What to do with an elevated Prostate-Specific Antigen (PSA) level of 8.35 ng/mL while taking tamsulosin (flomax) 0.4 mg for Benign Prostatic Hyperplasia (BPH) symptoms?

From the Guidelines

An elevated PSA level of 8.35 ng/mL while taking tamsulosin for BPH requires prompt medical evaluation by a urologist, as this level is concerning and warrants investigation for possible prostate cancer. You should schedule an appointment within 1-2 weeks for further assessment. The urologist will likely recommend additional testing, including a digital rectal examination (DRE) and possibly a prostate biopsy to determine the cause of the elevation. While tamsulosin effectively treats BPH symptoms by relaxing smooth muscle in the prostate and bladder neck, it does not typically affect PSA levels, as noted in studies such as 1. Your elevated PSA could indicate prostate inflammation, infection, or potentially prostate cancer. It's essential to note that BPH itself can cause some PSA elevation, but levels above 4 ng/mL generally trigger further investigation, as discussed in guidelines like those found in 1.

Key Considerations

• The PSA level of 8.35 ng/mL is above the threshold that typically triggers further investigation for prostate cancer, with studies indicating that levels greater than 4 ng/mL warrant concern 1.
• Tamsulosin does not significantly affect PSA levels, so the elevated PSA is not likely due to the medication itself.
• Additional testing, such as a DRE and possibly a prostate biopsy, will be necessary to determine the cause of the elevated PSA.
• It's crucial to continue taking the prescribed tamsulosin 0.4 mg daily for symptom management while awaiting the urologist appointment, but understand that addressing the elevated PSA requires separate diagnostic steps beyond the current medication regimen.

Next Steps

• Schedule an appointment with a urologist within 1-2 weeks for further assessment.
• Prepare for potential additional testing, including a DRE and possibly a prostate biopsy.
• Continue current medication regimen for BPH symptom management.
• Be aware that an elevated PSA level can indicate various conditions, including prostate cancer, and that prompt medical evaluation is necessary to determine the cause and appropriate course of action, as emphasized in guidelines such as 1.

From the Research

Elevated PSA Level and Tamsulosin Treatment

• The user has an elevated Prostate-Specific Antigen (PSA) level of 8.35 ng/mL while taking tamsulosin (flomax) 0.4 mg for Benign Prostatic Hyperplasia (BPH) symptoms.
• A study published in the European Urology journal 2 found that dutasteride, alone or in combination with tamsulosin, significantly reduced the relative risk of prostate cancer diagnosis in men with BPH undergoing annual digital rectal examination and PSA screening.

Impact of Antibiotics on PSA Levels

• Another study published in the BJU International journal 3 compared the influence of a 4-week course of empirical antimicrobial therapy or observation on PSA levels of asymptomatic patients with a raised baseline PSA.
• The study found that PSA levels tend to fall when repeated after 45 days, regardless of antibiotic use, and that a decrease of 20% in PSA was not predictive of a negative prostate biopsy.

Effect of Finasteride on PSA Levels

• A study published in The Prostate journal 4 evaluated the effect of finasteride and/or terazosin on serum PSA levels in men with moderate lower urinary tract symptoms due to BPH.
• The study found that finasteride significantly reduced PSA levels, whereas terazosin had no significant effect on PSA levels.
• Another study published in The Journal of Urology 5 found that finasteride decreased the annual median increase in PSA from benign prostatic hyperplasia and improved the performance characteristics of PSA to detect high-grade prostate cancer.

PSA Reduction during Finasteride Therapy

• A study published in Aging Clinical and Experimental Research journal 6 found that finasteride reduced PSA levels by approximately 40% in Chinese patients with BPH.
• The study also found that baseline PSA level was significantly correlated with PSA reduction during finasteride therapy, and that the doubling rule could be used for screening when baseline PSA level was greater than 4 ng/mL.