There is high PSA level but no symptoms. Is biopsy really necessary?

Q. There is high PSA level but no symptoms. Is biopsy really necessary?

Answered by
Dr. Karthik Rajan
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 22, 2018 and last reviewed on: Jul 07, 2023

Hello doctor,

My husband needs help. He is a 68-year-old male with a high PSA level of 8.65. It has gone from 5.3 to 8.65 in a year. Now, let me give you the facts. We believe at his age, he might have an enlarged prostate, but none of the two doctors he has seen in the past one year has told him so. We also believe that because of his acidosis, the inflammation in his digestive system may have also contributed to this high number. He takes a lot of herbal supplements, about 15 per day, and this too may have attributed to his high number. Because of the acidosis, he has developed gluten problems and just does not eat like he used to, so he lost 25 pounds in the year.

He was tested this past year and his prostate number was 6. They did a DRE test and found a nodule for which he had a transrectal ultrasound and sonogram of his prostate, liver, and kidneys, and all were alright. They just put on the report that maybe he should have more tests run. His current doctor only wants to discuss biopsies and will not listen to the reasons we have listed below. He is healthy and has no symptoms. I just need another opinion because I do not want my husband to have unneeded biopsies. We will consider an MRI, but what we want to know is this. Does it make a difference if his free PSA percentage score is 32 % as we read if it were over 25 %, chances are he does not have cancer and does it not seem plausible with the transrectal ultrasound and sonogram that he does not have cancer? Please advise. Thank you so very much for being out there for us.



Welcome back to

I have gone through your query and would like to know the size of his prostate on the ultrasound scan. An increase from 5.3 to 8 in a year is significant and so is a nodule in the prostate. A free PSA (prostate-specific antigen) test can give an idea of the possibility of it not being cancer, but it is not foolproof and cannot confirm. So, I would not make a decision only on the basis of that. At your age and the given PSA levels and nodule in your prostate, you definitely need evaluation to rule out prostate cancer. An MRI initially is now becoming an option, but again a negative MRI is not sensitive enough to rule out prostate cancer. I too agree with your urologist that you need a biopsy, though it may be negative in 25 percent of cases, it is for early detection of prostate cancer which gives you much better outcomes.

Hope this was helpful, feel free to revert back with any questions.

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Thank you doctor,

Here is what the report says from the ultrasound of the prostate: The prostate measures 2.4 x 2.5 x 1.9 inch for a calculated volume of 3.3 fluid ounces. The estimated weight is 3.5 ounce. Predicted PSA per volume is 11.9. Central gland measures 1.4 x 2.2 inches. There are cystic changes within the central gland as well as coarse calcification in keeping with benign prostatic hypertrophy. Within the peripheral zone on the right is a hypoechoic nodule measuring 0.2 x 0.2 x 0.1 inch. Within the left peripheral zone is a hypoechoic nodule measuring 0.27 x 0.23 x 0.1 inch and 0.2 x 0.2 x 0.15 inch. The right seminal vesicle measures 1.6 x 0.3 inch and left seminal vesicle measures 1.7 x 0.35 inch.



Welcome back to

I have gone through your ultrasound report. The prostate gland is significantly enlarged. There is a possibility that this enlargement can also cause the increase in PSA, but there are certain aspects that worry us: A quick rise in PSA over one year, which is unusual in prostate enlargement, as it is a gradual process, and nodules in the prostate gland. As a result, a prostate biopsy is indicated although an MRI before the biopsy can show us more light on the possibility. Also the supplements you have mentioned, do not usually cause a rise in PSA levels.

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