Elevated PSA with a negative biopsy What is the next step in the treatment of a patient who has a prostate-specific antigen (PSA) level between 4 and 10 ng/mL and a negative biopsy?— Jack W. Spitzberg, MD, Dallas

The standard biopsy technique currently includes taking 12 samples —one lateral and one medial sample from the base, mid, and apical regions, respectively, on each side. Even so, some cancers will be missed. Therefore, I monitor my patients who have a negative biopsy every six months with free and total PSA testing, along with digital rectal examination. The free and total PSA allow calculation of a relative risk ratio for prostate cancer. Thus if the absolute value of PSA increases or the ratio moves into a higher risk category (even though the absolute number may stay the same), I suggest repeat biopsy. — David T. Noyes, MD (133-2)

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