If you have a prostate, there is a high probability that you will have a fluctuating PSA. Going up or down a few points does not mean there is cancer. The current standard of care is that a PSA number above 4.0 warrants a biopsy. But does it? A million men are biopsied annually when they do not need to be. Only about 25% of men who have a prostate biopsy due to an elevated PSA level actually are found to have prostate cancer when a biopsy is done.
The PSA blood test is not cancer-specific; the limits set as being "normal" (< 4.0) are not normal as it can vary from man to man. In fact, this number of 4.0 is an arbitrary number and has no science behind it. The PSA will fluctuate based on age and size of prostate. Most importantly, the PSA test fails to detect the approximately 15% of potentially lethal high-grade prostate cancers. Although rare, the most dangerous diagnoses have a very low PSA. Furthermore, should an elevated PSA lead to a significant prostate cancer being detected, the elevated PSA is commonly caused by the enlarged benign portion of the prostate and not the cancer. In a nutshell, the PSA test is severely flawed.
If your uro says you have a high PSA and you need a biopsy:
- Get a few more PSA tests on a monthly basis to look for a pattern.
- Rule out an infection with a round of antibiotics, then get another PSA test.
- Rule out an enlarged prostate (BPH).
- Request the 4K Score test or another genetic test. Keep in mind that this is an area you will have to press your uro on. These tests are rarely recommended by uros because they are done at third party labs. Your doctor is not interested in sending revenue (you) away from their facility.
- If you agree to a biopsy, be sure that you know the type of biopsy you are getting and rule out a blind/random biopsy. A 3T MRI guided is more accurate than an ultrasound guided biopsy.
The objective here is that while none of the above methods are infallible, there are additional tools that can be used before undergoing a biopsy. Use them. Biopsies should not be taken lightly as they are not without risk. Remember that a PSA test cannot diagnose cancer. Only a biopsy can do that.
In the 48 hours before your PSA test you should NOT:
- Participate in vigorous exercise and activities that stimulate or “jostle” the prostate, such as bike riding, motorcycling, and riding a horse, ATV, or tractor, or getting a prostatic massage for 48 hours before your test.
- Participate in sexual activity that involves ejaculation. Ejaculation within this time frame may affect PSA results, especially in younger men.
- Schedule your PSA test to be done for at least six weeks after undergoing any of the following procedures: prostate biopsy, transurethral resection of the prostate (TURP) for BPH, urethral catheter, cystoscopy, or any other procedure that involves the prostate.
- Schedule a PSA test if you have a urinary tract infection. A bacterial infection in the urinary tract can cause PSA levels to rise temporarily. If you are not sure if you have a urinary tract infection, have a urine test before your PSA test to make sure. If you do have a urinary tract infection, you should wait at least six weeks after you have completed your antibiotic treatment before you have your PSA test.
- Schedule a digital rectal examination (DRE) before your PSA test. Although a DRE should not have an impact on PSA levels, having the PSA test first is a precaution.
- Always use the same lab.
Be sure to tell your doctor:
- If you are taking any pharmaceuticals, especially statins, nonsteroidal anti-inflammatory drugs, or medications that control urinary problems such as dustasteride or finasteride. All of these have the potential to affect PSA levels.
- If you are taking any supplements. Some sports and nutritional supplements, such as carnitine, fenugreek, pomegranate, and tribulus terrestris, can cause PSA levels to rise.
- If you have undergone urinary tract or prostate surgery recently, or if you have suffered a pelvic injury or sports injury.
- If you have prostatitis or BPH.