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Thread: Question about Sons PSA

  1. #1

    Question about Sons PSA

    I don't post much here any more but read the posts daily. This time i have a question and i want to get as many answers as possible to figure out if i am off the charts needlessly worrying or not.

    I advised my son, at age 36, to get a baseline PSA, which he did. His PSA came back at .6 or .7, dont recall which. That was two years ago.
    Last year he retested and it came back at .8.
    He just retested at age 38, and it is 1.0.
    Each time it was a different lab, because the Dr's changed.

    I am very concerned.
    He is 38 and single, will be 39 in April. This would be my worst nightmare.
    My own PSA was .7 at age 50, and a few years later at 1.3 is when my Dr sent me to a uro and at 1.7 is when a biopsy was recommended, which was negatve. That was at about age 60
    All the labs state a normal ref range of 0 to 4.0. But its the trend i am looking at.

    Am i overeacting? Cause for concern?
    Diagnosed at age 64 (in November, 2014), PSA 4.3
    Nov 2014 BX 3 of 12 cores positive original pathology G8. Johns Hopkins second opinion, G6
    Surgery with Dr Ash Tewari Jan 6, 2015
    Post surgical pathology, stage T2c, bilateral disease, upstaged to G7(3+4)
    5% of Prostate involved in Tumor. Organ confined, Margins, SV, lymph nodes (9) all negative, PNI positive
    PSA <.02 until (uh-oh), 2/17 .02. Then 5/17-.033, 8/17-.033, 11/17-.046, 4/18-.060, 6/18-.068, 7/18- .082, 8/18-. 078.
    Decipher score low risk, .37
    ADT/Firmagon started August 2018. SRT to start SEPT 2018. Finished SRT November 2018, Finished ADT Feb 2019
    T=7, PSA <.05

  2. #2
    Double tap my bad.
    Last edited by IceStationZebra; 09-11-2019 at 12:09 AM.

  3. #3
    Hi, that's a very interesting question. I had to go figure out why my signature wasn't showing up.

    At 37 mine was 1.3. After which it wasn't tested for several years.

    My take on it is that you should keep an eye on it and get regular checkups but I don't know that a uro or insurance would agree to a biopsy. I would want the testing done at the same lab and make sure the circumstances are the same. Sex before or during the blood draw (hey some people like to really party) could easily account for those fluctuations. 3 days on abstinence before draw 1 and 30 minutes before draw 3 and voila you have a jump.

    I'd be watchful but just chillax as it is very early in the game. Great that you're checking it and know your numbers.
    2006: 1.6 PSA age 36
    2007: 1.3 PSA age 37
    2012: 2.2 PSA age 42
    2013: 2.6 PSA age 43
    2014: 2.8 PSA age 44
    2015: 3.1 PSA age 45
    2016: 3.5 PSA age 46
    2017: ? N/A
    3/18– 4.1 PSA at 48 YO. u/s measured 46 ml prostate
    3/18–free PSA 10%
    3/18–TRUS all 12 cores negative
    9/18– 4.5 PSA
    9/18– negative pca3
    12/18- 4K at 17%
    12/18- 3t MRI, 5mm pirads 3-4 and a pirads 1-2
    2/19- Fusion TRUS biopsy. G6 (3+3) 20% of a single core. Two cores pre-cancerous.
    AS for now
    4/19-PSA at 7.21 (biopsy effect)
    6/19-PSA back down to 4.8
    9/19-TRUS-- three cores of G6 involving 25%, 90% and 40% of each core.

  4. #4
    I'm not an expert like so many on here but looks to me like you have nothing until you start using one lab . Anyway there is no worry in the world like a parent feels about his children. Best of luck to both of yall.

  5. #5
    Thanks guys. It’s nerve wracking. It also brings back memories, because my rise was slow and steady.
    He knows not to have sex or lift heavy weights or ride a bike for 2 days prior to the test. He Mentioned possibly going to Quest to get a baseline there Since it’s a lab he can stick with no matter what doctor he sees. I will leave it to him whether he actually does that or not. I think for now the best thing is to just forget about it until next year and when he tests again if it goes up again push him to go to a urologist which he wouldn’t object to
    Diagnosed at age 64 (in November, 2014), PSA 4.3
    Nov 2014 BX 3 of 12 cores positive original pathology G8. Johns Hopkins second opinion, G6
    Surgery with Dr Ash Tewari Jan 6, 2015
    Post surgical pathology, stage T2c, bilateral disease, upstaged to G7(3+4)
    5% of Prostate involved in Tumor. Organ confined, Margins, SV, lymph nodes (9) all negative, PNI positive
    PSA <.02 until (uh-oh), 2/17 .02. Then 5/17-.033, 8/17-.033, 11/17-.046, 4/18-.060, 6/18-.068, 7/18- .082, 8/18-. 078.
    Decipher score low risk, .37
    ADT/Firmagon started August 2018. SRT to start SEPT 2018. Finished SRT November 2018, Finished ADT Feb 2019
    T=7, PSA <.05

  6. #6
    Quote Originally Posted by Pratoman View Post
    Thanks guys. It’s nerve wracking. It also brings back memories, because my rise was slow and steady.
    He knows not to have sex or lift heavy weights or ride a bike for 2 days prior to the test. He Mentioned possibly going to Quest to get a baseline there Since it’s a lab he can stick with no matter what doctor he sees. I will leave it to him whether he actually does that or not. I think for now the best thing is to just forget about it until next year and when he tests again if it goes up again push him to go to a urologist which he wouldn’t object to
    In that case I suggest (unusually) using Quest's 2-digit "post-prostatectomy PSA" test (their name for their ultrasensitive test). Then the uncertainty will be in the hundredth place instead of the tenths.

    He should use the same test at the same lab going forward. PSA fluctuates, but given his low values, over time you'll have better info. Also, he can test a bit more frequently too, say at 6 months for a couple of tests for peace of mind (his or yours) and a better baseline, or, if something is amiss, more data points for a more accurate rate of rise.

    My two cents,

    Djin
    Last edited by DjinTonic; 09-11-2019 at 12:46 AM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg., then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%, 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (30-day check)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015
    08-28-19 (2 yr. ) 0.016
    Avg. = 0.013

  7. #7
    As you know , the PSA test isn't specific to prostate cancer. it does seem to have gone up in your son's case, but that doesn't necessarily mean cancer at all.

    For a man of his age, prostate cancer is a very rare disease.

    I think this is something to keep an eye on, but I don't think its just that likely to be 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

  8. #8
    Top User garyi's Avatar
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    Apr 2017
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    1,372
    Minor variation, and normal at his age. I sure hope he's not picking up on his dads undue concern....
    72...LUTS for the past 7 years
    TURP 2/16,
    G3+4 discovered
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor still in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    Radiation Procitis, and Ulcerative Colitis flaired after 20 years
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19, .081 9/19
    We'll see....what is not known dwarfs what is thought to be fact

  9. #9
    Thanks again for all of the additional responses. I agree, that not only is a biopsy not called for, but at this level of PSA the chance of finding something is probably 5% if there is something to find.

    As far as him picking up on my "undue" concern, of course he did. But i reassured him that at this point he should take the Doctors advice that its fine. But that if its up again next year, i will suggest he get followed by a uro. I did read studies suggesting that for men age 40 and under who have a baseline psa of 1.0 or higher, they are at high risk for developing PCa in the future. No need to share that with him, he already knows he has risk because of my and my dads history.

    Not meaning to be argumentative in any way, but i think the concern is real, based on a trend. But yes, he needs to get consistent with the same lab

    Djin, thanks for the advice. I dont think uPSA is a great idea at this point as the minor fluctuations would not be meaningful since he has a prostate, and they would cause more worry than necessary
    Diagnosed at age 64 (in November, 2014), PSA 4.3
    Nov 2014 BX 3 of 12 cores positive original pathology G8. Johns Hopkins second opinion, G6
    Surgery with Dr Ash Tewari Jan 6, 2015
    Post surgical pathology, stage T2c, bilateral disease, upstaged to G7(3+4)
    5% of Prostate involved in Tumor. Organ confined, Margins, SV, lymph nodes (9) all negative, PNI positive
    PSA <.02 until (uh-oh), 2/17 .02. Then 5/17-.033, 8/17-.033, 11/17-.046, 4/18-.060, 6/18-.068, 7/18- .082, 8/18-. 078.
    Decipher score low risk, .37
    ADT/Firmagon started August 2018. SRT to start SEPT 2018. Finished SRT November 2018, Finished ADT Feb 2019
    T=7, PSA <.05

  10. #10
    Quote Originally Posted by Pratoman View Post
    ...

    Not meaning to be argumentative in any way, but i think the concern is real, based on a trend. But yes, he needs to get consistent with the same lab

    Djin, thanks for the advice. I dont think uPSA is a great idea at this point as the minor fluctuations would not be meaningful since he has a prostate, and they would cause more worry than necessary
    That's fine, but remember that there is uncertainty in the right-most digit of any test, so it may take a number of readings to filter out fluctuations and inherent test imprecision. That's why I suggest using a test that has one decimal place more than the place you are interest in.

    Djin
    Last edited by DjinTonic; 09-11-2019 at 10:32 PM.

 

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