You have had two PSA tests that show a rise. In general, if you are over age 50 and have a change in PSA of greater than 0.75 units per year, the rise can potentially signify the presence of prostate cancer.

However, there are many reasons why the PSA can increase over time.

My approach in this case is to first ask about symptoms. Next, I do a digital rectal exam to feel for any prostate swelling or irregularities.

If a man has been urinating more frequently or has discomfort when he urinates, and/or the prostate feels a bit swollen or tender, this would suggest prostate inflammation or infection (prostatitis). I treat this with antibiotics, and repeat the PSA test in six weeks.

If the prostate feels normal or just slightly enlarged, it may be a benign (noncancerous) prostate. In this case, a repeat PSA can be performed. There is always a chance that the PSA value was a laboratory error. I prefer that the patient do the repeat PSA about four weeks after the last test.

If the repeat PSA level confirms the rise over one year, and there is no evidence of an active infection or inflammation of the prostate gland, it is quite likely that prostate cancer is present. Or, if I feel a nodule or some asymmetry, I refer the patient to a urologist for a prostate biopsy because the rise in PSA, combined with these findings, suggests prostate cancer is likely.

In these cases, I recommend that the patient discuss the following with a urologist:

• The pros and cons of having a biopsy
• What would your next step be if the biopsy does not show cancer?
• What treatment options might be best for you if the biopsy confirms the presence of prostate cancer?

You will want to learn about the possible treatment options and side effects vs. just repeating the PSA again in several months without doing a biopsy immediately.