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Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3546
Experience:  MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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I have a PSA OF 50. During the last 1.5 years, I have had

Resolved Question:

I have a PSA OF 50. During the last 1.5 years, I have had a total of 60 biopsies (12+12+36). The results were negative. What are my options?


 


In addition, I have been taking Metformin ER 1500mg daily.  I am  68 years old and understand via eHealth website that PSA scores increase with this med.  Any correlation?

Submitted: 12 months ago.
Category: Urology
Expert:  Dr. Tharun replied 12 months ago.
Hi

Have you ever done a MRI spectroscopy?

Do you have a family history of prostate cancer?

How is your free psa to total PSA ratio?

Please let me know.

Dr.Tharun
Customer: replied 12 months ago.


No on the MRI. Family = older brother (2 years) has radiation seeds implanted 4 years ago. What is Free PSA?


 

Customer: replied 12 months ago.


No on MRI. Older brother (2-years) had radiation seed implanted 4 years ago. What is Free PSA?

Expert:  Dr. Tharun replied 12 months ago.
Hello

It is not a very uncommon condition where PSA is raised and biopsies are negative. Biopsy is positive only in 50 % of cases. So in these cases there are few options which we can try out.

One of them is MRI spectroscopy. This scan can specifically identify cancer suspicious areas which can be targeted later on a biopsy. This has shown to increase the yield of biopsy.
You already had a saturation biopsy(36 cores) which is done in such situations.

Then are other options like power doppler and doppler elastography which are again more sensitive to find cancer in the prostate.

Free to total PSA ratio is a guide to know whether there are more chances of cancer . But again it may not very useful where the PSA is almost 50.

PSA of 50 cannot be caused by medications. So there is only option of keeping you in close follow up if these newer tests come negative.

Please let me know if you have any questions.

Regards,

Dr.Tharun
Customer: replied 12 months ago.


Is it necessary to have another saturation biopsy? What happens to the prostrate with 96 scar tissues?

Expert:  Dr. Tharun replied 12 months ago.
No saturation biopsy is not required. Only suspicious areas are to be biopsied which can be mapped by MRI spectroscopy or power doppler/ elastography.

More the biopsies harder will be future surgery if need arises as the gland will have scarring.

Dr.Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3546
Experience: MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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