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Thread: Low grade, high PSA

  1. #1
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    Low grade, high PSA

    Hello forum,

    I was diagnosed with prostate cancer last October. In the biopsy, 2 of 12 cores were positive. The highest Gleason score was 3 + 3. Overall prostatic tissue involvement was 1.7%. The stage is T1c.

    Now the month before the biopsy, my PSA was 7.4. But in December, my PSA went up to 12.9. What could this mean? Does this mean that it is very likely that the biopsy in October missed a larger/more serious lesion?

    I have been reading along on this forum for a while now, but this is my first post. Thank you for being such a helpful resource!

  2. #2
    Quote Originally Posted by doubleH View Post
    Hello forum,

    I was diagnosed with prostate cancer last October. In the biopsy, 2 of 12 cores were positive. The highest Gleason score was 3 + 3. Overall prostatic tissue involvement was 1.7%. The stage is T1c.

    Now the month before the biopsy, my PSA was 7.4. But in December, my PSA went up to 12.9. What could this mean? Does this mean that it is very likely that the biopsy in October missed a larger/more serious lesion?
    Anything is "possible" of course, and your doctor will be following up with you on this I'm sure.

    But it isn't time to panic at all. PSA isn't specific to prostate cancer for men who haven't been treated for it. It could have just as easily been caused by an infection or other irritation to the prostate- as sometimes happens when you have a prostate biopsy.

    12 is a pretty high score, but not so high it couldn't be caused by something other than aggressive cancer.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3, PSA test 7/2019 2.0


    DOB 1956, in Pittsburgh, USA

  3. #3
    Moderator Top User HighlanderCFH's Avatar
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    Glad to have you posting, DH,

    It sounds very possible like there could just be a prostate infection involved. Prostate cancer probably would not spike the PSA up by 5 points in just a couple months. It is highly likely to be an infection that you will be given a prescription to take care of.

    In the meantime, if your biopsy report is accurate, you have a very NON-life threatening form of PC. Gleason 3+3 CANNOT metastasize outside the body and, with only two positive cores, you are an excellent candidate for Active Surveillance.

    Hang in there and watch for others to comment as the day(s) goes on.

    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.
    Eight annual post-op exams 2012 through 2019: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  4. #4
    Quote Originally Posted by doubleH View Post
    ....I was diagnosed with prostate cancer last October. In the biopsy, 2 of 12 cores were positive. The highest Gleason score was 3 + 3. Overall prostatic tissue involvement was 1.7%. The stage is T1c.

    Now the month before the biopsy, my PSA was 7.4. But in December, my PSA went up to 12.9. What could this mean? Does this mean that it is very likely that the biopsy in October missed a larger/more serious lesion?.......
    Welcome doubleH! Very sorry about your PCa diagnosis but very glad that you have found The Forum!

    A few Questions:

    - What is your age?

    - What is your PSA history?

    - What was the date of your Oct Biopsy (Bx)?

    - What was the date of your Dec PSA blood draw?

    It is possible that your prostate gland was still "upset" by the biopsy. An additional possibility is infection related to the biopsy that was not symptomatic. Discuss issues with your URO MD.

    - When is your next PSA test scheduled?

    Also ask your URO MD about additional imaging such as an mp 3T MRI to detect any areas of suspicion that may have been missed by Bx.

    Best wishes for a significantly decreased upcoming PSA. Hoping that you will qualify to be a candidate for Active Surveillance (AS).

    Keep asking questions and keep us updated.

    MF
    Last edited by Michael F; 01-02-2019 at 08:09 PM.
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = G7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left: PM + EPE. 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 c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: 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" at 91 Months Post Op: Mean = 0.022 (22x uPSAs: Range 0.017 - 0.032) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  5. #5
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    Thank you all for your helpful replies. Here is some more information about my background & history (I'll try to get this into my signature):

    - Age: 49
    - PSA 1/14/17: 3.3
    - PSA 8/12/17: 4.3
    - PSA 12/13/17: 5.2
    - PSA 3/13/18: 6.0
    - PSA 9/14/18: 7.4
    - Bx 10/8/18: 2/12 cores positive, both cores 3+3, both cores 10% involvement, both cores NPI
    - PSA 12/15/18: 12.9

    All my DREs so far have been negative.

    Based on the high reading of my latest PSA test and the general upward trend over time before December, my urologist thinks that most likely my prostate cancer is more advanced than detected in the biopsy. My next PSA test is scheduled for 1/15/19 (to rule out infection or other irritation of the prostate). If the next PSA result is also high, he strongly suggests I should undergo a prostatectomy, after an MRI etc. for staging.

  6. #6
    Moderator Top User HighlanderCFH's Avatar
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    Even if there is more aggressive PC involved, it is still quite curable if still confined to your prostate -- and it probably is.
    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.
    Eight annual post-op exams 2012 through 2019: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  7. #7
    TY for the info doubleH. Here are a few more questions & observations:

    - Was there any advice to have a biopsy back in 2017? Your 1st PSA was elevated for your age group and each subsequent PSA has been on a rising trajectory.

    - So there is nearly 9 weeks between your 12 core Bx and the PSA = 12.9 My "guess" is that should be ample time for your prostate to calm down following the mechanical insult of Bx. Possibly an assymptomatic infection is the cause of the large PSA spike. Regardless, this must be further investigated and explained - exactly as your URO MD is doing.

    - You are young! Thus treatment is on the horizon. IF the current PSA = 12.9 is NOT due to causes other than PCa, Active Surveillance (AS) will not be an option. Based on your age, surgery will likely be the recommendation.

    - You will only have 1 Good Opportunity to get things done correctly from the start. For surgery, you want to have a highly experienced URO Surgeon who specializes in PCa. Such a surgeon typically does at least 3 - 5 Radical Prostatectomies (RPs) per week.

    - MRI is a very important next step. I would ask to go ahead and get on the MRI schedule asap. Again, consider where the MRI is being done. You want to be at a facility with state of the art Imaging Technologies (3T MRI) and a URO Radiologist who is highly experienced in evaluating MRIs for PCa.

    - In the past 4 years, there have been more than 52 Forum Brothers (FBs) in their 40's who arrived here. So you are not alone.

    Good luck on the 15th! You have an entire Team rooting for a vastly decreased PSA result! Stay optimistic but be prepared to take strategic actions IF necessary.

    MF
    Last edited by Michael F; 01-04-2019 at 08:49 PM.

  8. #8
    I would bet that your psa rise is due to the biopsy. One of my biopsies tripled my psa and another one doubled it. Those effects lasted for six months.

    Please calm down and consider the simple possibilities before assuming that your increase was suddenly caused by more prostate cancer.
    DOB: May 1944
    In Active Surveillance program at Johns Hopkins
    Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
    Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
    PSA has varied up and down from 3 to 10 over the years. Is 4.0 as of September 2019.
    Hopefully, I can remain untreated. So far, so good.

  9. #9
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    Thanks all for your informative and hopeful responses. I am happy to report that my PSA score went down to 7.8, which is just 0.4 higher than before my biopsy. My next PSA test is scheduled for mid-April. I also have an appointment early March for a second opinion regarding next treatment (or not) steps in the current situation.

    MF, I was not advised to have a biopsy back in 2017. Given my "low" (under 10) PSA score, my urologist didn't suggest an MRI at this point when I saw him last month.
    * Age: 50
    * PSA:
    - 1/14/17: 3.3
    - 8/12/17: 4.3
    - 12/13/17: 5.2
    - 3/13/18: 6.0
    - 9/14/18: 7.4
    * Biopsy:
    - 10/8/18: 12 cores, left medial mid: 3+3, 10% involvement, left lateral apex: 3+3, 10% involvement, both positive cores NPI
    * Oncotype DX:
    - 12/13/18: Unable to report due to insufficient RNA quality or quantity
    * PSA:
    - 12/15/18: 12.9
    - 1/14/19: 7.8
    - 6/1/19: 8.5
    - 6/1/19: 7.1 (switching from Beckman Coulter to Siemens method)
    * Prostate multiparametric MRI:
    - 10/1/19: No evidence of clinically significant prostate cancer; mild prostatomegaly with benign prostatic hyperplasia
    * Biopsy:
    - 10/15/19: 12 cores, left medial apex: 3+3, 10% involvement, left lateral apex: 3+3, 5% involvement
    * Under active surveillance

  10. #10
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    Quote Originally Posted by doubleH View Post

    MF, I was not advised to have a biopsy back in 2017. Given my "low" (under 10) PSA score, my urologist didn't suggest an MRI at this point when I saw him last month.

    that conflicts with what I was told, I hit a 5.7 a few weeks after I turned 47 and they wanted me to have a biopsy, they said the break number was 4 not 10

    I had my biopsy 2 days before I turned 50 and had a lower staging than what I turned out to be so am glad I went ahead and had the surgery to take advantage of my 'youth' for the recovery
    DOB:7/68
    8/15: 5.73 PSA
    1/18: 6.22 PSA
    2/18:6.85 PSA
    7/18:biopsy: left apex 3+3=6 Grade Group 1, 5% 1 of 2 cores, rest negative
    11/18: RALP at Northwestern Chicago
    gleason 7 (3+4) 30% gleason 4 component, tumor volume 10%; Pt2, Nodes pN0
    12/18: PSA 0.00
    4/19: PSA 0.00

 

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