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Thread: Thoughts on high and bouncing PSA

  1. #1
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    Thoughts on high and bouncing PSA

    August of last year I posted in this thread about high PSA. The last year has been interesting and I could use some advice.

    The short history:
    Father died a couple years ago of aggressive prostate cancer at the age of 66. Doctor recommended annual PSA.

    06/12/2015 PSA 1.80 DRE normal, prostate "small"
    08/15/2016 PSA 8.02
    08/29/2016 PSA 7.32
    09/13/2016 PSA 4.79
    10/13/2016 PSA 3.81 Ordered free/total PSA but lab only does the free test if above 4.
    01/09/2017 PSA 2.55 DRE normal, prostate "small"
    04/10/2017 PSA 3.26

    The doctor has recommended late last year that we monitor every three months. The high number and subsequent drop seems to point to something other than cancer as the cause which made me very happy. The latest result came in higher than the previous three month test and the doctor has ordered another test in six weeks. He says he recommends a biopsy if the next result doesn't go back down. I realize this last test isn't actually that much higher than the previous one but the direction was distressing and honestly I'm more concerned now that the doctor is talking about biopsy again. Presumably he wouldn't be thinking about that unless he thought there was a good reason.

    So, I have a couple questions. First, if it were you would you go get a second opinion at this point or just keep going and possibly get the biopsy? Second, does a biopsy seem reasonable at this point? I'd like to know the free/total number because that seems like it might be informative but apparently the lab will only do the breakdown for results over 4.

    Thanks for any words of wisdom that you can provide!

    Jason

  2. #2
    Moderator Top User HighlanderCFH's Avatar
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    Hi Jason,

    Can you give us your age? That will give us an idea on how your PSA recons with the general guidlines based on age group. Assuming you are not in your 70s, anything at 4.0, or less, would fall within normal ranges.

    However, your chances of getting (or having) prostate cancer are DOUBLE the normal rate because you have a direct family history of PC. That is probably one reason your doctor is discussing a possible biopsy.

    It seems like you've had some prostate infections in the past, which accounts for the higher PSA readings from last year. So I would wait to see how the next PSA compares with the current one of 3.26 -- and then decide yes or no on the biopsy.

    I would caution you, however, that your dad had an aggressive case of PC, which definitely puts you in a higher risk category. A biopsy may not be a bad thing to consider because there is always the possibility of an aggressive tumor being there.

    Good luck,
    Chuck
    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.
    Five annual post-op exams 2012 through 2016: PSA <0.1
    Semi-firm erections 5 years post-op whenever the moon turns blue.
    NOTE: ED caused by BPH, not the surgery.

  3. #3
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    Sorry, I should have mentioned that I'm 41 years old. Also, I did a round of Cipro after the September 2016 test.
    I don't seem to have any major symptoms of BPH. I've had occasional (rare at once every few months) rectal pain upon ejaculation or defecation though it's infrequent. Based on that I asked about the PCA3 test but my urologist recommended against it - said it was very uncomfortable and he didn't think it was worth it. The concern about my family history is the thing that scared me the most when the first high PSA result came in.

  4. #4
    KJ, There is a new study out regarding the association of heredity and the aggressiveness of prostate cancer. While your risk of getting PCa is twice that of someone else, any cancer that you get would not necessarily be aggressive.

    "Researchers found no relationship between family history and several prostate cancer biomarkers associated with tumor aggressiveness, for example. This suggested that family history does not increase the risk of prostate cancer aggressiveness."

    https://prostatecancernewstoday.com/...ggressiveness/
    DOB: May 1944
    In Active Surveillance program at Johns Hopkins
    Five biopsies from 2009 to 2014. The third and fourth biopsies were positive with one core and three cores <5% and G 3+3. Fifth biopsy was negative.
    OncotypeDX: 86 percent chance of PCa remaining indolent
    August 2015: tests are stable; no MRI or biopsy this year for my AS program
    August 2016: MRI unchanged from 2/2014; PSA=3.9; FPSA=26; PHI=28. No biopsy necessary.

    A NOTE ON PSA: My readings have been erratic for over 10 years; typically being 3.5-4.2, but spiking to over 10 at times.
    These spikes are asymtomatic to me, and resolve themselves. A prostate biopsy can triple the PSA, which lasts for months.
    Last Free PSA was 26. I don't worry about PSA spikes anymore.

  5. #5
    Top User Jim215's Avatar
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    Welcome Jason:

    In No Limit Texas Hold "Em poker, a pair of Queens versus a player holding Ace-King is considered a "classic race". The Queens are favored 55%-45% pre-flop but because the hands are so close in odds, it is considered a coin flip -- could go either way.

    With your erratic PSA pathway complicated by your family history, the question of whether to have a biopsy at age 41 becomes a similar coin flip. You can postpone it but indications are that you are merely delaying the inevitable.

    While ASAdvocate correctly points out that your father's passing from an aggressive form of prostate cancer does not increase the likelihood that such a fate awaits you, neither does it absolve you of such a potential diagnosis.

    While there are risks associated with a biopsy, it remains the only way to confirm a diagnosis of cancer. The key word there is "diagnosis" since a biopsy is nothing more than a diagnostic test that may or may not provide you with helpful information. It is then up to you to decide what to do with the info and how to proceed.

    If it was me, I wouldn't dick around with the uncertainty. I'd get the biopsy with the caveat that I tend to be pro-biopsy.

    Best of luck,
    Jim
    LUNG
    Age: 71 -- 12/2013 - Cat Scan sees new irregular 1.8 cm nodule in right middle lobe.
    3/13/14 - PET Cat Scan confirms presence of same nodule -- same size. Nodule lights up indicating likelihood of lung cancer -- Location not conducive to biopsy.
    3/17/14 - Three top doctors say it MUST come out via a wedge re-section. If cancerous, the entire right middle lobe must be surgically removed.
    6/13/14 - Nodule shrank by 1/3. Not cancer. Surgery cancelled. Next scan 9/14. Nodule "resolved" - gone.

    PROSTATE
    Age: 67 -- 2/2010 - PSA: 4.05
    8/2010 - PSA: 4.95
    9/2010 - Biopsy - 2 out of 12 cores positive - Gleason: 3+4=7
    11/8/2010 - DaVinci RALP - small positive margin - was told it was meaningless.
    2/11 - PSA: 0.02; 8/11 - PSA: 0.04; 2/12 - PSA: 0.06; 8/12 - PSA: 0.08; 2/13 - PSA: 0.11; 5/13 - PSA: 0.16 - referred to oncology radiologist.
    9/2013: 40 sessions of IMRT salvage radiation completed.
    1/14, 4/14, 7/14, 10/14, 1/15, 8/15, 3/16, 8/16, 3/17 - All PSA: 0.00

  6. #6
    Moderator Top User HighlanderCFH's Avatar
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    Quote Originally Posted by KJWin View Post
    Sorry, I should have mentioned that I'm 41 years old. Also, I did a round of Cipro after the September 2016 test.
    I don't seem to have any major symptoms of BPH. I've had occasional (rare at once every few months) rectal pain upon ejaculation or defecation though it's infrequent. Based on that I asked about the PCA3 test but my urologist recommended against it - said it was very uncomfortable and he didn't think it was worth it. The concern about my family history is the thing that scared me the most when the first high PSA result came in.
    The general guidelines on PSA from ages 40-49 is a high limit of 2.5 for white men. It is a bit lower for black and oriental people, with the threshold at 2.0.
    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.
    Five annual post-op exams 2012 through 2016: PSA <0.1
    Semi-firm erections 5 years post-op whenever the moon turns blue.
    NOTE: ED caused by BPH, not the surgery.

  7. #7
    Moderator Top User HighlanderCFH's Avatar
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    Nov 2011
    Location
    Highland, Indiana
    Posts
    5,965
    Both Jim and ASA make good points. For example, my Dad had prostate cancer with a Gleason 7 (not sure if it was 3+4 or 4+3). In my case, it was 3+3.

    But that still made me twice as likely to get PC at whatever aggression level it happened to be. My Dad also had at least one brother with PC, which then made me THREE times more likely to get PC.

    If you have a good, experienced uro who does many biopsies -- and uses numbing agents for both the rectum and prostate -- you should have a pretty painless experience if you opt for a biopsy.

    My thoughts are that you would be wise to do this since your PSA is above the high limit for your age -- and because of the family history.
    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.
    Five annual post-op exams 2012 through 2016: PSA <0.1
    Semi-firm erections 5 years post-op whenever the moon turns blue.
    NOTE: ED caused by BPH, not the surgery.

  8. #8
    Top User
    Join Date
    Jan 2014
    Location
    Greater Atlanta
    Posts
    2,379
    Hi Jason! Your PSA has an overall decreasing trend since the apex measurement on 8/15/16. Decreasing PSA is usually not suggestive of prostate cancer (PC). However, your PSA remains above the "normal" range and well above normal for your age.

    My suggestions to you are the same that I offered to GW434, so feel free to consider them in your situation

    https://www.cancerforums.net/threads...ing-for-advice

    Both of you are similarly in the "What do I do?" stage. Conversely you are on opposite sides: You are young with a (-) DRE and an elevated PSA while GW is older with a (+) DRE and a low normal PSA

    Also go back and re-read all of the responses to your original posts starting with:

    https://www.cancerforums.net/threads...se-some-advice

    It is always best to follow the URO MDs advice. If in doubt, get a 2nd opinion. If the 2nd opinion concurs, then accept it and take the recommended action(s).

    We hope that you never qualify for membership to our "PC Club." If you meet the qualifications, we hope that does not happen for several decades into the future.

    For now, follow your MD's advice. Remain vigilant moving forward - exactly as you are doing!

    Good luck!

    MF
    Last edited by Michael F; 04-21-2017 at 06:26 PM.
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = Gleason 7 (3+4) and 5 = Gleason 6
    March '12: Robotic RP: Left Positive Margins + EPEs. MD waited in surgery for preliminary Path Report then excised substantial left adjacent tissue(s) down to negative margins and placed 2 Ti clips for SR guidance, if needed in future.
    Pathology: Gleason (3+4) pT3A pNO pMX pRO / Prostate Size = 32 grams; Tumor = Bilateral; 20% / Perineural invasion: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml uPSA remains stable: = 0.020 ng/ml "Mean (+/-) STD" = 0.002 at 66 Months Post Op: (16 uPSAs: Range 0.017 - 0.024) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  9. #9
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    See what happens in 3 months seems like a good bet. Sex, a biopsy, bike riding can also increase your PSA.
    Last edited by JJ888; 04-20-2017 at 05:22 PM.

  10. #10
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    After taking Turkey tail extract for months my PSA is 1.5 as of yesterday. My PSA was as high as 9 so decreasing PSA is doesn't make sense to me. But I am still watchful waiting. I blame my decreasing PSA to that turkey tail extract.

 

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