PSA Test Results & Biopsy: Understanding Your Options

Question
I hope you can help me make a decision on whether to have a biopsy done.  I am a black male of 49.  i had have over the past year 3 psa tests done.  I don't have the exact numbers but I think the results ranged from 3.0 to 4.0. The second test result showed an actual decline but the 3rd went up again.  

I had all 3 tests with the same clinic. My first urologist recommended a biopsy. But I decided to consult another urologist to get a second opinion.  He looked at my paperwork and also recommended a biopsy.

My question is should I go ahead with the biopsy.  It seems awfully invasive, even painful, but on the other hand I would like to know once and for all if I have prostate cancer.  So I am torn.  please give me your best advice.  Thanks.

Answer
Hi Noel.  I'll try and give you my opinion, but remember, I'm not a doctor!  The TOTAL PSA test is basically a "screening" test for prostate cancer.  It's one of the most common tests that we perform at my laboratory.  It's recommended as part of a yearly exam for men over the age of 40.  The normal range for PSA where I work is 0.0 to 4.0.  Keep in mind that this is only the normal range for where I work.  The normal range is dependent on the methodology and the machine used at the lab where you had your lab work done.  There are also tests called a FREE PSA and an ULTRASENSITIVE PSA.  These blood tests are usually done when the TOTAL PSA is high (or in your case, borderline high).  This can give the doctor better information as whether a biopsy is indicated because the FREE PSA and ULTRASENSITIVE PSA are better indicators for prostate cancer than a TOTAL PSA.  I would recommend that you check with your doctor as to whether he/she did those tests.  If not, you may want to ask for them.  Remember this is just my opinion!  Hope it helps.  Good luck, Noel.

Samantha