PSA Level Concerns

hello and welcome to hw pc,,

you are asking a good and fair question, so please don't worry.

I don't think you have any worry at this point with your psa history, the total number is in range. my only concern was the last increase from 2012 to 2013, and increase of .4. Some experts consider any increase of .35 or more a year as a possible danger signal. But that doesn't mean there is trouble, I would continue to do your yearly monitoring.

Do you get DRE's too? (Digital Rectal Exams", and if so, are they negative? Do you have to wake up a lot at night to urinate? Ever have any burning or discomfort when you urinate?

If you are seeing a family/PCP doctor, perhaps you should see an urologist, and get his take on your situation to give you some peace of mind.

David

There are a few blood tests that might provide some info.
Free PSA. PCA3.
PSA will go up if the prostate increases in size or if there is inflammation, etc.
PSA density, PSA divided by prostate size can be informative.
Good luck.

Many of us find that the PSA doubling time is more of an indicator than the PSA per se. Yours only increased 25% in a year and the red flag tends to be 100% increase in a year or less.

In my case the pSA was relatively low 3.68 but the PSADT doubling time of 6 months was the red flag that led to the biopsy and subsequent diagnosis.

PSA can be elevated if you have sex within the prior 72 hours and to a lesser degree if you have ridden a bike recently before the PSA test, also as you mention by other inflammation.

With your family history you have to do watchful waiting but to this non medical professional, your metrics do not seem to be a cause for immediate concern.

LupronJim

K9guy:

The quote from Dr. Catalona is as follows:

"In my PSA Study, the median PSA value for the age group of men without clinical evidence of prostate cancer is 0.7 for men in their 40s, 0.9 for men in their 50s and 1.4 for men 60 years of age or older."

The entire article is at this address:

http://www.drcatalona.com/quest/quest_fall06_1.asp

Bill K. from NJ

Z06dude said...
K9guy:

The quote from Dr. Catalona is as follows:

"In my PSA Study, the median PSA value for the age group of men without clinical evidence of prostate cancer is 0.7 for men in their 40s, 0.9 for men in their 50s and 1.4 for men 60 years of age or older."

The entire article is at this address:

http://www.drcatalona.com/quest/quest_fall06_1.asp

Bill K. from NJ

Mostly Quotes below are from that article, but as far as I can tell he never defines "substantially":

Instead of the median quoted above, the author seems to be measuring substantially above the median.

"If the PSA is at the median or less for the age group, then the risk for prostate cancer is very low. If a man’s PSA is higher than the median for his age group, his risk of having prostate cancer is higher and the risk that the cancer is aggressive is higher. The higher the PSA, the higher the risk for cancer and aggressive cancer.

If the PSA is substantially above the median, I recommend a trial of antibiotics and repeat PSA measurements to see if the PSA comes down. If it doesn't, I recommend a biopsy.

In any case, I recommend an initial biopsy if the PSA is persistently higher than 2.5 ng/ml.

Several studies have shown that in men without clinical evidence of prostate cancer but most of whom have benign enlargement (called benign prostatic hyperplasia or BPH), the PSA level increases approximately 0.1 ng/ml/year.

If the total PSA is less than 4 ng/ml but the PSA velocity is greater than 0.3 ng/ml/year – verified with repeated measurements to rule out test variability– then I believe that rise in PSA calls for a biopsy."

If the PSA is higher than 4 ng/ml, a PSA velocity higher than 0.75 ng/ml/year should prompt a biopsy, even if a previous biopsy has been negative for cancer.

In all instances, rises in PSA should be treated with antibiotics and repeated PSA testing to rule out laboratory variation or prostatitis. Patients with dramatic increases in PSA are as likely to have inflammation in their prostate called prostatitis as prostate cancer."

LupronJim

Well hello everyone, it’s been awhile since I posted about this. I have been watching my scores and now I’m a little worried and have a consult with a urologist next month. I’m 48 now and my PSA just came back at a 3.00, last year is was 2.4 and the year before that it was 2.2. My father had his prostate removed when he was 57 and is doing fine so I have the family history. I’m just very worried about the whole situation, any words of wisdom and/or encouragement would be much appreciated.

No need to worry, just go see a URO for an evaluation. You should ask for some other blood work: FreePSA, PHI (prostate health index) which can provide other markers that might be helpful. You'll also need the DRE.

Remember that PSA alone is not a test for cancer. Just indicates that something is going on. Your URO can help you work through all the reasons that can elevate your PSA. BPH is also a possibility. Depending on other tests, you URO might suggest a biopsy, which is annoying and undignified, but is the only way to confirm PC. You're a long way from needing anything like that.

Even is the worst is true, you've caught it early enough for effective treatment and this is just a bump in the road of life. Big bump, but nothing more than yet another health concern for us who are aging.

Andrew

Good move, JH is the respected leader in the field. Please let us know know what they recommend.

It does not take too much math extrapolation to see where you may be heading by age 57. Do you know what your father's PSA history was and at what point his doctor's decided to to something?

I am about 10 years ahead of my Dad's PCa journey so you just never know. I thought it would be a thing in my 70's but got quite the surprise earlier than expected.

K9,

I think you’re doing everything right. If you get to the point of biopsy and IF it comes back with cancer, you’ll still likely be okay. No need for panic.

How do you all deal with the anxiety of all of this??? Even though I am doing everything correct, I still can’t get over the anxiety of everything. The more research I do the more anxiety I’m having.

I know I’m being super pro active with everything, and going to the best doctor possible for something that may not even be PC. I just can’t get over the anxiety of everything, especially all the stuff I have been reading about people who were diagnosed early, got surgery and then have PSA anxiety every time they are tested during a follow-up. I know I will be one of those a that will worry to death about those results wondering if it comes back even after everything.

Any advice would be appreciated, I’m driving myself crazy.

k9guy - As someone who is waiting for their first post-op PSA in February, I share your "results" anxiety. However, this is not my first trip to the anxiety rodeo since last summer and it gets easier as time goes on and you come to grips with the situation, if any in your case.

At this point, I would not recommend wasting time searching the internet and this forum for all the possibilities with PCa in the future as you will just go crazy. Don't buy the books at this point either and just try to relax with a video game or something. I did all of that from diagnosis to my eventual surgery and it is just too much to absorb. Your mind will play all sorts of tricks on you until you just get too tired from thinking about it and fall sleep.

I keep returning to an email that my Dad sent me after his brachytherapy in 2004 that settles me down:

"Now to sit back and wait. If you think I am wasting a moment of doubt, don't. I'm cured and intend to live that way. If the PSA changes, I'll rethink the situation then, not now."

At this time, you are "cured" so enjoy your life and family.

K9, you’ve gotten good advice here. Just try to find things to take your mind off this, SO THAT YOU DONT JUMP TO CONCLUSIONS.
when you get to the JH appointment you’ll get answers to your anticipatory questions. And after tests are done, you will know something definitive, one way or the other. Although even biopsies are prone to false negatives.

I would say for now, don’t worry. But I know you will. It’s inevitable. We all do. There’s not much in this game that is worse than uncertainty.
But try, at least to chill. Right now, you do not have cancer. So don’t waste one day, one minute, freaking out that you might, because you will never get today back to do over.
Think about that. Then try.