DRE Normal, PSA 30

LizNDale · Posted: Fri May 16, 2008 10:54 am Post subject: DRE Normal, PSA 30

My husband has not been well, had high white blood cell count, culture was positive for UTI that was "weird" to the dr, said that type of infection, related to prostate, was usually found in intestinal (or digestive? I can't remember) track. After antibiotic cleared infection, they did DRE, found no enlargement or other problem, took blood for PSA and we got a call yesterday that his PSA is 30. He has appnt with urologist on Monday the 19th of May.

30 seems rather high, isn't it? My web research (all last night) leads me to believe that dr will want to go straight to biopsy.

Biopsies seem to have potential for side effects, is that right?

Also seems to be controvery over PSA test. Diagnosing cancers that otherwise the man would never had known about and would never had affected his life.

My question is How high is 30, in the overall scheme of things? Should we go right to biopsy or don't react but have frequent PSA tests?

Thanks in advance,

LizNDale
_________________
My Mother - Stage IV NSCLC - Adenocarcinoma
Mets to Adrenal Glands and Brain
Diagnosed Thursday June 12th 2008
Died Sunday September 7th 2008

Her Story:
http://cancerforums.net/about9639.html
Her Statement of Faith Memorial:
http://cancerforums.net/viewtopic.php?t=10528

Replicant · Moderator Joined: 01 Nov 2006 Posts: 244

I would follow the recommendation of the doctor. Biopsies have a very low rate of side effects and provide very useful information. The complications include:

*Pain. This procedure has the potential to really sting. The doctor will likely minimize this in a couple of ways. First, the use of lidocaine gel on the probe. Second, many docs these days administer a small injection of lidocaine to the prostate area before the biopsy. If this is done, there should be very little pain.

*Infection. This risk is greatly reduced by the use of powerful antibiotics before and after the biopsy. Patients should report any post-biopsy fever to their doctor.

*Bleeding. It's common to have a little bleeding afterward, but this is hardly ever a reason for concern. The blood shows up in ejaculate.

*Impotence. Pretty rare, according to Walsh, and if erectile dysfunction occurs because of the needle getting too close to a neurovascular bundle, the problem is temporary.

It sounds like your husband MIGHT have had prostatitis. That can raise PSA levels, and it can take some time for the PSA to drop off again. So maybe that's the cause of the elevated PSA, but I wouldn't want to second-guess your husband's doctor. PSA can also be slightly elevated by ejaculation or a DRE.

Your husband could ask for a "free PSA" test. That's the name of the test, not the cost. The ratio of free PSA to bound PSA can help determine whether the cause of the elevation is benign or cancerous.

You ask a good question about PSA testing. There is some controversy about whether it leads to overtreatment, especially in older men who would not be bothered by the disease. However, I'm guessing your husband does not fall into that category. If your husband's PSA was not elevated by a benign cause, you should be concerned. A New England Journal of Medicine article reported that when a man has a PSA over 10, the odds are 65% that his biopsy will be positive for cancer, and the higher the PSA, the greater the chance of a high Gleason. (Walsh, p. 156). Hopefully, your husband's PSA is not elevated by cancer.

There is that distinct possibility, however. If I were you, I would educate myself now. A very good resource is Patrick Walsh's book "Dr. Walsh's Guide to Surviving Prostate Cancer." Get the 2007 edition. It's cheap on Amazon. Even if your husband doesn't have cancer, there's good stuff in there about prostatitis and BPH. The American Cancer Society and Prostate Cancer Research Foundation have excellent material on their websites.

Best wishes.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, 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 <0.1, 12/07 <0.1, 4/08 <0.1, 11/08 <0.1
http://pcabefore50.blogspot.com

LizNDale · Posted: Fri May 16, 2008 12:11 pm Post subject: Thanks

Thanks Replicant,

I really appreciate the quick response.

I learned some about the free psa vs attached psa, and plan on asking dr about it on Monday.

An Early Prostate Cancer Detection flow chart I looked at, for "DRE negative, PSA > 10" it skipped the free vs attached consideration and went straight to biopsy, see page 9 of
http://www.nccn.org/professionals/physician_gls/PDF/prostate_detection.pdf.

As for biopsy complications, it was the very ones you site that has me concerned, but you did a fine job of calming my concerns about them. Thank you.

Well, I guess one step at a time, eh? But boy I read these posts from folks going through cancer treatment and they talk about much lower PSAs than 30, so I have to admit I am very scared for my husband. By the way he's 56.

I just wish I had an idea about how bad "30" is. Or am I concentrating to much on a number?

Thanks again,

LizNDale
Anyway,thanks again.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 244

LizNDale,

Again, I hope it's prostatitis that has elevated the PSA. BPH generally doesn't raise it that high, and I think you wrote there was no indication of that. Prostatitis by itself CAN raise PSA that high:
http://www.familydoctor.co.nz/index.asp?U=conditions&A=32702 but I am worried because it would seem this has been ruled out, unless the PSA test was done too soon.

A lot of the time the general wisdom is "it's the trend that matters, not the number." However, the fact remains that with a PSA of over 20, there is a very high probability of cancer, at least 90%

http://www.phoenix5.org/Basics/UndPSAJH.html
http://www.prostatecancerweek.org/members/Basics/PSA.htm

And a study by the University of Florida showed 100% of men with PSAs over 30 had prostate cancer. http://www.ncbi.nlm.nih.gov/pubmed/17722667

I know what you're asking. If it's cancer, what does the PSA of 30 ng/ml mean? Well, there are no easy answers, and no guarantees, but your husband would be more likely to have advanced cancer. Now, the fact that the doctor didn't find anything on DRE is encouraging. On the other hand, one textbook on prostate cancer says that a PSA over 20 is "highly indicative" of metastatic disease:
http://tinyurl.com/3fwy6f
and a PSA of around 20 is where bone scans can start to show metastases. IF a biopsy shows cancer, your husband should have at least a bone scan.

Here's a study from Chile that showed that 21% of men with PSAs over 20 had abnormal bone scans: http://tinyurl.com/42pqno

The Prostate Cancer Foundation of Australia says "Once the PSA is above 30, it is very likely the cancer has spread beyond the prostate." http://www.prostate.org.au/testing-for-prostate-cancer.php

I think you're correct. The doctor will want to do a biopsy. The biopsy, if your husband has cancer, will provide CRUCIAL information.

You may be interested in this posting, where a woman asks urologists at the Henry Ford Health System about her husband's PSA, 34.6, and normal DRE. The doctors said her husband should not wait for another PSA, but go right to biopsy, followed by a bone scan if the biopsy should be positive: http://www.medhelp.org/forums/urology/archive/4415.html

Hope for the best, plan for the worst is my motto in these matters. I hope things turn out for the best. Right now you just have a single PSA score, as well as a possible benign explanation.

Best wishes.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, 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 <0.1, 12/07 <0.1, 4/08 <0.1, 11/08 <0.1
http://pcabefore50.blogspot.com

LizNDale · Posted: Fri May 16, 2008 2:20 pm Post subject: Re: DRE Normal, PSA 30

Replicant,

I am pretty sure it Prostatitis that he was diagnosed with. And that was only a week ago, and in fact he is still on the antibiotic treatment for it, no where near the 6-8 weeks mentioned at FamilyDoctor.

So for now, that is what I'm going to hold onto, because the rest of what you said scares the heck out of me! And that's ok, I'd rather have as much info as possible.

So, at least for the weekend, I'm hanging my hat on the probability that the PSA test was done too early. If the Dr says not to wait 6-8 weeks, then I'd think the freePSA is a good idea, rather than a biopsy.

Thanks again, I'll post an update late Monday.

Liz (and DALE)

LizNDale · Posted: Sun May 18, 2008 1:33 pm Post subject: Proteus Mirabilis

Replicant,

fyi, The infection Dale had is Proteus Miribilis, not Prostatitis. Today, Sunday, is the last day of antibiotic treatment.

I'm trying to see if PM can cause high PSA levels.

LlizNDale

Replicant · Moderator Joined: 01 Nov 2006 Posts: 244

Prostatitis just means inflammation of the prostate, and bacterial infection can cause it. Google "Proteus Mirabilis and prostatitis" (note the spelling) and you'll see that PM can cause prostatitis. Prostatitis, as you know, can elevate PSA.

From the National Library of Medicine:

Definition

Acute prostatitis is an inflammation of the prostate gland that develops suddenly.

Causes

Acute prostatitis is usually caused by a bacterial infection of the prostate gland. Any organism capable of causing an urinary tract infection (UTI) is also capable of causing acute bacterial prostatitis, including enterococci, Escherichia coli, Klebsiella pneumonia, Proteus mirabilis, Pseudomonas aeruginosa, and Staphylococcus aureus.

http://www.nlm.nih.gov/medlineplus/ency/article/000519.htm
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, 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 <0.1, 12/07 <0.1, 4/08 <0.1, 11/08 <0.1
http://pcabefore50.blogspot.com

LizNDale · Posted: Sun May 18, 2008 2:33 pm Post subject: PM

Ah, thank you Replicant!

I was googling proteus miribilis and PSA.

Liz

LizNDale · Posted: Mon May 19, 2008 4:00 pm Post subject: Wait and Watch

Dr recommended we have another PSA in 2 weeks, and if it has gone down at least 50%, then wait another 2 weeks and do another PSA. Keep doing that as long as PSA halves itself.

If PSA is not down 50% in 2 weeks, then will do biopsy.

He said he had a patient with UTI that had PSA over 70.

Said we'll probably end up having a biopsy, but this way he'll have more of a complete story/history. Dale has never had PSA taken before so we have no baseline.

He said we could go right to biopsy if we want.

Said if this were him, he'd wait and do PSA in 2 weeks.

Said if it wasn't for UTI, he'd recommend biopsy right away.

DRE showed some enlargement, otherwise felt normal.

So! we feel much brighter now, he said we're not out of the woods yet, but we do feel better about it.

oh, he also said that Free-PSA test is valueless with PSA > 10.

So thanks for all your help, Replicant. I'll take this up again after next PSA test.

I went to your blog, and read most of it. Our hearts go out to you.

LizNDale · Posted: Sat Jun 07, 2008 3:58 pm Post subject: Re: DRE Normal, PSA 30

Good news, Dale's PSA was down to 13.2. So we'll wait another couple weeks and get another test.

The same day as as his PSA result came in, Wednesday, my mom was diagnosed with lung cancer that has spread to her adrenal glands and to her brain.

We have all been so anxious about Dale, and never saw this coming.

I'll move over to that forum, but wanted to let Replicant know about Dale.

Good luck to everyone,

LizNdale

Replicant · Moderator Joined: 01 Nov 2006 Posts: 244

That's great news for Dale. No biopsy! I hope it continues to drop like the doctor wants.

I'm terribly sorry about your mom. The John Lennon line "Life's what happens to you when you're busy making plans" comes to mind. I'm sure you felt blind-sided by that one.

Good luck to the two of you and your mom.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, 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 <0.1, 12/07 <0.1, 4/08 <0.1, 11/08 <0.1
http://pcabefore50.blogspot.com

LizNDale · Posted: Sat Jun 07, 2008 9:26 pm Post subject: Re: DRE Normal, PSA 30

Thank you so much Replicant, I really appreciate it.

Best of luck to you in your fight,

Liz

LizNDale · Posted: Mon Jun 30, 2008 3:27 pm Post subject: Re: DRE Normal, PSA 30

Dale had another PSA, it went down but only to 10. Dr says give it 6 more weeks to make sure we have his baseline #. Said we could go for biopsy now, but we decided to wait and do one more PSA, around August 11th.

He had another DRE, no lumps or bumps.

I really thought it would be down to about 6 by now, he waited almost 4 weeks since the last one. So we're disappointed. But Dale says he's not worried, so I guess I'll put it on the back shelf for now. We have enough "knowns" to worry about anyway!

Liz
_________________
My Mother - Stage IV NSCLC - Adenocarcinoma
Mets to Adrenal Glands and Brain
Diagnosed Thursday June 12th 2008
Died Sunday September 7th 2008

Her Story:
http://cancerforums.net/about9639.html
Her Statement of Faith Memorial:
http://cancerforums.net/viewtopic.php?t=10528

brainman · Posted: Mon Jun 30, 2008 5:24 pm Post subject: Re: DRE Normal, PSA 30

Liz, I take this a good news. It is not the absolute number that is important, it is the trend. The trend is going down... that is great! Keep us informed.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

Replicant · Moderator Joined: 01 Nov 2006 Posts: 244

Glad to hear the PSA is coming down. I'm glad you're not sweating it. I agree that the important thing is the trend.

My thoughts are with you and your mother.

All the best--
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, 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 <0.1, 12/07 <0.1, 4/08 <0.1, 11/08 <0.1
http://pcabefore50.blogspot.com

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