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Thread: Rising PSA, potential Biopsy coming up

  1. #1
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    Rising PSA, potential Biopsy coming up

    New to this site and some background on me. At 35 I had LUTS issues along with pain in my feet, similar to plantar fasciitis. I went to my GP and was DX with Prostatitis. At the time they did do a PSA test that came back at 1.5. Which I remember the phone call from the nurse at the time and said oh you are fine you under 4.0. So along with her words and my ignorance I assumed all was well. I was given a regimen of antibiotics. The symptoms did go away and no issues or recheck of my psa till I turned 45 years old. Only reason for the recheck was I started to get kidney stones. This started in 2014. The first PSA came back at 1.5 still and the urologist was told about my prior psa back 10 years ago. He was floored with the idea of a 35yo male having a PSA of 1.5 and said he would have done a biopsy if presented with that and my age. I clearly have been DX with BPH as well at this point. I have had repeated stones for the last 5 years. 1 or 2 a year and continued to see a Urologist for this issue. They put me on the stone protocol and added for me to get my PSA tested as well. Well two years ago I had an increase in my PSA to a 1.7. No symptoms besides the BPH and because of the kidney stones some LUTS issues but nothing more than mild. BTW, Rapaflo works very well for me. At the time the DRE came back (Neg).

    Last December 2018 I had another stone issue and was given a CT scan of my abdomen. Besides the stone there was a note from the Radiologist that my prostate was bigger than before. I had several CTs in the last 5 years because of the kidney stones. So another PSA was done this last March and came back @ 2.3. Since the beginning of the year I have had some discomfort when sitting. Pain comes and goes and even my feet were affected again like the first time I had Prostatitis. The pain is in the perineum and along the lymph nodes of the groin. Feels like a burning pain and only happens when sitting on a hard seat. The doctor wanted to recheck my PSA again in a couple of months after the PSA test in March so in June had another PSA this time 2.7. The urologist did do another DRE and that too came back (neg). He put me on a 4 weeks worth of antibiotics which seemed to help at first but now that I'm off them the pain is back. I have to do another PSA test in the next week or two and if it doesn't go below 2.5 was told a biopsy will be given. Yes I'm scared as heck over the biopsy option and of course the uncertainty of the whole process. I truly hope my issues are just prostatitis related but who knows. My question to everyone here is has anyone has similar experiences and if so what was the outcome? Most stories I read about PC the cancer was found because of screening and some LUTS issues but have not read any about the pain I'm dealing with. Can anyone relate or give some feed back on my questions?

    Thank you all for reading my post
    Last edited by Moruss; 07-06-2019 at 05:10 PM.

  2. #2
    Urinary symptoms and conditions as well as prostatitis can certainly cause PSA to rise, and Prostate Cancer is a pretty rare diagnosis for a young man like yourself.

    There is no way for anyone to know on the internet whether or not you actually do have PC, even if they were a doctor.

    However, although your PSA score is elevated, it would most likely be a lot higher if you had a prostate tumor large enough to cause the pain that you are describing. If you do have prostate cancer, it would be likely that it isn't related to your groin pain. Usually,PSA scores associated with symptomatic prostate cancer are at least 10 times what you have and sometimes even a lot higher. There are people with PSA scores in the hundreds or even thousands, walking around like the happy wanderer oblivious to the idea that they even have 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
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    -Southsider-

    Thank you for your input. I am sorry for trying to get a DX in my comments. What I guess I'm more looking for is has anyone had a similar experience? In the last 5 years I have gone through a whole gambit of issues because of the kidney stones. So much poking and prodding and the pain. I am fortunate though I have passed every stone without any type of surgery. Lots of drinking water (gallon a day), Rapaflo (which is finally covered by my insurance) and walking/hiking 6-8 miles a day. Each time they do a CT they see something that at first of course I react to but once it's finally gone over and checked turns out to be a benign issue. With the last CT -Dec 18- Now we are onto the prostate because it has grown and my psa is rising.

    Reading online information (not peer reviewed) tends to cause more anxiety than helps. What turns out to be the norm is the abnormal. I am awe of the honesty and information I am finding on this site. Also very thankful. It's nice to be in the digital age even if sometimes to much information or worse wrong info is out there. Imagine back in the day when we didn't have such easy access to this type of information. I do find reading patient stories are helpful and (YANA) was another good site for me to find. I do truly appreciate any input anyone has on my situation. Yes I also understand it's not only impossible to get a DX over the net but every case of PC is unique. Just hearing your comments "Southside" gave me some focus and for sure helped. I know it doesn't mean good news or bad news but empathy and understanding is some of the best medicine....at least for my mind.

  4. #4
    I would recommend that you have a 3T mp-MRI of your prostate. That would identify any areas suspicious for cancer, which could then be followed by a targeted biopsy.

    But, even before that, there are the PHI and 4K Score blood tests, which can provide more accurate information than PSA/free PSA alone.
    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 4.4, fPSA 24, PHI 32
    Hopefully, I can remain untreated. So far, so good.

  5. #5
    Urinary symptoms including prostatitis and kidney stones can be very frustrating for everyone involved. A friend of mine who is now 70, does not have PC, but has been seeing his urologist for a quarter of a century over his symptoms. Try to be patient about it, I think anxiety can aggravate your kind of symptoms.

    I had 3 biopsies before I had an MRI, the standard of care seems to be changing on this.
    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

  6. #6
    Hi and Welcome Moruss!

    Re "I have had some discomfort when sitting. Pain comes and goes and even my feet were affected again like the first time I had Prostatitis. The pain is in the perineum and along the lymph nodes of the groin. Feels like a burning pain and only happens when sitting on a hard seat...:" Prostate Cancer (PCa) in the early stages usually has no accompanying symptoms. Based on your age, PCa is unlikely. Your PSA = 2.3 is elevated for your age and should be monitored - exactly as you are doing. You are now in the care of a URO MD which is the exact right place to be. If your URO MD is not overly concerned about PCa, then neither should you.

    "Dittos" to the input by Southsider and ASAdvocate. At your next URO MD appointment discuss ASAdvocate's suggestions.

    Best wishes keeping kidney stones from forming.

    Good luck!

    MF
    Last edited by Michael F; 07-08-2019 at 02:41 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 84 Months Post Op: Mean = 0.021 (20x uPSAs: Range 0.017 - 0.026) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  7. #7
    Experienced User
    Join Date
    Apr 2019
    Posts
    59
    Agree with the suggestions for an MRI - be picky about where it's done though, and be prepared to pay for a 2nd opinion on it. You could also request more advanced blood/urine testing such as PHI or PCA3.

    My husband had pain that was assumed to be prostatisits that was more pressure than burning, and it turns out he's got intermediate risk cancer.
    Wife Posting, Husband D.O.B. 1975
    2/2018 - routine physical PSA 15
    3/2018 - PSA 13
    4/2018 - PSA down to 11.6, free PSA done, 18%
    6/2018 - PSA 10, free PSA 20%
    7/2018 - mp- MRI done, prostate volume =22cc, "inflammation consistent with prostititis"
    11/2018 - PSA 14, free PSA 11%,
    3/2019 - PSA 12, free PSA 17%, 2nd opinion on MRI = PI RADs 3 lesion
    4/2019 - Cognitive Fusion Biopsy
    5/12 cores positive
    4 Gleason 3+3
    1 Gleason 3+4 (Where PIRADs 3 lesion IDd)
    Decipher Biopsy score: .07 very low risk

    Bone scan negative
    MRI 6/19 said PIRADS 4 lesion, no definite EPE

    RRP 7/19 Final Path: pT3a
    G6 - 75-90%
    G7 - 11-25%
    24mm tumor, 30% of prostate
    EPE+, BNI+, SM + (at bladder neck), LVI-, SVI -, PNI-, Nodes -

  8. #8
    Newbie New User
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    Follow up and to where I am at now -

    First off I did call the URO's Office to discuss the other options of PHI and 4K Score blood tests as well as the MRI. I only spoke with the MA(Medical assistant) but she was pretty annoyed with my asking about this to be honest. I've had a really tough time with keeping my doctors because I have ACA insurance good old O'bamacare. Spending a ton of money and getting next to the worst type of service possible. Many of my doctors have dropped the program so having to find new ones all the time. My current Uro is a Military Doc and doesn't seem to powder puff anything. Which I guess is a good thing but the MA made it clear that the doctor wouldn't have ordered the biopsy if it was not was needed. Right before the next scheduled PSA test my IBS acted up and had some major issues with bowel movements. I contacted the office to make them aware of this and if they still wanted me to do the PSA test since the doctor did mention IBS issues can affect the PSA results. They did advise me to hold off for 2 more weeks and let my stomach settle and see if I can get regular again. I waited and made sure I ate a bland diet and kept up my exercising and then had the next PSA test. I was told if my PSA was at 2.5 or higher I would have to have the biopsy done. The PSA came back at 2.2 (first drop in 2 years) and the doctors office did call me and told me not to do the prep for the biopsy and to come in for just a follow up visit with my URO.

    This next Monday the 12th of Aug was my biopsy date. Instead it's been changed to a follow up visit. I'm not going lie I am thrilled I don't have to do it at this time but really wonder what is in my best interest. Another thing I didn't mention before which I had no idea had any effect on prostate is my PTH or Parathyroid Hormone was tested about 2 years ago when they were investigating my kidney stones. It came back at a 67 and the cut off for high normal range is 66. At the time my calcium was low so my GP said don't worry about it. Now I come to find out elevated PTH raises prostate PSA level's and the worst news is if I ever get PAc it's a major factor in getting bone meta involvement. PTH has a lot to do with your Calcium levels and figures there is a connection. I hope that I am really getting the best care possible and not sure what I should bring up in this appointment on Monday. To use a PSA number of 2.5 seems to be arbitrary at best. Any suggestions of what I should be discussing with my doctor on this follow up visit?

 

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