What does a high PSA but no PCa on biopsy mean?

[KJMinPhx]

My friend has a steadily increasing PSA (now 15) and just got the results of his prostrate biopsy= cancer free. His urologist says that is rare but to be happy. Seems strange to me. Any ideas on what this might mean?

[LearnAll]

To be honest, biopsy does not capture prostate cancer with 100% certainty. Regular biopsy is done by using a thin needle into 10 to 12 areas of prostate and s tiny piece of prostate tissue is obtained and inspected under the microscope. It usually shows prostate cells who have changed into prostate cancer cells. But if these needles do not hit the tumor then, they might not be able to show cancer cells under the microscope.

In normal healthy humans, PSA is only secreted by prostate cells. No other cell in human body of a healthy man releases PSA.

Up to 4 ng/ml PSA is normal as a normally functioning prostate releases upto this amount to liquify semen for transportation of sperms. Vigorous activity, sex etc can also increase PSA by another 2 to 5 points but that is temporary increase.

The big question is: What is his PSA number ? If it is above 4 in 3 repeated tests at an interval of 10 days each...you must take this seriously as the possibility of prostate cancer rises significantly.

However, biopsy coming negative in all cores is a good thing as it at least tells us that tumor is not very big and may be small and localized to one part only.

One very important point is that he might have prostate infection and/or inflammation (prostatitis) A diligent search for infection of prostate and treatment is needed before you conclude that it can be prostate cancer.

[KJMinPhx]

Great ideas, I’m sending him back to his urologist

[Tall_Allen]

You are posting this on an advanced prostate cancer forum, so I assume that the biopsy was of a would-be metastasis? If so, it obviously was not a metastasis. His elevated PSA must be due to mets that are too small to be seen.