Fluctuating PSA

Hi ashu and Welcome to the Forum!

It should be a urologist who makes that call together with your input (do you have a uro?). Do you have BPH? Increased PSA from it can complicate the picture, as can other, non-malignant, prostate conditions. There are some tests further tests that can be run to help with the biopsy decision, such as looking at the ratio of percent free PSA to total PSA, and the prostate health index (phi).

I trust all your PSA test were done at the same lab (?). This is the best way to avoid discrepancies between labs and test methods and ensuring that any rise is actually yours.

Given what looks appears to be a large increase from your 2020 values, a 3T MRI may be in order. It can help identify and grade lesions seen on a 1 to 5 scale for how suspicious they appear on the imaging (generally any lesion graded 3 to 5 warrants a biopsy); however, a baseline biopsy can be a good even if nothing is seen on MRI if your uro has reason to want to rule out prostate cancer.

Having a first-degree relative with a history of PCa is another risk factor that should be considered.

I, too, had a slowly increasing, but fluctuating PSA, but my fluctuations were much smaller than yours. I had many biopsies over several decades that were all negative (until the last one). The recurring concern triggering these biopsies was that some of my PSA jumps were a bit higher than what was expected from BPH alone.

Given your PSA history, even if they show no cancer, a baseline MRI plus biopsy can be very helpful going forward. The bottom line from my layman's view is that your fluctuations are less of a concern than what appears to be an upward trend.

Djin

Thanks Djin and Sr Sailor. Will consult urologist and request for MRI.