Question on PSA rise of .3 ng/ml in 1 year

b b · New User Joined: 29 Feb 2008 Posts: 8

Hi all,

I've been a lurker here for quite awhile, and greatly appreciate all the information this forum has to offer. I have not been diagnosed with PCa (and I hope to be able to say that for a long, long time), but my stepfather passed away from PCa a couple of years ago, and going through that process has made me all too "aware" of PCa.

Anyhow, on to my question. I'm 42 years old, and had my first PSA test in Nov. '06. PSA was 1.0 at that time. Shortly thereafter, I developed what I believe (and my urologist believe) was non-bacterial prostatitis. Symptoms were discomfort/burning after urination, feeling like I needed to urinate when I didn't really have to, and some dripping after urinating. We tried the usual anti-biotics with no effect. Eventually the symptoms mostly went away, though I do still tend to drip a couple of drops a few minutes after urinating. In January '07, I had another PSA test done in the midst of my prostatitis attack. Value was 0.9. I then had my annual physical this past week (Feb 2008), with my first PSA test in 13 months, and the value was up to 1.2. My family doctor is not at all concerned about this, but a .3 jump in a year seems somewhat alarming to me. That's really the main impetus behind this post: does anybody have any input on whether I should/shouldn't be concerned about this? I generally tried to behave myself before the test. The blood draw was done 80+ hours after my most recent ejaculation. I do ride an exercise bike this time of year, but it's a recumbent with pretty much a standard chair type of seat, so I don't know if that would have caused the value to nudge upward.

Basically I'm concerned that this .3 spike in a year means something. I'm trying to decide if I wait another 12 months for my annual PSA test, or if I shouldn't schedule something in a couple of months just to see if there's a trend here that could be caught early.

By the way, I should mention I have been researching this on the net. I know many of the guidelines for PSA velocity suggest a rate > .75 is a problem, but in some of the more recent articles I've read many seem to be advocating additional tests if the rate is .4 or more for younger patients. In my mind .3 isn't far from .4, thus the concern.

Thanks very much for your help!

bucky · New User Joined: 28 Feb 2008 Posts: 3

i have my own concerns with this and would love to talk with you about it

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

Walsh, on p. 164 of "Dr. Walsh's Guide to Surviving Prostate Cancer", says:

"If you have a low PSA level (between 1 and 4 ng/ml), any increase is alarming. In a study using data from the Baltimore Longitudinal Study of Aging, Carter and colleagues found that PSA increases greater than 0.2-0.4 ng/ml per year were predictors of death from prostate cancer. Currently, change in PSA over time is the most valuable tool we have for interpreting PSA and for predicting prostate cancer, including whether it is life threatening."

In my LAYPERSON'S opinion, you should be seeing the urologist about this. I wouldn't put a lot of confidence in what the family doctor says. I bet the urologist will want to see another PSA much sooner than 12 months from now.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

b b · New User Joined: 29 Feb 2008 Posts: 8

Thanks Replicant, that's my opinion as well, though not the answer I wanted to hear Smile

.

A couple of follow-on questions for anyone who can offer an opinion:

1) I went from a 1.0 to a 0.9, then to a 1.2. Is the velocity always measured against the last value, (which would be a difference of .3), the highest previous value (which would be a difference of .2), or something else?

2) Any thoughts on how I long I need to wait for another test? I'm assuming another test in a week would come back pretty much the same. What's the minimum time between tests for the results to still be meaningful?

3) Finally, does anyone have a uro recommendation in the Chicago area? Nothing in particular wrong with the guy I'm seeing now, but I feel like I'd like someone with more experience in these types of issues.

solunetta · New User Joined: 04 Mar 2008 Posts: 2

You are wise to pay close attention to your PSA. I would like to tell you of the husband of a friend of mine who is in his 50s whose PSA was in the 4 range. He was advised to have a biopsy but he refused, and instead decided to change his diet and began to take supplements. After 4 months his PSA was checked again and it had gone down to 1.7. He was already an avid exerciser. As you know, PC is very much a western disease; Asian populations who consume more vegetables and fish have a low incidence. My suggestion would be to investigate natural ways for prevention... there are many books out there, as it is still early for you and much can be in your hands. Wishing you luck...

johnw100

Unfortunately there are a lot of grey areas with PC and PSA which can be influenced by many factors as discussed.

As a prostate enlarges it naturally produces more PSA: prostate size needs to be factored in for a PSA number to be meaningful, or a "free PSA" test included to indicate the % of PSA produced by more normal causes.

Often there's an unexplained elevated reading. One definition of a rising PSA is 3 higer peaks, which don't don't need to be consecutive readings.

brainman

Replicant or John, I have a question: If a lab took one sample and tested it many times, how much variation in test results would they find? Do you know was the standard deviation of the test is? Just curious but it would help to answer questions like this one.
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Administrator and long-term cancer survivor
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Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

The individual lab company should have that information. I got a nice email in reply to my voicemail to a chief chemist with a local lab. My concern at the time, as I recall, was a PSA of 0.2 after prostatectomy. That was my second test result after surgery, the first being less than 0.1. After prostatectomy, PSA should fall below 0.1 and stay there.

In the email response, the chemist told me that the lab experienced variation of up to 0.1 ng/mL between machines. That is, if the same sample were tested on two different pieces of equipment, it might be different by as much as 0.1 ng/mL. Well, that wasn't extremely comforting, because it meant that I was still probably no lower than 0.1, and maybe as high as 0.3.

At the time I was trying to assess my odds of progressing further, and I had some studies at hand that showed the odds, depending on your present PSA. Being 0.2 or 0.3 was not a good sign.

The chemist suggested getting an ultrasensitive PSA assay done for greater accuracy. My doctors aren't fans of ultrasensitive testing, and I don't really want the anxiety that goes along with watching numbers bounce around from 0.03 to .05 and so forth, so I haven't pressed for it.

Walsh (p. 380) says that Daniel Chan of Johns Hopkins "trusts the sensitivity of assays down to 0.1 ng/mL, or slightly less than that." I assume he's talking about the standard (non-ultrasensitive) test. That sounds in line with what the lab person told me.

John is right--you really need to look at a trend of PSA over time. bb is asking about PSA in the pre-treatment stage. Since he has a prostate, PSA can be affected by several things. Variation in the lab is certainly a possibility, and so is inflammation, infection, prostate stimulation through DRE or sex, etc. bb asked about doubling time...PSA doubling time is calculated by dividing the natural log of 2 by the slope of the relation between the log of PSA and the time of PSA measurement. (whew--thank goodness for computers!) PSADT calculators do this using all of the available dates and measurements. In my uneducated opinion, it would seem like you would need quite a few measurements over many months to accurately graph the curve. But that's just my amateur's view.

IMHO, in the post-surgical setting, PSA is a more useful tool than it is before surgery takes place. If my PSA goes up, I know it's not because of prostatitis, BPH, sex, or exam. There's nothing left there to irritate. (I know the surgeon didn't leave a glob of prostate behind because of high resolution CT scans and the old "finger wave" exam). It would almost certainly be because of cancer, once lab variation was ruled out by subsequent or repeat tests.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

brainman

Thanks for the great reply. As always, you know Prostate Cancer better than most no doctors Smile

. I take it then that a + or - 0.1 variation can probably be ignored? Is that your understanding? I know that below 0.1 most doctors just take a wait and see approach (after a digital exam, of course Razz

). I was just curious... my last PSA was insignificant and I have no history of elevated PSA or Prostate Cancer.
_________________
Jim
Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendroglioma grade 3, same location.
http://cancerforums.net/viewtopic.php?t=2405
My Story Part 1: http://cancerforums.net/viewtopic.php?t=2528
My Story Part 2: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 3: http://cancerforums.net/viewtopic.php?t=8029
Twitter: @JimHawkins54

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

Jim, the way I would look at is to generally accept the PSA score for what it is, but realize it might be off 0.1 in either direction (on the standard test.) In my own case, if my next PSA is 0.1 instead of less than 0.1, I'll be worried, but I'll tell myself that it's possible that it's just normal lab variation.
That variation within a lab might be different from lab to lab; I don't know.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

b b · New User Joined: 29 Feb 2008 Posts: 8

Just as an update for everyone....I saw my urologist today. He's not concerned, but suggested another PSA test in 6 mos. instead of waiting a year. I haven't decided how I feel about this answer; I may push for the test sooner, maybe in a month or so. I see no advantage in waiting 6 months.

goruck · Posted: Thu Mar 13, 2008 4:42 pm Post subject: george rucker urologist

hi bb,

i saw your private message question asking me to address your findings.
I personally agree with your urologist completely based on what I have read. There is too much false positivity rate for psa testing..that is why it is a screening test and not a diagnostic test. If one interprets fluctuation too much, then the false positive rate will rise even more, hence I agree with the opinion of your care provider here.

Best,

george rucker
urology
urologist
_________________
George Rucker
Urology/Urologist
http://prostateconcerns.blogspot.com/
www.urology-partners.com
http://www.cornellurology.com/past-res.html
http://www.lakewoodranchmedicalcenter.com/index.php?&PageID=1088

b b · New User Joined: 29 Feb 2008 Posts: 8

[quote="goruck"]hi bb,

i saw your private message question asking me to address your findings.
I personally agree with your urologist completely based on what I have read. There is too much false positivity rate for psa testing..that is why it is a screening test and not a diagnostic test. If one interprets fluctuation too much, then the false positive rate will rise even more, hence I agree with the opinion of your care provider here.

Best,

george rucker
urology
urologist[/quote]

Hi Dr. Rucker,

Thanks for your help, and for taking the time to post your thoughts, I appreciate it!

Toby · New User Joined: 13 Aug 2008 Posts: 1 Location: UK

Hi ,
to give you my own experience in variations in my own PSA readings over the past 5 years (my 1st PSA test being in March '03) during my annual medicals.

March '03 =0.8 (age 47)
Jan '06 =1.9 (age 51)
March '07 =0.8 (age 52)
Jun '08 =1.18 (age 53)

All except the last one were conducted by the same lab.

Even although these readings were all within an acceptable range for my age ,I did become a little concerned with the 1.9 reading and even more concerned when I started to read on the internet about the possible significance of a rising PSA level and PC. I would have preferred the most recent Jun'08 reading to back in the 0.8 range , but I'm not unduly concerned and my doctor had no concerns whatsoever.

All the research I've done about PC , brought about by my PSA level rising to 1.9 , was to make me much more aware of the possible effect that nutrition has on PC. I now very rarely eat dairy or read meat, I use soy milk instead of skimmed milk , I drink green tea and have increased my intake of fruit , veg, tomatoes , nuts (inc Brazil nuts for their selenuim content) . I also bought a road/race bike and do ~10+ miles most days at an av HR of ~140 bpm and I've lost 15 kg very quckly. I know feel great. However I know I will have some trepidation when I go for my next medical as I antipate the result of my PSA test.

Otago · Experienced user Joined: 20 Jan 2008 Posts: 64

[quote="Toby"]
March '03 =0.8 (age 47)
Jan '06 =1.9 (age 51)
March '07 =0.8 (age 52)
Jun '08 =1.18 (age 53)

All except the last one were conducted by the same lab. I would have preferred the most recent Jun'08 reading to back in the 0.8 range , but I'm not unduly concerned and my doctor had no concerns whatsoever.

All the research I've done about PC , brought about by my PSA level rising to 1.9 , was to make me much more aware of the possible effect that nutrition has on PC. .[/quote]

Toby, your experience sounds similar to my own, although mine at a somewhat later age.
My first at about age 51.7 was standard at .8
I then stopped doing the tests with all the controversy about them even from one of the inventors (Stamey)...
So after a friend was having trouble 5.0+.... I had my next one done 5.3 years later at age 56.9.....and got a 2.9....yikes!.....
While my doctor said "good results" I was, like you, reading all the data on the net about velocity etc. My already low fat diet took a more radical turn to near vegetarian along with all the other things you've done.
Thank goodness I wasn't seeing someone who instantly goes for a biopsy.
With dietary change and perhaps a calming of what I think may have been some distinct "itis".....either bladder or prosate related, 6 months later I got a 1.6 reading followed up by a 1.8 last Dec.
So probably my true area is in that range. Not perfect by any means, but if it stays around there and only ticks up slowly with age, I'll be happy.

Regarding your last one being 1.18 instead of .8, I wouldn't give it a second thought. Either a slow progression with age which is normal or just a testing range on the upper end. Tests can vary that much from day to day and lab to lab.
Heres a good page discussing that..
http://www.prostate-help.org/psa.html

I've taken the opinion that with a full effort on the dietary front and your losing weight, you stand a good chance to influence and moderate your PSA climb. One never knows, but what you are doing could keep you down in the safe range until it no longer matters because of your age.
Your new way of eating will also help your health in many other ways.

So I'd say a 1.18 is just fine. See what your next test reveals but stay vigilant on the dietary front and keep reading the latest.
Hopefully within the next 10 years they'll have a new test that will distinguish between PCa that is bad and PCA that is just a normal part of aging (indolent). By age 90 I'd say we all have some PCa, but in most of us its not a problem to leave it alone. Perhaps the newer tests will tell us who is who in that regard.

Otago

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