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Thread: PSA increase from .9 to 2.1 in one year (40 yo)

  1. #1
    Regular User
    Join Date
    Apr 2009

    PSA increase from .9 to 2.1 in one year (40 yo)

    Hi folks,

    Had a question for you guys...my brother just got back from having his physical and his PSA was 2.1, this was up from 0.9 last year (the first time he ever took a PSA). He is 40 years old and his doctor told him that while the increase was surprising he didn't think it was cause for concern and that no follow up was necessary.

    I guess the initial basline of 0.9 was enough to not concern his doc.

    Our Dad was dx when he was 65 so there's a family history.

    Is his doctor's advice sound? Should he request re-taking the test in a couple of months (perhaps after a course of anti-biotics)?

    Thanks in advance for your help!!!

  2. #2
    I'm thinking to have the PSA retested in 3 to 6 months, hopefully using the same lab.
    The Digital Rectal Exam can find nodules on the prostate.
    There is a Free PSA blood test as another additional possiblity.
    There is a newly approved test, Prostate Health Index (phi) that just came out.
    A urologist would know more about this stuff than a primary doctor.
    Good luck.

  3. #3
    Regular User
    Join Date
    Apr 2009
    Hi Lancepeace,

    Thanks, I've also communicated that to my brother. His doctor did perform a DRE and didn't find anything.

    Anyone else think a follow is necessary?


  4. #4
    Experienced User
    Join Date
    Mar 2012
    Hey there!
    Considering the family history and the doubling of PSA it would be reasonable to see a good urologist for his take on the situation. PSA is not the whole story. A DRE and another PSA would give you more information and possible peace of mind. Not to scare you, I went from .8 to 1.6 in three years and had a Gleason 9. I am 22 years older with no family history of PC. So, go figure. When in doubt get a second opinion.
    Peace and Grace
    BD: 3/8/50
    PSA .864 2009
    PSA 1.68 2012
    PSA <0.08 7/12 one month after surgery, PSA <0.08 three months after surgery, 9 month PSA <0.08, 1 year PSA<0.08, 15 months PSA <0.08
    2/2012 Biopsy 4+3 (7)
    Da Vinci Robotic Surgery 6/2012
    Histologic grade Gleason 4+5 (9)
    Nerves spared
    Right lobe involved 26%
    Seminal vesicles negative for tumor
    Lymph vascular invasion not identified
    Margins negative for tumors
    Pathologic stage: T2b N0

  5. #5
    Regular User
    Join Date
    Apr 2009
    Thanks Fasteddie,

    First and foremost best of luck to you, sorry to hear about your dx.

    I figure the doc knows what he's doing and considering the follow up procedure is fairly simple I was surprised he took that position. I came on here to see if my logic/conclusion was sound.

    Anyone think my brother should just follow the doctor's orders (basically do nothing)?


  6. #6
    Regular User
    Join Date
    Apr 2009
    I just found out that the doc performed the DRE prior to drawing blood for the PSA. Could this be the cause of the elevated PSA? I've read conflicting studies on this.

    Thanks for the help!!!!

  7. #7
    Regular User
    Join Date
    Feb 2012
    Hello Ventura,
    I have to agree with Lancepeace, I found out with a PSA of only 3.0 and no family history. Go to a urologist at least to get anothor PSA test and PCA3 test.
    12/21/11 - Biopsy = PSA 3.0 / PCA3 85.5/ Gleason 3+4 / 4 out 12 cores positive
    2/28/12 - RRP with left Lymph node =post Path Gleason 3+4=7, left lobe 30%, right lobe 5%,
    Margins negative,perineural invasion present, patholgic staging pT2c, age 40

  8. #8
    "I just found out that the doc performed the DRE prior to drawing blood for the PSA. Could this be the cause of the elevated PSA?"

    It might be...I would have a second PSA done in a month, being careful not to insult the prostate beforehand. No sex or bike riding...If the second reading is below 2.0 I would not worry..But if it moves above 2.1 I would be seeing a urologist...
    PSA at age 55: 3.5, DRE negative.
    65: 8.5, DRE " normal", biopsy, 12 core, negative...
    66 9.0 DRE "normal", BPH, (Proscar)
    67 4.5 DRE "normal" second biopsy, negative.
    67.5 5.6, DRE "normal" U-doc worried..
    age 68, 7.0, third biopsy (June 2010) positive for cancer in 4 cores, 2 cores Gleason 6, one core Gleason 7. one core Gleason 9. RALP on Sept. 3, 2010, Positive margin, post-op PSA. 0.9, SRT , HT. Feb.2011 PSA <0.1 Oct 2011 <0.1 Feb 2012 <0.01 Sept 2012 0.8 June 2013 1.1, Casodex added, PSA 0.04 10/2013. PSA 0.32 1/14. On 6/14 PSA 0.4, "T"-5. 10/14 PSA 0.6, T-11. 1/2015 PSA 0.106. 4/15. 0.4, 9/15 1.4, 3/16 Zytiga, 0.04, 5/17 1.4 may switch to Xtandi

  9. #9
    Moderator Top User HighlanderCFH's Avatar
    Join Date
    Nov 2011
    Quote Originally Posted by Ventura View Post
    I just found out that the doc performed the DRE prior to drawing blood for the PSA. Could this be the cause of the elevated PSA? I've read conflicting studies on this.

    Thanks for the help!!!!
    Hi there,

    This shows the importance of seeing a specialist depending on the type of health situation. I doubt that an experienced urologist would have performed a DRE and then immediately conduct a PSA test.

    The reason is that any physical activity that involves the prostate tends to elevate the PSA on a temporary basis. This is why they recommend that a man does not have sex for at least 48 hours prior to a PSA test. Likewise, manipulating the prostate during a DRE can have the same effect on the PSA reading.

    Thus, it IS possible that his intrinsic reading is not really as high as the test indicated. A test several days later (assuming none of the aforementioned activities have taken place) might reveal a much lower PSA.

    Your brother should seek out a highly experienced urologist to examine and advise him. This is very important.

    But, at the same time, I agree with one of the other posters who pointed out your family history of PC. If there was one family member who had PC, the chances of eventually developing the disease are TWICE as strong as in families with no previous history. In my case, my Dad had PC -- and one of his brothers also had it -- which led my urologist to advise that having two close relatives made me THREE times as likely to get it.

    Your brother probably does not have PC. But, with the family history, he should have another PSA test taken in the very near future just to play it safe. The age of 40 is usually a bit too young to expect PC, but it HAS happened. He should probably begin having annual PSA tests (assuming the test in the near future is okay) from here on out.

    Wishing him the very best of luck!
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Six annual post-op exams 2012 through 2017: PSA <0.1
    Semi-firm erections 5 years post-op whenever the moon turns into blue cheese.
    NOTE: ED caused by BPH, not the surgery.


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