[livingwith]

Over the past three years, my PSA level has risen slowly but steadily. My digital rectal exam showed good results, soft tissue etc. I am 56, and my latest PSA was 4.3 with a free PSA of 19. My previous test showed 3.2 for the PSA and the one a year earlier showed 2.8. My urologist has shown no urgency for me to get a biopsy, but friends think I’m nuts not to get one. Your opinion?
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[Happilyretired]

I have had two unnecessary biopsies in the past 11 years (I am 65) due to my PSA going up over the magic “4”. My urologists, two different cities, both recommended a biopsy each time, “just to be safe”, even though the DREs were good.

Of course they create an uncertainty about the possibility of prostate cancer, which is unsettling, so you go ahead with the biopsy “just to be safe!” In my case, my PSA went up and down, and my last urologist told me (after the fact) that if your PSA ever goes down, you don’t have cancer.

If your PSA is steadily rising, and your DRE is good, it is probably due to BPH. If the concern of cancer is causing you stress, and it probably is, you might want the biopsy to ease your mind.

Unfortunately PSA scores seem to have a high percentage of false alarms, and unnecessary biopsies.

[rajek]

Some men say a prostate biopsy is no big deal. I disagree. I am 59 and my psa jumped from 4.1 to 7.6 over a two years span. I had a 12 samples trans-rectal biopsy done on Thursday 3 rd Dec. 2009. That was painful despite locally applied Novocaine. The results are expected within two weeks. I still have some discomfort in the area and urination frequency has increased. Ejaculation is bloody and the Uro said it will be so for at least 12 cums. Bowel movement was not affected as was feared.
Prostate cancer is supposed to be a slow developer compared to more aggressive types but I will advise that a biopsy be done sooner than later just because the psa has crossed the threshold even though the accompanying DRE says everything is okay. Some medics advise a 'wait and see' approach when an early cancer is detected but this approach can only be adopted when the prevalence and stage of cancer is established.