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Dr. Roach: PSA score continues to rise amid negative biopsy results

Dr. Keith Roach
To Your Health

Dear Dr. Roach: I am a 74-year-old male in relatively good health. The only prescribed medication I take is 5 mg of amlodipine daily. My issue is my PSA score. In 2004, I had a UTI, and the urologist told me that my prostate was enlarged. At the time, my score was somewhere between 1.5 and 2 ng/mL. He then did a procedure with a laser that opened up my urethra.

By February 2014, my score was 5.13 ng/mL, and I had a prostate biopsy done in 12 locations by a different urologist. The results were negative. In January 2019, my score was over 6 ng/mL, and I had a genetic test that showed a low probability of cancer. By March 2021, my score was at 8.18 ng/mL, and I had a fusion biopsy. There was a suspicious spot detected and targeted, and 13 samples were taken. The results were negative again.

Dr. Keith Roach

In April 2023, my score was 10.29 ng/mL, and I had another fusion biopsy. Again, there was a suspicious spot detected and targeted, and again, 13 samples were taken. No one could say if the suspicious spot was the same, but the results were negative. My most recent PSA score was 12.71 ng/mL in December 2023.

I am a three-time lymphoma survivor, and in 2016, I had an autologous stem-cell transplant. All my doctors tell me that this has no bearing on my prostate issues. My older brother had prostate cancer that was successfully treated.

My question is: Is this something that I should continue with every two years for the rest of my life, or is it three strikes, you’re out? I am still sexually active, and it is not the most pleasant procedure to go through, with my recovery time being well over a month.

— K.U.

Dear K.U.: Given the three sets of biopsies, two of which were guided by MRIs and ultrasounds (”fusion biopsies”), as well as the genetic study without any evidence of cancer, it is unlikely that another biopsy will be positive now when 13 were negative just a year ago. My research confirms that stem-cell transplant for lymphoma does not appear to increase the risk of prostate cancer.

However, you do have a family history, and when I plotted your PSA levels against time, it appeared that your PSA level is increasing faster now than it has in the last 10 years.

One option would be to repeat the MRI with a biopsy only if a repeat PSA test confirms that the level is increasing faster than before, or if there is a suspicious area that looks worse than last time. I also read that finasteride both reduces the risk of prostate cancer and makes it easier to diagnose cancer by shrinking normal prostate tissue. It might help.

Dear Dr. Roach: I am 66 years old and in fairly decent health, except recently I’ve been more and more unable to come up with simple, everyday words. Is there an over-the-counter vitamin supplement that is worth using? I currently take several vitamins, plus medicine for neuropathy and blood pressure.

— J.B.

Dear J.B.: There remains no convincing evidence that OTC supplements reduce dementia risk. A healthy diet high in fruits and vegetables, such as a Mediterranean-style diet, and regular exercise are much more likely to reduce dementia risk — and heart disease as well. Controlling blood pressure is also important.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.