Rising PSA

ddooley · Posted: Fri Nov 10, 2006 8:23 am Post subject: Rising PSA

Hi,
I am 61 years old, in 2001 I had my first PSA test. My PSA rose steadily from 4.42 in 2001 to 8 in 2004 during which time I had 2 negative sets of biopsies. In December 2004 I had a TURP for BPH. 3 months after the operation my PSA had fallen to 0.51. 1 year later it was 0.94. Why is it rising again and should I be worried about this?
Thanks.

johnw100 · Posted: Fri Nov 10, 2006 9:34 pm Post subject: Re: Rising PSA

A few things to discuss with your doctor:

I would keep a close check on it with regular PSA checks, DRE, and biopsy if warrented.
When you get next PSA done, request a "FREE PSA" test as well. Free PSA can help indicate the likleyhood of PC.

Unfortunately there's no such thing as a "normal" PSA and it's usually the TREND which is important. Many things can influence it including SIZE OF THE PROSTATE. Larger the prostate is, the more PSA is produced, so as we age and the prostate becomes enlarged, the PSA can rise.

There could be several reasons for your PSA rising. As you know PC can cause it. One gauge is PSA doubling time: for example, a PSA that doubles in 3 months is of more concern than one which takes a year or more.

John

ddooley · Posted: Mon Nov 13, 2006 3:53 am Post subject: Rising PSA

Thanks John, I will take your advice.

ddooley · Posted: Tue Nov 14, 2006 6:43 am Post subject: PSA rising

Hi John, coming back to my post of 13/11/06 and one of your answers this morning. I was never told the size of my prostate. I do know tha 40 grams was removed during the TURP, does this indicate a large prostate?

johnw100 · Posted: Tue Nov 14, 2006 7:30 am Post subject: Re: Rising PSA

It sounds as if you had a large prostate.

Some might think a PSA of .94 is not high, however it has risen considerably in a year (in % terms).

As you are young, I'd be doing further investigation, or at least keeping a close check on it.

John

ddooley · Posted: Tue Nov 14, 2006 9:52 am Post subject: Rising PSA

John,
when my GP, who originally referred me in 2001 and knows the history, received this result of .94 in April, he said file, no further action. I'm confused and slightly worried!
Thanks.
Don.

johnw100 · Posted: Tue Nov 14, 2006 7:59 pm Post subject: Re: Rising PSA

Your doctor probably feels it's from benign causes.

Personally, I'd be getting another PSA, including "freePSA" if it's available, as this might assist your specialist.

Although your PSA is relatively low, this will indicate whether there's any trend starting to develop. If that turns out to be the case, you could ask your urologist's opinion on it.

John

ddooley · Posted: Wed Nov 15, 2006 3:06 am Post subject: Rising PSA

Thanks John,
I will get a PSA test with "free PSA" and take it from there.
Don

ugbandtulsa · Regular Joined: 28 Nov 2006 Posts: 11

Don,

I would not be overly concerned at this point. The fact that your PSA got as high as 8, but then dropped to well below 1 is a good sign. It would seem to indicate benign causes, if PSA is your only indicator. I would request a TRultrasound, if it makes you feel better.

Yes, it is a 94% increase in a year, but to be above 8 then back to the .5 range is a very good sign. Sounds like BPH to me.

Mike

ddooley · Posted: Wed Nov 29, 2006 4:43 am Post subject: Rising PSA

Mike,

thanks for your reply,

I am just slightly concerned at the level of PSA increase, but as you point out, it did drop dramatically after the TURP.
I suppose I need to be convinced that BPH can cause that sort of increase in 1 year. Would that mean then, that the prostate is enlarging again and is that usual? In previous posts on this thread, it was thought that I may have a large prostate anyway. I am not a medically trained person, so I have no experience of this.

I am currently reading the book that johnw100 recommended, "Prostate cancer prevention and cure" by Lee Nelson. It is a very informative book, but of course it does not deal thoroughly with BPH.

Don

ugbandtulsa · Regular Joined: 28 Nov 2006 Posts: 11

I have not read the majority of your posts, so I'm not totally familiar with your situation, however-

You might have a slightly larger prostate than normal. This would not cause a fluctuation of PSA, rather a continuously elevated or slightly higher PSA than "average", whatever that might be. Have you taken or ever taken any homone or DHT modifying drugs, such as Propecia? This should cause a drop in PSA, but if you were taking them and stopped this could be the reason for an elevating PSA. Or possibly just BPH.

At your age of 61, I would monitor closely. Get a PSA test done every 3 months if you like. A FPSA or "free" PSA test might be more helpful for your urologist to make an accurate diagnosis. This may have been requested already. Either way, PSA tests are not super-expensive (around $85 in my area), and can give valuable information.

I still feel that at 61, to be <1.0 is excellent. As most doctors agree, PC would get all of us if we live long enough. So, at this stage (<1a most likely), you should be fine. If it starts doubling every 3 months, I would be concerned. From personal experience, my father's PC didn't produce any real tell tale signs until his PSA was around 18 or so. At that point, we figured out through a Bone scan that it had met'ed into the pelvis, etc.

You could have a bone scan done if you want, since normally PC does met into the bony structures. An MRI, CT, or even an HDMRI would not, at this point be the direction I'd go for you. Even a bone scan at a very early stage can be difficult to read, and will offer no gaurantee of certainty. However, if caught early, you could significantly extend your life. Of course, many people find that peace of mind simply is worth the expenditure, so that's up to you...

Good luck,

Mike

glass318 · New User Joined: 17 Dec 2006 Posts: 5

Prostate cancer screening is one gray area. There is no survival benefit to screening for prostate cancer. The natural course of the disease is not very well understood as yet. Nevertheless, a rising PSA could be of concern. Treatments available for prostate cancer at this time have shown almost no survival benefit.
_________________
Glass

ddooley · Posted: Mon Jun 11, 2007 8:54 am Post subject: Rising PSA

Hi all, last month I had my second yearly check and my PSA was 1.19, after 0.94 the previous year. Looks like everything is okay and it was just BPH.

chrisz · Regular Joined: 09 Apr 2007 Posts: 29

I think that in the very near future they will find that the PSA test
can be caused by changes in the prostate that are not cancer.
I know about BPH and inflammation can cause a high PSA too.
But maybe multiple biopsy's- punching holes all through your
prostate- may just aggravate the prostate to the point that cancer
develops. That's just my opinion.

But with a dramatic decrease in PSA levels with a TURP that showed
no cancer should tell us something.

From what I have read, only about 30% of the high PSA people
actually have cancer. I know, PSA velocity is what's important,

but I have a Small prostate, a PSA of 5-7, a bad free PSA ratio,
yet the biopsy in 04 and this latest biopsy (30 core) showed no
cancer.

Chris

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