Just had biopsy

cymbals · New User Joined: 07 Apr 2008 Posts: 7

Yesterday I had a Biopsy after my Urologist dsicovered that my PSA went ftom1.75 to 4.8 in 10 months. This is upsetting because I just lost my dad in Dec after a long battle with bone cancer that metastisised for his prostrate (after 15 years). I have no lumps, and the Biopsy Tech. said he didn't see anything suspicious. During my dads long struggle I did much of the caregiving, needless to say it was a very stressful and difficult time. Is it possible that stress can cause an elevated PSA. I sure don't need this right now. Any thoughts?
Tim

brainman · Posted: Tue Apr 08, 2008 8:26 am Post subject: Re: Just had biopsy

Hi Tim. PSA is rather specific. Test results do fluctuate some but usually not more than +or - 0.1. Since you PSA has more than doubled in less than a year, it is a very strong indication of Prostate Cancer.

What kind of a biopsy did they do? You should as your doctor for the results... Techs and trained to be evasive and to just let the doctors do the diagnosing. But, Prostate biopsies are notorious in the sense that there is a high number of false negatives. Continue to work with your medical team to try to find the cause of your high PSA.
_________________
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/

cymbals · New User Joined: 07 Apr 2008 Posts: 7

Thanks Jim
I will meet with my urologist in 2 weeks, I'm scared to death after watching what my father went through!!!!

brainman · Posted: Tue Apr 08, 2008 9:52 am Post subject: Re: Just had biopsy

Tim, I can imagine who scared you must be. I was in a similar situation but reversed when my mother was diagnosed with a primary brain cancer in 1998. My diagnosis came in 1992. It was like a de ja vue experience for me sitting in the examination room with here and hearing her doctor tell her in almost the exact same words what my doctor had told me less than 6 years earlier. Unfortunately, her cancer was a grade IV while mine was a grade II. Hopefully, you caught yours early. At this point, there is no reason to believe that you will not live for many more years.

You are in my thoughts and prayers.
_________________
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: 178

I've never heard of stress affecting PSA, but benign enlargement (BPH) can, or inflammation from prostatitis certainly can make it go up.

Ejaculation can also cause a temporary rise in PSA.

It's the trend over time that matters with PSA. I agree with Jim that the doubling time is of concern--especially since you have a family history of the disease.

I also agree with him that if the biopsy is negative for cancer, you should still be vigilant, since prostate biopsies are like sticking a needle in an orange looking for the seeds. Sometimes you hit it and sometimes you don't. If the biopsy doesn't find cancer, you should ask about a "free PSA" or fPSA test. fPSA can help figure out if the PSA elevation is coming from a benign or cancerous source.

I recommend getting the 2007 edition of Dr. Patrick Walsh's book ("Dr. Patrick Walsh's Guide to Surviving Prostate Cancer"). It will answer a lot of your questions.
_________________
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
http://pcabefore50.blogspot.com

chrisz · Regular Joined: 09 Apr 2007 Posts: 29

Tim,

I hope the comment that Brainman made :

"Test results do fluctuate some but usually not more than +or - 0.1. Since you PSA has more than doubled in less than a year, it is a very strong indication of Prostate Cancer. "

Does not scare you, because I disagree. There are other factors that
can make your PSA go up and down. My own PSA went from 2 to 8.4
over a period of 3 years. The Udoc tested my Seminal fluid and found
a Prostate infection. Treating it brought it down to 5.6 , Now it is 2.5.

You can read "My Story" a few posts back. This cancer is hard to detect.
I still don't know why you can't see it on an x-ray. I have read and studied and read....... and I am still confused. And it appears that the doctors are confused too. My Free-PSA is bad. So if that definitely means I have Prostate cancer then I want it taken out. But the Udoc won't he says my two biopsy's were negative and they don't take action until they are SURE you have PC.

Below is an article from the Medical College of Wisconsin :

-------------------------------------------------------------------------------------

Prostate Cancer Tests Vary in Specificity, Sensitivity

Q: For checking a man's prostate, a blood test to determine the prostate-specific antigen (PSA) has been the gold standard of the exam. Now in the past several years, a new reading called free prostate is being used. Just how much more accurate is this than the former PSA, and can it also sometimes be a false positive like the PSA? It is claimed that the free prostate can more accurately determine the possible presence of cancer. Is this true?

A: Yours is a complicated but important question since prostate cancer is the leading cancer in men, with about 180,000 new cases diagnosed every year. Patients often have no symptoms and are taken by surprise when a nodule is discovered on exam or a high PSA is found.

William See, MD, Professor and Chairman of Urology at the Medical College of Wisconsin, explained to me that there are now at least six different ways to look at serum PSA: total PSA, free PSA, age-adjusted PSA, ethnically adjusted PSA, PSA velocity and PSA density. Each of these has unique characteristics.

Some tests are more sensitive for identifying patients with cancer and others are more specific, meaning that fewer patients without cancer test false positive. Unfortunately, none of the available tests is perfect. All will miss a percentage of cancers (false negative), and all will incorrectly identify some patients who prove not to have cancer (false positive).

The Total PSA test, which measures nanograms of PSA per milliliter of blood, is a more sensitive test. The drawback is that the more sensitive the test, the more likely that the result is a false positive.

The Free PSA test, which measures the percentage of PSA that is not bound to proteins in the blood, is more specific. This means that fewer patients without cancer test false positive.

To give you an example, I have a 65-year-old patient whose PSA went from 3 to 9 in the past year. Since he was double the Total PSA threshold of 4, he underwent a biopsy, which fortunately was negative. So the abnormal PSA was a "false positive" and NOT cancer.

If his Free PSA had been measured at 30% he might have avoided immediate biopsy. The free PSA threshold of less than 25% is more specific for a diagnosis of cancer and avoids the need for biopsy in about 20% of patients who would otherwise undergo this procedure based upon total PSA alone.

Determining the risk of a given patient harboring prostate cancer is not always easy and involves more than just going by one PSA value.

Article Created: 2002-04-14
Article Updated: 2004-05-07
-------------------------------------------------------------------------------------

Okay Tim, are you confused yet ??? Looks like everyone is.
So I am waiting my next PSA test in MAY and then if it's gone up, then I'm sure my Udoc will want to do another Biospy. Whether I will or not I haven't decided. My Internists seems to think that I do not have PC. And my Udoc says he doesn't know, but he could not find any in the saturation Biospy that he did. And he says that's good.

I just want an answer and NOBODY can give it to me. That has kept me on needles and pins for several years now. If my PSA has gone high again in May I think I'm gonna ask my Udoc to take my Prostate out, if he won't do it, then I will find a doctor that will. I think multiple Biospys on a cancerous prostate is not a good thing to do.

Chris

cymbals · New User Joined: 07 Apr 2008 Posts: 7

Thanks Chris
Very informative and somewhat comforting. Someone mentioned that ejaculation can cause a spike in the PSA. Is that really true?
Tim

chrisz · Regular Joined: 09 Apr 2007 Posts: 29

Yes Tim, I read that you should wait a few days after having sex or riding a bike or doing anything that puts pressure on the Prostate. But I don't know
how significant it is as I never had a doctor ask me if were involved in those
types of activities at any exam or meeting with my Udoc or any other doctors

So, I'm not sure how much difference it makes. I guess I ask my docs about it the next time I see them, and see what they say.

Chris

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

I'm certainly no expert on this, but I have read a fair amount. Sex/recent ejaculation does cause an increase in PSA. Some references I saw claimed "a point or two", I believe Dr. Walsh's book stated an increase of up to 40%. Interestingly, the theory seems to be to wait 24 - 48 hours after ejaculating before getting your blood draw done (even Dr. Walsh suggests this). However, in his book, Dr. Walsh also states that the half-life of PSA in the bloodstream is 2 - 3 days. Therefore if it jumps by 40% because of an ejaculation, it's still up by 20% 2 - 3 days later, up by 10% 4 - 6 days later, etc. So in my mind it seems you probably want to wait at least a week after ejaculating before getting blood drawn for a PSA test.

I haven't heard that stress/anxiety can directly lead to a higher PSA level. However, many people (doctors included) believe that chronic non-bacterial prostatitis (basically inflammation in the prostate) can be caused by long-term stress. The theory is that under stress, people have a tendency to chronically tighten the muscles in the pelvic floor. Over time, this can lead to a variety of pains, etc., and can also cause the prostate to become inflamed. This in turn could cause a PSA level to rise.

Again, I'm no expert, this is all just based on information I've read and that seems to be accepted by a wide variety of people.

Good luck, hope your tests come back clean!!

cymbals · New User Joined: 07 Apr 2008 Posts: 7

Thanks bb
The plot thinks here. There is a very good likelyhood that I may have ejaculated the morning before my exam/ blood draw. My wife and I are quite active sexually, and I don't keep track of when we've made love. The day I had my blood draw and DRE the nurse said like always" if you don't hear from us in a week to ten days everything's okay" Three weeks later they call me and say that my PSA had gone up and I need to consult with the Doctor. They let me walk around for 3 weeks thinking all is well (which is why regardless of the outcome of my biopsy I'll be looking for a new Urologist). So after three weeks had gone by I can't recall,but there is a great possibility that I ejaculated that AM.

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

Hi Cymbals,

That being the case, I think a re-test probably would have been in order prior to the biopsy. Actually, most every doctor I've ever talked to would have suggested a re-test prior to the biopsy just to make sure the reading wasn't due to a lab error, etc. But I suppose what's done is done at this point Smile

. Regardless, ejaculation the moring of the test definitely could cause a spike according to everything I've read & heard. Hopefully that's what has happened here in your case. (And of course, keep in mind I'm not a doctor, I'm just regurgitating what I've read and heard elsewhere!!).

Replicant · Moderator Joined: 01 Nov 2006 Posts: 178

In spite of what I wrote earlier about ejaculation causing a spike, I took a cue from the other poster and looked it up in Walsh's book. Walsh says that ejaculation can cause PSA to spike "as high as 41%". I'm no statistician, but it would seem to me that if your "real" PSA was 1.75, then ejaculation would cause a temporary rise at most to 2.47 ng/ml (a 41% increase, rounded off).

So a rise to 4.8 would seem to ring some alarm bells, unless there was something else like BPH, prostatitis or a prostatic infarction.

Cymbals, you didn't say how old you were. Walsh provides a chart (p. 155) where he shows that only 3% of men aged 50-59 have a PSA of 4.1 - 9.9. Only 9% of men in their 60's have PSAs in that range.

So--just your plain old PSA score is raising a red flag with your doctor. Not many men in your age group (assuming you're in your 50's or 60's) have a PSA over 4. But even more troubling is the rapid rise you've experienced. PSA doubling time calculators show your doubling time is about 6.9 months, although it's probably not all that accurate with only two scores.

I don't want to unduly alarm you, but I thought I'd re-post after thinking about how ejaculation really affects PSA.

Best wishes on the biopsy results.
_________________
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
http://pcabefore50.blogspot.com

cymbals · New User Joined: 07 Apr 2008 Posts: 7

Gloom and doom!!

cymbals · New User Joined: 07 Apr 2008 Posts: 7

I met with my Urologist this AM, And think god the biopsy showed nothing. They did 12 biopsies and they were all negative. He mentioned that the precancerous liesion that was found back in 2001 is no longer there as well. Man am I relieved. I'll go back in Oct for the usual digital exam and PSA.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 178

I'm sure you're relieved, and glad to have the biopsy over with. 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
http://pcabefore50.blogspot.com

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