My PSA tests read 4.49 in July and 3.32. in Sep. What can cause this difference? Is this a concern?

Question: My doctor wants to perform a biopsy of my prostate based on the first resding despite the second reading.

Answers:
Prostate-specific antigen (PSA) is a protein normally produced by the healthy prostate gland. It is commonly used to screen for prostate cancer, as it is very often produced by cancerous cells as well, though there is some controversy surrounding its usefulness as a screening test. Many things besides prostate cancers can cause PSA to rise. For example, infection in the gland (prostatitis), enlargement of the gland (benign prostatic hypertrophy) or trauma.

While the absolute value of PSA may be of some utility in deciding whether to work a patient up for prostate cancer, a better means of assessing PSA is to follow it over time for trends. Rapid accelerations in PSA values are more worrisome for cancer than are steadily elevated levels. Additionally, some advocate normalizing PSA values for estimated prostate volume as another means of reducing overdiagnosis of benign disease.

Many physicians use the value of 4.0 as an accepted cutoff for normal vs. abnormal PSA. Again, this is somewhat arbitrary and elevation above 4 is commonly seen in benign disease. In the case of cancers, you would definitely expect to see an upward trend in PSA values, not a stagnation or decrease as in your case. If you are not having symptoms, considering discussing alternatives with your physician, including following the PSA for some period of time to map its trend rather than skipping right to biopsy.

Alternatively, you can ask about measuring the unbound/bound PSA ratio, which tends to be decreased (<25%) in men w/ prostate cancer.

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