Stable elevation of PSA

@drj
I think poster are asking about age as statistics show as a man gets older the more chance of BPH and the resulting PSA rise.

If I read your post right, it is your concern about an elevated PSA but not a rising one over time, is that correct? You mentioned biopsies and they came back negative.

Of course a high PSA needs to be addressed but it is the steady rise over time that a urolgist will not like. When I was diagnosed with PC I had a PSA of 3.75. So you can see having a high PSA does not mean you have cancer nor does a normal PSA mean you do not. It is the steady rise over time that is a concern.

If I read right you stated had a 7 PSA for several years with no rises and biopsies did not reveal cancer. I see other poster posting about riding a bike. Yes per my PCP, urologist, and R/O this can lead to a higher PSA as prostate responds to irritation.

Now if he is having a steady rise and not staying steady needs to pain attention. A poster some time ago on MCC said a rising PSA is like a "check engine light" and needs to be checked to what is causing. If you can't find anything wrong through biopseies and MRI, etc. your brother in law and his doctors are aware of it.

As others have mentioned, your brother-in-law may have a large prostate.
> what is his PSA Density?

I just reached him. He's never been told his prostate is particularly large. Also, no history of prostatitis. He no longer bikes. Just a couple of hours of pickle ball daily.

As to PSA density: 25 years ago, ultrasound had been developed to measure prostate size, and it was proposed to look at a ratio of PSA versus prostate size or volume to try to normalize out the effect of enlarged prostate on PSA. I recall some promising abstracts at the AUA, but I wasn't aware it made it to clinical practice.

@drj
Technical correction for accuracy. An ultrasound probe was developed for the prostate to help guide needle biopsies and reduce false negatives. With the introduction of PSA, it was then suggested that it could also be used to measure prostate size and differentiate PSA elevations due to BPH from PSA elevations due to PCa.

@drj His MRI report will tell how large (volume) his prostate is. That’s what to look for, rather than “not particularly large.”

With his most recent PSA result and most recent prostate volume (from the MRI report) he’ll be able to calculate his PSA Density. The MRI report might even mention it.

That may (or may not) explain his elevated PSA, while finding nothing else.

(How old is he?)

@drj You might want to suggest to your brother n law that he takes the PSE blood test which will tell him, with 94% accuracy, whether he is likely...or unlikely, to have prostate cancer. It is made by Oxford Biodynamics.

Two ways to go. 1) Poke and hope biopsies. Sometimes they identify cancer and sometimes they miss it altogether. 2) MRI, with a URONAV biopsy. MRI images overlaid with URONAV software rendering 3D magnified imaging. The prostate is mapped and there is a zero chance of missing cancer cells with this type of biopsy. Nothing is perfect but it is almost with an experienced urologist. Then you can determine your plan after discussions with your urologist and oncologist. PSA tests are huge factor and also the position of the tumor. Tumors close to the colon wall are extremely dangerous regardless of size. PET scans are not that accurate and sometimes ordered and are expensive.

@bens1
This test was announced in 2024 I believe. It combines PSA with tests for some "epigenetic" gene changes to get better accuracy.. This test is available from a single private lab, and perhaps with limited availability.

I know little about this test, which is a thoughtful and promising idea, nor the detail of their clinical data, particularly their PSA data. Without digging deeper, their comparative claims of PSA clinical performance raises questions for me.

First, was the PSA data taken from the medical literature? Was it based on simply the finding of an elevated PSA followed by a biopsy? PSA should only be used by an established rising value over time. A single value by itself would be improper clinical use of PSA. I don't think I've looked at recent sensitivity and specificity data for PSA using specific PSA "velocity" or trending criteria. I'm sure it exists, and I would expect it to be better than the data the company reports for PSA.

Second: How was the biopsy done in the PSA data group? Was it done with the accuracy of targeted MRI/US Fusion biopsies? Dramatic impact on sensitivity and specificity calculations versus earlier 12 Core TRUS biopsies, or systematic biopsies.

I'm not going to dig into the study designs and the data quality. These are the questions I immediately think of if I were to look.

@brianjarvis
I agree with your points. That's exactly what I would do. I've told him this again today, and of my discomfort of him having a PSA this high (albeit "stable"). I wonder if anyone has collected and looked at or report such patients.

@edutron

I agree. One caveat I have in communicating with friends with PCa, as well as following the discussions here for the past two years or so: there are significant variations across the country as to availability of these super new technologies (from which I have benefitted), the approach taken by urologists in initial evaluation and initial treatment, but likely also, some variability in cost/benefit perspectives influencing the decision tree.