Should I get a prostate biopsy or should I temporarily stop use of Androgel?
I am 67, good overall health, & exercise regularly. Started using 1% Androgel approximately 4 years ago. PSA was 2.1. It has risen steadily since then. I have a manual exam and my PSA checked every six months. When the my PSA reached 4.0 about 18 months ago, my urologist had me stop taking Androgel for 30 (maybe 60) days and my next reading went to 2.8. Six months ago my reading was 4.2. I had another check recently and it was 4.3. The urologist strongly recommends a prostate biopsy. My thoughts. The manual exam has never shown anything although I recognize that does not rule out cancer. Since my PSA level dropped significantly when I went off of Androgel previously, I advised the urologist that it makes more sense to me to stop Androgel and do another PSA test in 30 and 60 days before doing a biopsy. Obviously if my PSA goes up when I stop using Androgel, further investigation is needed. Your thoughts?
This dilemma that you are in is the exact reason why the United States preventive services task force has recommended that PSA testing be stopped altogether for all men. While this seems to be a radical move, given that you are in the middle of this very dilemma of whether or not to have a biopsy is the exact reason why this well-respected group believes that PSA testing does more harm than good. For starters, yes the Androgel can increase your PSA and you saw that happen. I assume, that you went back on the end or gel and this is when your PSA reached 4.2. The most likely reason that it has reached 4.2 is simply from the Androgel. However, there is no way to rule out the possibility that you have developed a small prostate cancer. An urologist could be in big trouble if he or she missed a prostate cancer so they are not going to recommend you sit on this. If you have developed this prostate cancer, it is likely going to be small one. If you are very concerned about this, then you might have the prostate biopsy just to feel better about it. However, going off the Androgel, getting your PSA rechecked, and then following a watchful waiting regimen is certainly within the realm of acceptability by most physicians. I would suggest that you additionally speak to your primary care doctor about this issue in addition to your urologist. Having two opinions on the issue is always helpful.