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Dr. Keith Roach
To Your Good Health
Dear Dr. Roach: My age is 73, and I've had a steadily increasing PSA level for many years. In 2020, the result was 11.8 ng/mL, and it has risen to 17-18 ng/mL, where it has stayed for the past year. Since July 2024, I have been taking 10 mg of alfuzosin daily. I had a biopsy in 2017 with no sign of cancer. I had MRIs with/without contrast in 2021 and December 2024; these showed no sign of cancer.
After the last MRI, my urologist wrote: "Your recent MRI showed no suspicious lesions. Only evidence of benign prostate changes is noted. Your prostate volume was 49cc, which gives a predicted PSA level of approximately 6 ng/mL. Your PSA is much higher than this, and the reason is unclear. You should continue to follow your PSA level. At this point, I would not recommend a biopsy of your prostate."
He then retired with no further comment. I have an appointment with another urologist but have little idea as to what is happening. -- W.D.W.
Answer: It is completely understandable to be concerned about a PSA level of 18 ng/mL, but you and your urologist have, in my opinion, done everything appropriate to look for cancer, which hasn't been found. It is likely that you do not have prostate cancer as the MRI and biopsy results are reassuring.
I do see this in my own patients from time to time; in these cases, men have continued to have a high PSA level, but I have not seen advanced cancer diagnosed, which is something you are probably worried about. I agree with your (now retired) urologist that additional biopsies are unlikely to be helpful given your normal MRI.
You might consider a 5-alpha reductase inhibitor to reduce your prostate cancer risk. These give a 60% expected reduction in prostate cancer risk. Most men do not have side effects, but some men do, so I'd suggest discussing this with the new urologist. These medicines (finasteride and dutasteride) also reduce the PSA level by about half.