First off if your doctor thinks labs don't make mistakes he's a fool.

Second, to my knowledge biopsies are not usually considered until PSA is
usually up around 4.

Personally I'd find anohter uro. It sounds more like he just bought a new
BMW and need someone to make payments for him

Hi Larry...A PSA increase of 0.75 ng/ml, some say 0.50, in a year
suggests further evaluation.  A repeat of the PSA test is a good idea,
IMO.  Better yet might be a retest after a 2-3 antibiotic regimen to
see if prostatitis might be the real culprit (unfortunately not all
prostatitis responds to antibiotics)...ron

I'm not a doctor but  it is my understanding that prostatitis
does elevate PSA levels.  Furthermore, I suspect that PSA tracks
flareups.  When you're having a bout of prostatitis the PSA may
go up during that period and then come back down if the
inflammation recedes.

Apparently, PSA levels can go up due to a number of different
factors.  If you had sex the night before the blood draw, or if
you had a digital rectal exam shortly before the blood draw, that
could elevate PSA levels (again, I'm not a doctor, but those are
the conventionally accepted views.)  The theory is that there
should be no stress on the prostate for 48 hours before the blood
draw in order to get an accurate reading.

It is commonly held that people with prostatitis should get a
round of antibiotic treatment to see if it goes down.  From my
reading, I think that the majority of prostatitis cases are not
in fact due to bacterial infections and won't respond to
antibiotics.  I know that I've suffered from prostatitis and had
no response to antibiotics except a queasy stomach for 28 days.
I personally don't believe in taking antibiotics unless you
really need them, and would ask the uro to do a urine culture to
find out if there are higher than normal levels of bacteria in
the urine - which might indicate that an antibiotic would do some
good and not just wipe out beneficial bacteria in your body and
help breed antibiotic resistant organisms.

As for labs making mistakes, well, I'm sure it's true that
mistakes are pretty rare.  But no matter what systems they have
in place to prevent them, there are still human beings running
the labs.  I would have liked your doctor's statement better if
he had said that mistakes are rare rather than that they don't
happen.  Still, the odds are high that the reading is correct.
The main issue is, is this increase in PSA really due to cancer?

Did the uro feel anything on his digital rectal exam?  If he did,
then I think he's right that a biopsy should be done.

If not, then I like your idea of repeating the PSA rather than
getting a biopsy.

I'm a little reluctant to contradict your uro.  He's a
credentialed expert and I'm not.  However, your PSA is well
within normal limits, you have an alternate explanation for the
recent rise (prostatitis), a biopsy is expensive and invasive, a
PSA test is cheap and non-invasive, and prostate cancer is
normally a very slow growing disease anyway so that waiting a bit
and re-testing is unlikely to put you at much risk.  The usual
theory is that anyone with a PSA below 10 and a Gleason score
(which you can't get without a biopsy unfortunately) below 7, has
a very high probability of successful treatment.

So, I'd schedule another PSA test.  I'd be sure there is no sex,
no digital rectal exam, maybe even no bike riding, for 48 hours
before, and see what it says.  I think there is a good chance it
will be lower than your last reading.  If it's higher, then maybe
you should get a biopsy.

Good luck.

   Alan

Hi Larry. Get the biopsy. I'm 45 years old, had a normal PSA, but a lump was
found during my annual physical. I was sent off for a consultation with a
urologist and they repeated the DRE. As a result, I had a biopsy done right
on the spot. My test results came back positive for prostate cancer. My
surgery was on March 20th and I'm recovering slowly.

A PSA test is not the definitive answer as to whether there is a problem or
not. Get a DRE and get a biopsy just to make sure. The biopsy is unpleasant
but releatively painless and it will take about 10 to 15 minutes depending
on how many samples need to be taken.  Waiting for the results is actually
worse.

If you have any questions, feel free to ask.

Larry:

you don´t need a "permission" from your uro to have another PSA test.
There are good reasons to have several, preferably spaced by time
intervals. PSA may vary within a short time and results are affected
by many activities and conditions. Get the information and learn about
PSA velocity and PSADT (doubling time). Always get a second opinion.
And labs do make mistakes.
best of luck

Well, it's not exactly true that labs don't make mistakes.  But an 80%
increase over 12 months is significant.  It's best to rule out cancer.

Hi Larry,

Labs do make mistakes. My PSA went (supposedly) from .5 to 1.8 in
about 18 months, and I freaked out. I went to a uro, who examined me
and told me a biopsy was not necessary, and suggested I monitor my PSA
every six months. The subsequent six month readings were 1.6 and 1.9.
Well, it turns out that when I had my yearly physical last October, my
GP and I looked more closely at my past tests, and, sure enough, there
were other discrepancies on the lab tests in which the PSA was .5. For
instance, my lipid profile was also way off my "usual" results. This
does not, of course, prove the lab screwed up, but it does make it
more plausible.

One thing about PSA velocity. Two readings are not enough, you need at
least three PSA tests done at the same lab on the same equipment over
at least 18 months to get any useful information. The general idea is
that you're trying to distinguish exponential from linear PSA growth,
which can not be done with two readings alone. I'm a mathematician and
can vouch for this. Do some research and you'll see what's going on
here. The .5 ng/yr threshold should be an average of at least three
readings taken at least six minths apart.

You'll get great feedback from this group, Larry. I have learned much
from the posters, and still occasionally lurk here, reporting in with
my PSA numbers. As of yet, I'm not a certified member of the club, and
have no desire to change my status. I get a DRE and a PSA test every
year, without fail.

Good luck.

Burney replied to Larry about a biopsy:

My first biopsy was 7 years ago, the second 6 years ago.

I swear we both had the same doctor. <g>  Hottest day of the
year up to that date in May, and the facility's air conditioner
was on the blink.  No mention of a pain killer or sedative.
I did receive an antibiotic because I had a THR(L) and any
medical/dental procedure requires one to ward off infection.

The latter biopsy 8 months later was a second opinion by another
doctor in a different practice.  That I demanded from my PCP and
insurance company at that time (I've since dropped the HMO and
now have Tricare For Life).

Still no pain killer or sedative, just an antibiotic as before,
but it more tolerable.  I didn't break out in a sweat nor become
nauseated, clammy, light-headed, ready to faint as I did the
first time.

YES!!!!!!!!!!!  Even if you have nerves of steel, get some
type of pain killer and possibly a sedative.

Joe N.

___ Blue Wave/QWK v2.12

Thanks, Alan. The only thing he noted upon DRE is the left lobe bigger
than the right. He said sometimes that means something and sometimes
not. And in fact, I am having a bit of dull pain on the left side, so
I'm thinking it could be the prostatitis

Based on what you said in the first paragraph you should push for more
information and a Second PSA. However, based on the second paragraph which
you added for another poster, you should get the biopsy. It's always good to
give complete information if you want an accurate answer. Getting the biopsy
will give you peace of mind one way or the other.

I suspect the Uro is concerned about the unevenness or lump in the left lobe
as well as pain more than the PSA. He's probably not concerned about the PSA
that's why the dismissive answer.

I got a biopsy after a lump was felt during an DRE and, fortunately the
biopsy was negative. It's no big deal, you don't feel the needle which
usually samples a number of times, not just once. There is no pain. The
biggest issue is the feeling of having to poop with the ultrasound probe
pushing this way and that over about 10 minutes. The Doc is using ultrasound
to view the prostate and find locations to take the biopsy samples. The
needle pops out of the probe very fast taking it's sample and that part
doesn't feel like much of anything. Again the biggest problem is the feeling
of fullness and pushing in the rectum.