Elevated PSA Level But Negative Prostate Cancer Biopsy

Each year, about 50 percent of men over age 50 receive a PSA test to measure levels of prostate specific antigen, according to the Centers for Disease Control. About 10 percent of men who have a PSA test receive results showing an elevated PSA level—traditionally determined as 4 ng/ml or greater. Receiving an elevated PSA level usually means your physician will recommend a traditional 12-needle biopsy.

Three-quarters of those prostate biopsies will be negative. This conventional prostate cancer biopsy, however, does not always accurately detect prostate cancer because it only collects six to 12 prostate tissue samples. The small, scattered number of samples means that tumors can easily be missed. Conversely, if the needles happen to hit upon the only diseased areas in an otherwise healthy prostate, the presence and severity of cancer can be over-represented.

If your prostate cancer biopsy is negative, your prostate cancer doctor may recommend having another PSA test every three to six months. However, you may want to seek additional diagnostic testing in some circumstances, such as if you have:

  • A family history of prostate cancer
  • Other symptoms
  • Multiple elevated PSA tests
  • Other risk factors
  • Stress and worry over your result
  • Your physician has not ordered genomic biomarkers or is unfamiliar with their use

Additional testing does not necessarily mean another prostate cancer biopsy. We now have non-invasive tests that measure biomarkers for prostate cancer in the blood and urine. Those tests can be used in conjunction with PSA testing or a prostate cancer biopsy to give a much clearer picture of whether prostate cancer is probable and, if so, how aggressive the cancer is.
If your biopsy or additional prostate cancer biomarkers testing indicate prostate cancer, you may be a candidate for a 3D mapping biopsy of the prostate. This type of biopsy takes 30 or more tissue samples and uses them to create a 3D model of your prostate to accurately determine if prostate cancer is present, as well as map the size and location of each tumor.

About two-thirds of men who obtain a 3D prostate cancer biopsy are given a result that is different than their initial standard prostate cancer biopsy. About one-third of patients who receive a 3D prostate cancer biopsy are candidates for targeted focal therapy, which removes just the cancer tumors.

One-third are candidates for active surveillance (also called watchful waiting); and the remaining third receive recommendation for radical therapies, such as surgery or radiation treatment.
If you have received an elevated PSA level — we recommend anything above 1.5 ng/ml—and want a clearer picture of your prostate health, consider a customized prostate cancer evaluation that looks at all risk factors to determine the next best steps.