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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #21

Have a patient with a moderately elevated prostate specific antigen (PSA)? Do not freak out!

To many providers are trigger happy with referrals, especially with an elevated PSA.

Take a deep breath and simply recheck it in 6 weeks. That is what many urologists are going to do anyways.

Go ahead and get the appointment set up considering there is likely a 6-8 week wait list. Before they go to the appointment though, recheck the PSA.

I have seen PSA’s at my men’s health and testosterone clinic be in the 4-5 ng/ml range and then when I recheck it 6-8 weeks later it goes back down to 2 ng/ml. An increased PSA can be transient and associated with something as simple as riding a bike.

If the PSA is in the 4-7 ng/ml range, recheck it in 6 weeks. If it is over 7 ng/ml though, refer it out to urology.

If the patient is on a 5-alpha reductase inhibitor and the PSA elevates, send it to urology regardless. This has been associated with an elevated risk of prostate cancer.

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2 Responses

  1. This is so true. I would also add that if a gentleman is having an acute urinary problem such as acute retention, UTI, etc that is not the time to be checking PSA levels. They will be elevated every time.

    1. Yep. I see transient increases in PSAs all the time as I check it everytime I check labs on my mens health patients.

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