Should I be concerned about the elevated PSA level before undergoing the UroLift procedure?

PSA Elevation Before UroLift Procedure: Evaluation and Recommendations

Your PSA increase from 1.18 to 2.07 ng/mL over three months warrants a repeat PSA test before proceeding with the UroLift procedure, especially since ejaculation the night before may have artificially elevated your result. 1

Understanding Your PSA Results

• Your PSA increased from 1.18 ng/mL to 2.07 ng/mL over a 3-month period, which represents an increase of 0.89 ng/mL 1
• This falls into the 0.7-0.9 ng/mL increase range that guidelines suggest should be monitored with a repeat PSA test in 3-6 months 1
• Ejaculation within 24-48 hours before PSA testing can cause temporary elevations in PSA levels, which may explain part of your increase 1
• Your recent cystoscopy showing no signs of cancer and a PSA level that remains below the traditional 4.0 ng/mL threshold are reassuring factors 1

Recommended Next Steps

• Repeat your PSA test in 4-6 weeks, ensuring no ejaculation for at least 48 hours before the test 1, 2
• If the repeat PSA shows:
  • A decrease back toward your baseline (1.18 ng/mL): Proceed with planned UroLift procedure 1
  • Continued elevation or further increase: Consider consultation with your urologist about potential prostate biopsy before the UroLift procedure 1

Important Considerations

• PSA can naturally fluctuate by up to 20-25% between measurements due to laboratory variability alone 1, 2
• Benign prostatic hyperplasia (BPH), which you have, commonly causes PSA elevations, especially with an enlarged prostate that is "twice as big as needed" 1
• For men in their 60s, the median PSA value is approximately 1.2 ng/mL, with age-specific reference ranges for white men aged 60-69 being 0-4.5 ng/mL 1
• Short-term decreases in PSA may occur even in men with prostate cancer, so a decrease on repeat testing doesn't completely rule out cancer 3

PSA Velocity Considerations

• An annual PSA increase of more than 0.75 ng/mL is considered concerning for men with PSA values between 4.0-10.0 ng/mL 1
• For men with PSA levels below 4.0 ng/mL (like yourself), a lower threshold of 0.4 ng/mL per year may be more appropriate 1
• Your increase of 0.89 ng/mL over just 3 months exceeds these thresholds, which is why a repeat test is important 1

Conclusion for UroLift Planning

• The UroLift procedure itself is not contraindicated by your current PSA level, but clarifying whether this is a true elevation or a temporary fluctuation is important 1
• Obtaining a stable baseline PSA before the procedure will help with post-procedure monitoring 1
• If your repeat PSA remains elevated above 0.7-0.9 ng/mL from baseline, discuss with your urologist whether additional evaluation is needed before proceeding with UroLift 1