PSA after Biopsy

[Mpls]

I've heard that the biopsy procedure (14 cores) can elevate future PSA results. What is the recommended number of days or weeks to pass before scheduling a follow up PSA test? Thank you!

[Tall_Allen]

What you heard is wrong. After 3 months, there is no effect.

[Currumpaw]

Hey Mpls,

First--insist on an in bore, real time, mp 3.0T biopsy. Only suspicious areas should be biopsied. Your prostate doesn't need to be turned into a pin cushion by having a saturation biopsy.

Second--if it is a transrectal, insist that fluoroquinolones not be the antibiotics used to prevent sepsis. These drugs can cause serious and lifelong side effects. Cefdinir or Rocephin can be safely substituted.

Third--Not only is there little chance of infection if a trans perineal biopsy is done but areas of the prostate not accessible with a trans rectal biopsy are with the trans perineal biopsy. Try to get a trans perineal biopsy.

Currumpaw

[Starr15 in reply to Currumpaw]

Rarely, as in my case, a biopsy can cause a large rise in PSA that persists. At my first negative 12 core random biopsy , my PSA was 3.8.

6 months later in was 12. Repeat after antibiotics and it was 14. No symptoms. MRI showed no lesion. A second random 14 core biopsy was negative. PSA has fluctuated between 6 and 13 ever since. Some kind of low level prostatitis induced by biopsy seems most likely. It’s very rare so don’t let it prevent you from getting a biopsy if indicated.

[Currumpaw]

Hey Starr15,

I have been there as a result of the third biopsy I had. A 12 core trus followed by a 27 core Artemis and then a 32 core Artemis to ensure that I was cancer free. Pathology results showed no cancer. My PSA was lower than your 3.8--until after the 32 core--uh uh. I made diet changes, supplements and exercise and not only lowered but stabilized my PSA--for a while. Two years later the uro insisted on another biopsy with a large number of cores taken. I resisted saying my PSA test free and total results showed that I only had a 12% chance of having prostate cancer. I had wanted a mp 3.0 T MRI instead. The uro was adamant. We went into a conference. I should have walked out but I finally agreed. My PSA became very much destabilized. I began seeing an oncologist who is the head of the genitourinary department at very respected hospital associated with Brown University. As we watched my PSA rise over time, he advised not to allow anyone to ever biopsy my prostate again.

The uro that did the biopsies used an image from a 1.5 MRI taken hours before--no real time there--fused to an ultrasound screen. He had also pointed to areas on the image on his laptop in his office saying that he couldn't determine if these areas were lesions or scar tissue. Let's just say that when he told me this, I had the 12 core trus and the 27 core Artemis in the past. Twelve and twenty-seven is thirty-nine. That was the day he took thirty-two cores using the Artemis--and no cancer of any type was found. My PSA was a stable 3.3 before that biopsy. That was the end of the 3.3! Scar tissue doesn't heal as well or completely as tissue that hasn't been damaged before. Trauma? Incorrectly cleaned equipment and instruments? I certainly got enough fluoroquinolones with these procedures. The doctor mixed a prescription of six, 500 mg Cipro pills, two the day before the procedure, two the day of and two the day after as well as what the nurse said was an intramuscular shot of a humongous amount of Levaquin, injected in my butt. My old athletic injuries, gone for years, came back worse than they had been originally literally crippling me and the pain making even sleep difficult.

Prostatitis is inflammation which can, over time, cause a cancer.

I do believe I covered the very best practices that are available for biopsy in my previous reply.

I have read in the past that antibiotics have been directly injected into the prostate of men who have suspected inflammation that hasn't responded to normal treatment. You might try to find if such a thing is viable, if it is being done to treat prostate inflammation or if something else has come along.

The sentence in the first paragraph--"I should have walked out". --when things don't sound reasonable, or a doctor is pressuring you hard--walk out, give yourself a chance to think and there is nothing wrong in getting a second opinion. Don't learn the hard way.

My best to you,

Currumpaw

[Mpaddler]

Check out this YouTube regarding inflammation and PSA at about 3-4min:

youtu.be/zQktPZ6U80s?si=Yt5...(Not working as expected?)

Dr. Scholz clearly relates prostatitis with a PSA bump.

Personally, when my PSA first started going up, I went to my GP and described symptoms of a warm achy feeling in my perineum. He put me on Cipro for 2 weeks thinking it might be due to prostatitis - even though my urine tests were negative. After 2 weeks the warm achy feeling went away and my PSA dropped from 7 to 5. Unfortunately, after 6 months PSA was back to 7 without the symptoms I described and I was referred to a urologist.

The urologist, at my insistence, ordered a contrast MRI which showed a tumor in prostate. He then did transrectal biopsy of tumor plus a few additional samples. Gleason 4+3 result. 6 weeks later my PSA jumped 2 points and I have started to have that same warm achy feeling again. I thought maybe it was prostatitis but the urologist says no since my urine test is negative. Still don't know...

Anyway I start my 1st of 5 SBRT treatments next Friday. Looking forward to seeing the PSA go down over the next year!

[Mpls]

Thanks to all for the informative replies. Best wishes to all!

[datatech]

I had a 30 core transperineal biopsy in early november. PSA prior to the biopsy was 4.3, PSA 6 days after the biopsy was 4.7. I am a low risk, gleason 3+3=6 patient. Get a transperineal biopsy if at all possible, recommend doing it under general anesthesia also.