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Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3566
Experience:  MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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Is there any reason to think that taking Warfarin leads to

Resolved Question:

Is there any reason to think that taking Warfarin leads to an increased PSA test result? I have been taking Warfarin since mid November 2012. Prior to starting on Warfarin my PSA reading was 4.33 (October 2012). Six months later i.e May 2013 the reading was 5.87
I think my doctor panicked and I am well on the way to a biopsy I suspect.
So, in your experience is it likely that there is a correlation between Warfarin and an increased PSA test result? Should I put off any potential biopsy for, say 6 months, and revisit? My date of birth was Septemebr 1942
Submitted: 1 year ago.
Category: Urology
Expert:  Dr. Tharun replied 1 year ago.
HI

Do you have a family history of prostate cancer?

Have you done a free PSA to total PSA ratio?

Any recent urinary infections?

Please let me know

Dr.Tharun
Customer: replied 1 year ago.

I believe my father died with prostate cancer at the age of 95. He died in 2007 and I don't recall him ever doing anything about this. He was incontinent towards the end.


My PSA test are as follows:


 


1. 5/2006 TPSA 2.66 ng/ml and FPAS 1.04


2. 10/2006 TPSA 3.21 and FPSA 1.64


3. 10/2007 TPSA 2.83 and FPSA 1.06


4. 10/2012 TPSA 4.33 no FPSA shown


5. 4/2013 TPSA 5.87 no FPSA shown


6. 5/2013 TPSA 5.43 no FPSA shown


 


I have had no urinary infections and have no 'waterworks' problems. Am not incontinent and don't need to urinate overnite.


 


I am due another PSA test tomorrow 27th and fully expect, when I see the Urologist again on 31st, that he will recommend a biopsy. I am in two minds about having this and I prefer to 'let sleeping dogs lie'.


 

Expert:  Dr. Tharun replied 1 year ago.
HI Martin,

This is the Gray zone of PSA reading.Between 4 to 10.This is the range which is hardest for the urologist to interpret and they prefer to err on the side of biopsy.

Coming to your initial question regarding warfarin and PSA, there is hardly any relation between the two.
Your free to total PSA was always above 25 % which is suggestive of non cancerous pathology.
I would recommend you to do the free to total PSA again and if the % free PSA is above 25 %, then there is no harm in waiting.

Your PSA levels have fluctuated over the period which makes it highly likely that the next reading might be on lower side.If it is , then it is an additional point in favor of wait and watch.
There is another test known as MR-spectroscopy which can help detect high risk zones in the prostate which can be later targeted for biopsy.This is non invasive test can be easily done without the fear of biopsy complications.

Your father having prostate cancer at the age of 90 is not a risk factor for you.

I hope this answers your question.

Regards

Dr.Tharun
Customer: replied 1 year ago.


Many thanks - I shall certainly make sure I ask for Free PSA test as well.


What is involved with the MR- spectroscopy test? You say it is non-invasive but how?

Expert:  Dr. Tharun replied 1 year ago.
It is MRI -magnetic resonance imaging with a coil in the rectum.

It will also detect the levels of choline and glycine in the various parts of the prostate tissue and according to the ratio detect high risk zones.

Regards

Dr.Tharun
Customer: replied 1 year ago.

Many thanks indeed. Your helpful answers give me some avenues to explore.


I note that you say that there is no relationship between Warfarin and a high PSA result but I am still not convinced - the coincidence is too much!

Expert:  Dr. Tharun replied 1 year ago.
Hi Martin,

I understand your point and it could be more than a co-incidence.
But there is nothing much in the literature to suggest or support it.But you can always confirm it by stopping the warfarin for some time and repeating the PSA, if the doctor who started the warfarin is OK with it.

Regards

Dr.Tharun
Customer: replied 1 year ago.


That sounds like an excellent idea!


I shall see what the PSA test result is tomorrow; discuss with the Urologist on Friday and then review everything with my doctor the following week. Maybe, for the first time in some weeks, there is a light at the end of the tunnel!


 


Many thanks indeed for all your help.

Expert:  Dr. Tharun replied 1 year ago.
Hi Martin

You are welcome and all the best.

Dr.Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3566
Experience: MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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