PSA levels/results impossible fluctuation

No way for a man that has not been treated for PCa to have a 0.21 PSA. Something weird happened with your August lab results, something in the lab, something getting info into your file, maybe the nurse was reading a different lab test or from a different patient. Consider August to be a fluke and go with all the other tests. Anyway, that's my opinion, but of course talk to your urologist in a month.

Extremely unlikely the .21 is real. Rely on numbers you have seen. The urologist is seeing you at the right time. See if an MRI before any biopsy is possible. You could always get a PSE test, it is 94% accurate in finding that cancer is there and you need another biopsy.

I have been on ORGOVYX (relugolix) for 9 months for gland contained Pc, PSA was in the 4.5 range and monthly dropped through 8 months to 0.4 then jumped to 0.6. This occurred one week post a two week influenza like illness: [runny nose, fever, sneezing coughing productive cough (white to light green)] Will repeat testing in mid February. Any over the horizon thoughts?. I suspect the illness kicked up the number. Nasal swabs did not detect the usual suspects. I have subsequently just got a COVID vax booster (77 years old)

BTW: I believe even High RISK gland contained ds. now ( >December 2025 ) includes SBRT in the standard of care ('SOC') guidelines.

Thanks for the feedback. I feel like if that was actually a result from the lab, my Dr should have questioned it at the time and had me come in for another test. My plan is to insist on mpMRI and decipher test on biopsy sample. I don't really want to go through the 12 sample routine if I can help it but I will if it's necessary. Thanks again and best wishes to everyone!

@thmssllvn
My brother had five sessions of SBRT on his prostate when he was 77. He’s 80 now and doing fine.

He did have some urinary issues after the radiation, but intermittent Flomax resolved it.

It could be your being ill did cause the PSA to rise. Good to hear you’re having it tested so soon again.

I’ve had nine Covid vaccinations. The place I go for medical care would prefer I get one every three months.

My experience —> My PSA zig-zagged all over the place from the time I had my first PSA test (in 2000), to the time I was diagnosed with PCa (in 2012), through the time I was on active surveillance up to the time I had proton radiation treatments (in 2021). (See my attached PSA tracking chart.)

Also, consider that since testosterone levels are diurnal - and PSA levels are often tied to testosterone levels - that PSA may very from morning to afternoon.

Sometimes there are lab errors. I would get a follow-up PSA test just to confirm (& also have them do a “Free PSA” test at the same time).

To validate your PSA test see if there is a Quest lab nearby. I use Quest once in the last year to validate my test with the VA. My PSA has increased slightly over the years since proton radiation therapy in 2010. I suspect part of the issue is the aging factor. But, just to be certain, a "second opinion" was done thru Quest. For $75.00, it was worth it. Lastly, a second opinion or even a third is merited when issue of prostate issues arise. There are so many metrics in the disease that no man is like another. Each case seems unique based on age, quality of life, diet, exercise, health history and a host of other metrics. Do not depend on one doctor..reading many of the comments here over the years reinforces the recommendation of seeking validity of the issue by a second or third opinion.

@westernflyer I’ve done the same thing on a few occasions - self-ordered a PSA test. Be sure to shop around. There are a number of labs that offer tests at competitive prices. Here’s the one that I use: https://mylabsnow.luminatehealth.com/dat/test/details

Could tracking prostate density help refine psa test results and decisions about biopsy/treatment?

@ezupcic
It’s a place to start but getting an MRI when the PSA is rising or getting a PSE test can let you know whether or not it is time to get a biopsy.