Elevated PSA, Negative Biopsies: What does this mean?

“My PSA is elevated, but I keep having negative biopsies. What does this mean?” This is a common question among many men under the care of a urologist. If you are familiar with prostate cancer, you know that having an elevated or rising PSA (prostate-specific antigen) may mean you have prostate cancer. While there are other possible reasons for an elevated or high PSA, prostate cancer instills the most fear. Therefore, having a high PSA, no sign of the other possible causes, and having had multiple negative biopsies causes much anxiety for patients because this means that the physician does not have a definite answer for their abnormal results. As for following-up, the patient usually has another biopsy in about six months, leaving the possibility for a future diagnosis of prostate cancer open.

Why no definite answer?


PSA test is not specific for prostate cancer. The PSA test is used as a diagnostic and screening tool. However, it is not specific for prostate cancer. There

TRUS biopsy samples less than 1% of prostate tissue. Since the 1980s, the biopsy technique known as a transurethreal ultrasound (TRUS) biopsy has remained the same and is sub-optimal. This technique only samples less than 1% of the prostate tissue when looking for prostate cancer. It also only samples the lower portion of the prostate– yet almost 30% of cancers are found outside this area. This means only 30-40% of the 1.2 million prostate biopsies performed each year are positive for prostate cancer. While the majority of those biopsies are negative, a negative biopsy does not mean you do not have prostate cancer – it just means that your biopsy was negative. There is still a possibility that you have undetected disease.are several other possibilities as to why your PSA may be elevated including an enlarged prostate, prostatitis, inflammation, or a urinary tract infection. But when the PSA is above 4.0 ng/ml, or is “abnormal”, and other possible causes have been ruled out, the next step for the patient is to have a prostate biopsy. A new test called the Prostate Health Index (PHI) test, which is specific for prostate cancer, is currently underway in the United States. However, it is not widely available yet. Until then, the PSA test is the best available blood test biomarker for detecting prostate cancer.

New and better way to detect prostate cancer

There is now a solution for men to avoid having repeat prostate biopsies. Thanks to clinical and technological innovation, the traditional biopsy technique has been updated to a state-of-the-art diagnostic system to detect and diagnose prostate cancer more accurately than ever before: the MRI-guided prostate biopsy. The MRI-guided prostate biopsy “fuses” MRI scans with real-time ultrasound images of the prostate. This allows the urologist to pinpoint specific tumors within the prostate gland. This technique plays a valuable role in ruling out prostate cancer, monitoring low risk patients with active surveillance, or identifying more aggressive cancers which need to be removed quickly. The urologist can also detect or eliminate advanced disease in patients who have an elevated PSA and have had multiple negative biopsies.


David Samadi, MD - Medical Contributor

View posts by David Samadi, MD - Medical Contributor
Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel's Medical A-Team. Learn more at roboticoncology.com. Visit Dr. Samadi's blog at SamadiMD.com. Follow Dr. Samadi on Twitter, Instagram, Pinterest, and Facebook.
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