CZA: Normal prostate tissue produces PSA by the quart. It has a role in reproduction. It changes the viscosity of semen so the spermatozoa can swim better and (most) doctors think it increases the permeability of the cervical mucous plug to facilitate conception. What a PSA test measures isn't how much is being produced but how much is leaking into the blood stream. Prostate cancer cells are particularly leaky so PSA in the blood is an indicator of PCa. But there are other things that can cause inflammation of prostate tissue that can make it tend to leak -- infections, cysts, calcification, etc. -- and that can add considerable noise to the results. Prostate cancer cells leak reliably so as the cancer grows the PSA gradually goes up. Inflammation comes and goes so prostatitis (inflammation of the prostate) gives a PSA that zig-zags. You've clearly got some of that going on. When your doctor says there is something going on but it's probably not prostate cancer that's what he's thinking about
. Physical activities that squeeze the prostate -- sex, bicycle riding, DREs, bull riding, etc. can squeeze enough PSA out (like squeezing a sponge) to affect a PSA reading during the next day or two so you should avoid them prior to having blood drawn.
Unfortunately, having prostatitis doesn't mean you don't have prostate cancer, too, it just makes diagnosing it via PSA tests more complicated. There are some additional tests that look at the proteins that are bound to the PSA (free PSA and PHI tests) that help sort out PCa from prostatitis but they are still only so-so accurate.
Right now if you sort out the signal from the noise it looks like your PSA is only a little bit high for a guy your age. If it continues to zig-zag gradually upwards you might need a biopsy. Your doctor should be mildly worried. If he is worried then you don't need to be. That's why you pay him -- to worry for you.
And if he does decide you need a biopsy it's not that big a deal. As you are reading this grab your ear lobe and give it a good hard pinch. Hurt, didn't it? Congratulations, you have just endured pain more intense that most biopsy samples even if the doctor misses the nerve with the local anesthetic. The trick, as Peter O'Toole's character said in Lawrence of Arabia
is not minding that it hurts. T E Lawrence did this with nerves of steel. Me, I prefer the pharmaceutical detachment offered by two Valium, one in the waiting room, one when they call you back. I find that guys in white coats poking noisy uncomfortable objects up my behind makes me nervous. So I let my urologist hook me up with the Valium and I'm fine. General anesthesia is probably overkill for an ordinary TRUS sextant biopsy.