PSA checked after higher values. My Dad had prostate CA at age 75. My younger brother who also has lonstanding BPH had high PSA's and 4 years ago when it was over 8 he had a biopsy; it was negative for cancer and positive for prostatitis. My urologist has always described my prostate as large but very smooth. My PSA levels 8/02=4.5 (free >25%), 9/02=3.5, 3/03=5.4 (free>25%), 4/03=3.8, 2/04=2.7, 3/05=3.8, 1/06=3.2, 2/07=4.0, 2/08=3.4, 6/09=4.0, 5/10=3.3, 9/11=4.8, 1/12=5.4 (free=24%). I had an inguinal hernia bothering me for several months and had a repair done on 2/17/12 and had a lot of pain and swelling (I'm still not fine but better). On 2/29/12 I had a PSA of 6.7nd my urologist said I should probably have a biopsy. I have scheduled it but am terrified. My question is : Is it possible that the hernia and especially the surgery have elevated the PSA. I also have had night sweats of and on for about 5 months which have improved lately (my brother told me that was the main symptom of his prostatitis. I also have what some would consider excessive sex. I know I may be looking for excuses but knowing the uncertainty of this whole area is there any case to be made for not having a biopsy and repeating a PSA.
I don't blame you for wanting to avoid a biopsy. Not because it's painful or dangerous (it doesn't have to be either), but because it so often starts one on a slippery slope to often unnecessary treatment. By your age, most men will have some PC in their prostate if one looks hard enough, but the PC will most likely be indolent. Because we don't have any definitive way of knowing (other than by waiting and monitoring it) whether the cancer is indolent or not, most men will decide to treat and endure all the side effects of treatment. Who wants to face the prospect of regret down the road, even if that prospect is minuscule? But who would want to treat it and have the associated problems if we could know for certain that it was indolent? Biopsies force us into that dilemma.
It's certainly possible you picked up some prostatitis from the operation. Why not try a 3-week course of Cipro and see if the PSA goes down. Don't have sex for 2 days before the next test. Are you taking finasteride for the BPH? If not, that might stop the rising PSA -- if it doesn't, a biopsy may be in order.
There are some other tests in addition to PSA and free PSA that you might want to pursue before a biopsy: PCA3 (get this done after the PSA blood draw), [-2]proPSA, and TMPRSS2-ERG. These five biomarkers taken together probably are a better indicator of prostate cancer than a biopsy. However, you can't get a Gleason score without a biopsy.
The Following User Says Thank You to Tall Allen For This Useful Post: p0506img (03-12-2012)