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Making Sense of My PSA Numbers

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Posted 7/7/2014 11:19 AM (GMT 0)
I am a 55 year old male. Very healthy and active. I have been going for a physical every year and getting a clean bill of health with each visit, except for high cholesterol (between 150-200). Now taking Simvastatin (20mg) to keep the cholesterol below 200, but HDL still remains below 40.

Since 2010, my annual physicals have shown a PSA between 1.0-1.3. In May 2013, it jumped to 2.2. This alarmed my GP and he gave me two choices - begin chemo or wait 6 months and try again. I chose to wait 6 months. At that point, my PSA dropped back down to 1.2. So I thought the 2.2 was just an anomaly. I just had my bloodwork for this year's annual physical and my PSA is 2.7. I see my GP later this week for my physical and to discuss the numbers from my bloodwork. What questions should I be asking him? He checks my prostate every year using the finger test and indicates that all is well. I assume this means my prostate is not enlarged.

So I am looking for my next step. Is this just another anomaly? Should I try my PSA numbers again just to confirm the 2.7 is accurate? Should I wait 6 months and try again, hoping they go back down like last year? Or is 2.7 still far enough below 4.0 that I don't have to worry yet? Or do I start the chemo? And if I do, what can I expect?

Appreciate any advice from this forum from folks who have much more experience than I do on this topic.

John
Posted 7/7/2014 6:59 AM (GMT -5)
I'm sure you must have misunderstood your doctor about chemo. It would be one of the most grievous cases of mal practice if he were serious.
He most likely said Cipro, or another antibiotic which would make perfect sense as ups and downs in psa are indicative of infection and not cancer.
Ask him to estimate the size of your prostate and calculate a psa density for you; it should be below 1.5. I would keep monitoring psa and get a free psa test. Don't get pushed into a biopsy until all other causes of psa have been eliminated such as large prostate or infection.
Posted 7/7/2014 7:07 AM (GMT -5)
Your GP proposed that you begin chemo just based on a move of PSA from 1.3 to 2.2? Oh my.

Please see a urologist who is familiar with prostate cancer screening. At your age, PSA of 2.7 might be quite acceptable and you should continue life carefree. Perhaps a urologist will want to do a biopsy to check for the presence of cancer cells in your prostate.

-Gedman
Posted 7/7/2014 7:34 AM (GMT -5)
Hello Va Cop,

Welcome to the forum. Sorry you have worries but glad you found us. I hope we can help.

As JohnT said, your PSA that bounces around sounds more like an infection than prostate cancer. With cancer you usually see a long gradual rise in PSA that seems to be rising a bit faster every time you measure it. One frequent diagnostic tool to use with men whose PSA bounces around is to give them antibiotics to treat an infection. If the antibiotics make the PSA go down then the presence of an infection is indicated. I agree with John that what your doctor probably said was "Cipro" not "chemo" since Cipro is the antibiotic most used to treat prostate infections.

Another thing that can affect you PSA reading is having sex during the 48 hour period previous to having your blood drawn for a PSA test. Bicycle riding, bull riding, and other extreme sit down sports should also be avoided prior to the test. If your doctor does a digital exam before the blood is drawn that can also make the reading go up.

Let us know what your doctor says.
Posted 7/7/2014 7:36 AM (GMT -5)
I suspect that you didn't understand or he didn't explain properly.

"Chemo" would be a step that would not come in your situation, or I could at least say I don't know of any insurance company that would approve it.

He might have been using is loosely in a context I've recently seen with my uro. Suddenly my bills are showing my Lupron in the category of "Chemo". I asked about this, and it has to do with billing classifications and administration as a medical procedure rather than a prescription drug. But in the traditional sense, we would not consider Lupron to be the "Chemo" that we all fear.

Cipro is, on the other hand, a very normal thing - to check for other infections and retest.

The best advice I could offer is to go ahead and find a good urologist. You'll need one soon enough as you get older. Better to have a good one instead of searching later on.
Posted 7/7/2014 8:30 AM (GMT -5)
va_cop81

At least your GP was proactive and wanted to do something further. Mine failed to recognize a significant spike in psa from the previous year and had he did, I may not have the final pathology I do. Get some clarification from your GP. Like the others said, it's usually Cipro to rule out infection. Best of Luck to you.

*********************************************
DX 10/04/2013 PSA 187.5
07/11/2013 psa 3.31
3/10/2010 psa 1.87
1/24/2006 psa .87
Biopsy 10/28/2013 4 cores positive gs 9 (4+5)
Bone Scan 12/09/2013 2 hot spots in spine
Hormone Therapy started 12/17/2013 22mg lupron, 50 mg Casodex
Bone biopsy 01/09/2013 negative
RALP 2/19/2014 Non Nerve sparing, Lymphovascular invasion
Pathology T3B NX, MX, prostate size 4.2 X 4 X 3 cm, 31 grams
Bilateral cancer found involving 6% of prostate
03/07/2013 PSA .6
05/29/2014 psa <.01
Posted 7/7/2014 9:06 AM (GMT -5)
Vacop

I agree that your your GP was right to be proactive but I doubt he recommended chemo as that would be ridiculous. My GP failed to do a PSA test in 2010 and failed to recognize that finasteride cuts PSA in half. So now I'm a high risk case.
Good luck.
Posted 7/7/2014 9:33 AM (GMT -5)
Welcome to HW.

You likely have nothing to be concerned with as has been mentioned. I wouldn't have GP treating this kind of problem. You should really be talking to a good urologist. I'd ask for a referral.

Nothing in your numbers suggest to me PC. Remember that PSA can bounce around for a lot of reasons - infection or enlarged prostate are more common.

Andrew
Posted 7/7/2014 11:42 AM (GMT -5)
I really appreciate the responses to my recent post. Honestly, I did not expect so many responses in so short a time. This forum is such a tremendous asset!

My GP seems pretty sharp, so you have convinced me that I probably heard "chemo" when he actually said something else. Your responses have made me better informed and when I discuss the latest PSA number with my GP this week, I will be able to provide better input on the way ahead.

Thanks!

John
Posted 7/9/2014 10:26 PM (GMT -5)
va-cop81

I am in a similar situation with PSA numbers jumping. My GP/Internist retired at end of last year so going to a new GP and routine blood test revealed PSA 5.4. Unfortunately going back to review my last tests from records of my now retired doctor and only tests from 2009, 2010, 2011 can be located and those readingswere 1.0, 1.1 and 1.1 respectively. My GP recommended seeing Urologist which I did last week. My Urologist which I have used for kidney stones and in my opinion one of the best in NO. VA. told me he would not be that concerned with my current 5.4 if he had the 2012-2013 tests results and they showed a steady climb but since we don't have those he will be performing a prostrate biopsy in a few weeks. I am about 10 years older than you but he told me that many men's PSA will start rising in 50's and 60's and that it is normally a steady rise a little each year, for that he would not be concerned. He has prescribed Cipro that I am to take just before the biopsy and says if he had those records he may not even be doing the biopsy. Take it from me, with a Father who past away from prostrate and colon cancer, I am paranoid. While I am not a doctor your's sound like nothing to be extremely alarmed about, my urologist said that if it was cancer or any real alarming problem we would be seeing numbers far in excess 10 and with a malignancy its not unusual to see 50+. Made me feel better anyway. Good luck with yours and see a good urologist.
Posted 7/9/2014 10:58 PM (GMT -5)
Patriotman, Many, many of us here on HW never saw PSA numbers as high as ten, and certainly not as high as 50. Some here have said that some of the more serious, more aggressive variants of prostate cancer don't produce much PSA. Your advice that he see a good urologist is right on, but we've seen high PSA scores attributable to infection, and occasionally low scores associated with actual cancer. My number at diagnosis was about 6.2.
Posted 7/9/2014 11:38 PM (GMT -5)
Welcome Va Cop,

Sorry you are going through this. As others have already said, I am sure that your doctor didn't immediately mean you were going to need chemo. Sounds to me as if you might have an infection. Also, I believe a biopsy would then be in order to diagnose. Good luck to you, I will be rooting for you.
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