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Posted 3/7/2010 12:15 PM (GMT 0)

My husband is 52 and has had some PSA numbers that I find confusing and hope someone has some advice on PSA numbers.

In 2007 my husbands PSA levels were 2.5.

In Feb 2008 they were 1.7

In Oct 2009 they were 3.67 with a free PSA ratio of 27

In Feb 2010 they were 4.03 with a free PSA ratio of 31.

He has now been referred to a urologist on our request. He has not yet had a DRE.

I understand on reading about the free PSA numbers that the 31 is good, indicates BPH. What is alarming me is how fast they are rising - PSA velocity.

My question is the Free PSA ratio indicates BPH but the PSA levels indicate a fast growing malignancy so what do you think I happening here? Are there other reasons for high PSA velocities other than cancer.

What should we be asking the urologist and what should he be doing at this stage.

This is all very scary for me and any advice you could give me is so well appreciated.

Regards,

An

Posted 3/7/2010 12:34 PM (GMT 0)
An, welcome to Healing Well...many will chime in soon.

While your husband's PSA is rapidly rising, his free PSA is a very good sign. An infection could be causing the rising PSA, so don't be surprised if the urologist puts him on cipro or similar medication to see if the PSA drops before jumping to a biopsy.

A question: by any chance did your husband ejaculate prior to his PSA tests? This will cause an elevated PSA reading, as will intense exercise. A DRE will cause PSA to rise as well, but doesn't apply in your husband's case. The DRE should have been performed during your husband's physical with his doctor. The urologist will almost definitely do one.

Make sure your husband gets an appointment with the urologist soon. Regardless of what's causing the rising PSA, he'll want to get it diagnosed and treated sooner rather than later. There is nothing much to do at this point except wait, and that's the hard part. I'm no medical expert by any means but my gut tells me that your husband will be fine.
Posted 3/7/2010 12:40 PM (GMT 0)

Dear An:

Welcome to the forum...you will find lot of information and support here but hopefully you will have a short stay and your hubby will not have a serious problem.  Some comments:

1.  Going to a urologist now is the correct thing to do.

2.  The free PSA is indeed indicative of BPH but is not for sure.

3.  The PSA levels do not necessarily mean cancer.  It could be a prostate infection and the urologist may suggest a course of antibiotics as a start to see if the PSA comes down.  You should also tell the doc whether or not there was sex within 48 hours of the PSA test as that may raise PSA levels.

4.  The urologist will most certainly do a DRE.  Frankly, your husband's PCP should have been doing this routinely as part of a physical exam.  It's not exactly fun...uncofortable but not painful.

5.  There is a good chance the urologist might suggest a biopsy.  If so, the state of the art these days is 16 or more samples....although some uros still do 12 or less.  The more samples, the more likely you are to find out what is going on.  There are several ways to do biopsies from no anesthesia to local anesthesia to IV sedation.  Mine was IV and was no problem.  For some men the biopsy is no big deal and for others there is a lot of pain.  You never know until you have one.

Good luck and please drop back in and let us know what happens at the uro visit.

Tudpock

Posted 3/7/2010 12:45 PM (GMT 0)
Thank you Sephie, especially for posting so quickly.

No he did not ejaculate in the week prior to his last two tests.
His appointment with the urologist is on the 19th, in 12 days time. I plan to go with him. You are right, the waiting is hard but I am so worried about what he is going to say.

An
Posted 3/7/2010 12:53 PM (GMT 0)
Thanks Tudpock,

Thank you for your quick and easy to understand response.
If the urologist does not suggest a biopsy should we push to have it?

An
Posted 3/7/2010 1:00 PM (GMT 0)
An, it's great that you are going along to the urologist.  My wife was present for all of my journey and it was a big help.  Not only was it support for me, but also two heads remembering everything! 

As for insisting on the biopsy...not necessarily.  As Sephie and I both said, a course of cipro/other may be an appropriate first course of action.  See what the doc says...

Tudpock

Posted 3/7/2010 1:03 PM (GMT 0)
Get other tests like the urine test PCA3 if you wish to avoid biopsies atleast for a while. This test is useful but like all tests in PCa can be lacking or not 100% factor, even biopsies can be less than 100% on definitive I can elaborate if need be.

(revised by myself...might have been TMI for a new person, written prior-off it went)

Dx-2002

Post Edited (zufus) : 3/7/2010 6:47:03 AM (GMT-7)

Posted 3/7/2010 1:34 PM (GMT 0)
An38 said... My husband is 52 and has had some PSA numbers that I find confusing and hope someone has some advice on PSA numbers. An38,   You’ve gotten some good inputs already.   I’ll add some big picture comments which I hope will reduce confusion.   Elevated PSA level is an important marker of many prostate diseases, including BPH, prostatitis (infection) and prostate cancer (and other less common causes).   Unfortunately, the PSA test does not test specifically for any one or the other of these possible causes.     PSA test results in your husband’s range (which is low ) tend to naturally vary.   For this reason, the American Urological Association guideline says that “consideration should be given to confirming an abnormal PSA before proceeding to biopsy .   This is especially true if a normal DRE is combined with either low, but abnormal PSA levels (i.e., <5-6 ng.mL), or with abnormal, but limited fluctuations in PSA at low levels.”   The percent free PSA test is the most common method of determining whether a man with your husband’s circumstances (very slightly elevated PSA , assuming no findings in DRE ) should proceed with a biopsy…or stated in other words, whether a needless biopsy can be avoided .     It sounds like you are already aware of what the percent free PSA test is.   Benign prostate tissue contains more “free” (versus “bound”) PSA than prostate cancer tissue.   The general statistics show that for men between 4-10 ng/mL of PSA , elevated PSA with above 25% free PSA usually indicates BPH.   I wouldn’t worry too much about the trip to the urologist.   But, with prostate cancer as common as it is among men, it’s never too early to start learning about it…but I don’t anticipate you’ll need too learn much more about it at this point.   best wishes...
Posted 3/7/2010 1:57 PM (GMT 0)
Hi Casey,

Thank you for the overview.

Does the %free PSA test "overide" the PSA velocity for the purposes of the above guidelines in doing a biopsy? The reason I ask this is that I hear that an increase of over 0.75/year is of concern.

Could a flareup in BHP cause a sudden increase in the PSA level? Wouldn't BHP typically give you a high but stable PSA number? (I really don't know the answer to this, these are genuine questions)

At the rate my husbands PSA level is going up he will be well past 10 before he is 60. This is what's really getting to me. I don't know how long he will stay at 5-6 at this rate. If anything the velocity seems to be accelerating.

Sorry to be fixated on the velocity question but if he has an infection can an infection last for so long (many months)? Does an infection result in % high free PSA numbers?

An
Posted 3/7/2010 2:49 PM (GMT 0)
Hi An,

Your husband's track per psa is similar to mine, and I ended up discovering prostate cancer. My PSA was 1 in 2008. Then it went to 4.3 in March 2009. I went on cipro for 6 weeks to rule out inflammation (prostatitus) and my psa dropped to 2.9. I went off cipro and in August it shot up to 5.6. I had a biopsy in 09/2009 and the core samples hit the tumor. I had a more aggressive form where my gleason score came in at 8. I had surgery (DaVinci) 6 weeks later, and caught it where it was contained. If his score continues to escalate, you'll probably hear to have a biopsy. It takes about 15 minutes and isn't too bad...mild discomfort that goes away quickly. FYI, my prostate was small through all of this, so digital exams and sonogram etc. didn't tell me a thing.
Posted 3/7/2010 2:58 PM (GMT 0)
The velocity test needs to measure PSA changes caused only by prostate cancer. PSA increases caused by prostatitis or BPH are not meaningful in velocity tracking. I would expect that your urologist will seek to reduce the PSA by treating non-cancerous causes as the next step.

As you are learning more about PC, however, you should be aware that one-third to one-half of men at age 50 have some amount of prostate cancer, and that percent increases with age. Not meant to scare you, but that’s just a known fact of life. What is equally important to know is that the PC that most men have at that age is absolutely tiny, only microscopic, and never causes a threat to health. Prostate cancer is most frequently a very slow growing cancer—in contrast to other types of cancer—and so an aggressive treatment may be unnecessary, unwarranted, or inappropriate.

Focus on the possible non-cancerous causes for now…following the AUA “best practices.”
Posted 3/7/2010 4:46 PM (GMT 0)
Tudpock,

Dang I hope this Wife-Going-To-The-Uro trend is not catching on. I, for one, don't want her tagging along for every little thing (especially DREs!!) -- at least not until the Biopsy comes back positive. But that is just Big-Manly-Me. Each couple should talk that over -- don't just assume one way or the other.

An38, the DREs would have been helpful since that would have told the PCP the approximate size of the prostate and from that the Doc could estimate how much PSA is 'normal'. For instance my prostate was well over 100 cc which translated into around PSA 4 or so. Thus my PCP did not start to worry about anything until it went above that (and actually was my more cautious newer PCP who sent me off to the Uro -- lucky for me --sort of).

Good about the Free PSA numbers as everyone has said -- mine flunked at 15% i think it was.
Posted 3/7/2010 5:09 PM (GMT 0)
An

You're getting all the right tips here already.

All I'll add is to reinforce the idea that you get things done in the right order.

Main thing is about what your husband does before he has another PSA test.
Ejacualtion, ie using the prostate before a test, is to be avoided. I think 48 hours without sex is what some recommend.
Also if he is going to have a DRE make sure that that is done after the PSA test too as poking the prostate like that can make the level rise.
Sitting on a saddle, (horse, motorbike, pushbike) will also have a detrimental effect.
And a biospsy will make the PSA level soar, my PSA was taken after a biopsy and it had gone up from 8.6 to 13.6 in about a week! (My second uro basically threw that second set of test results in the bin)
And infections raise the level too, so let any course of antibiotics have time to take effect.

(I wouldn't worry about having my wife around during a DRE. I was having a DRE and some woman from hospital admin walked in looking for someone to give some papers too! And I am pleased to say that I ended up being treated in a different hospital!)

Finally not an easy suggestion to follow, but try to think about the problem and not worry about it.

Alfred
Posted 3/7/2010 5:49 PM (GMT 0)
An,
The following resources will better explain PSA and give you a nymber of questions you should be asking your doctor.
http://www.prostate-cancer.org/pcricms/node/119
An article by Dr Stephen Strum "What every doctor treatng male patients should know"

The YANA website has an excellent article on psa by Terry Hurbert and also shows the normal varieations as Terry took a psa test daily for 30 days and the daily variations were quite significant.

Also my wife was present in the room for all of my 13 biopsies. I found it comforting. She was as much a part of the process as I was.
JohnT
Posted 3/7/2010 9:29 PM (GMT 0)
My husband seems pretty happy that I am going with him to the urologist, especially to ask the questions he may forget. Also to listen.

John the website you sent does help - it seems that based on his high % free PSA what we are looking here is BPH and not infection which would result in a low % PSA. So the first thing is for the doctor to work out what his PSA level should be based on the size of his prostate which is through the DRE or preferably through the transrectal ultrasound. Many of you are also saying the same thing.

Its only at this point we can work out what his PSA numbers should be. The other great tip is the urine test.

All this is making me pretty anxious - a lot more anxious than my husband who instictively has a lot more faith in individaul doctors than me.

Its quite amazing Casey that so many men in their 50s have PS. But I see your point about following guidelines and not overdoing it,

Thanks for your responses. They are tremendously helpful and although it will be very hard I will try to think about the problem and not worry about it as you say Alf. I think it would be easier if this was happening to me and not my husband who I dearly love.
Posted 3/7/2010 11:21 PM (GMT 0)
An 38, as the wife of a prostate cancer survivor, I know well the toll of wondering and worrying can take.

There are some amazingly knowledgeable and supportive people here. Remember, all of us have walked - or are walking - the same path that you and your husband are on. It's good that your husband is not worried - mine wasn't either. I did enough worrying for the both of us!

My husband was also glad I went with him to the urologist for both the biopsy and the consultation after the biopsy came back positive. In fact, the urologist/surgeon specifically told John to bring me when we went back to discuss his diagnosis and treatment options. The doctor's opinion is that women hear things differently and assimilate information far better than most men (not my words, guys!). Also, for your sake, it is good that you will be there to hear first hand what the doctor has to say.

An, stay with us and we will help you get through this. Hopefully, the news will be good, and you'll be able to relax.
Posted 3/7/2010 11:37 PM (GMT 0)
Thank you Ohiostate, yes like you I believe that knowledge is the key and I just ordered the book you suggested online.

And thanks Sephie, you know how I'm feeling.
Posted 3/7/2010 11:46 PM (GMT 0)
I have gotten my almost 83 year old mother to start taking a mini tape recorder with her when she meets with her doctors and specialists, for the same reasons suggest by both Sephie and Ohio above. It's hard to remember every word discussed, and its a nice tool to review with later. I don't do the tape thing, but I always have a list typed out for the doctor to read at the start of a meeting, and I carry my day timer and take serious notes along the way. This past Tuesday, as I was in the pre-op room, ready to be rolled away, I had a neatly typed note in the pocket of the hospital gown with some last minute news/instructions to my surgeon. When he came in to talk to my wife and I, I handed him the note, he read it on the spot, and gave me a thumbs up. I feel that all patients need to be very pro-active on the communication part.

David in sC
Posted 3/8/2010 12:50 AM (GMT 0)
Good info Andrew (OhioState) I never had the whole story on Dr. Fred Lee(good web link you found), but he is a tribute to doing something excellent with his life.
Posted 3/8/2010 1:34 AM (GMT 0)
Hi An,

Per free particles. Mine was very positive at first psa at +25 with a psa of 4.6 approx. After antibiotics for next read and then when I went off antibiotics and psa shot up to 5+, free p's dropped like a rock to around 11, so with myself as an example, not sure I would be relying on that.
Posted 3/8/2010 8:31 AM (GMT 0)
Thank you redman, not relying on anything yet.

I understand there is a risk of cancer even with high %free psa.

At this early stage I think the correct course of action is to do the things we haven't done which is the dre, the transrectal ultrasound to understand the size of his prostate and perhaps the urine test. Any of these may point us to a likelihood of cancer and if this happens we will need to do a biopsy to check. Or maybe our urologist wants to do the biopsy anyway.

With a PSA of 4 there is a chance he has cancer. And if he has it hopefully we have got it in time so he can get sucessful treatment. But I am letting myself hope that things may be OK and that he is lucky enough to be in the group of people with high %psa and no cancer.

An
Posted 3/8/2010 12:28 PM (GMT 0)

An38 said...

With a PSA of 4 there is a chance he has cancer. And if he has it hopefully we have got it in time so he can get sucessful treatment.

An38,

I'm still anticipating that your husband is dealing with non-cancerous causes, either way there is a high likelihood that at age 50+ any man has some microscopic traces of PC.  For most men, these never need to be aggressively "treated"; but unfortunately out of fear they are frequently "overtreated." 

Please do keep these words (from my earlier post) in mind:

... be aware that one-third to one-half of men at age 50 have some amount of prostate cancer, and that percent increases with age. ... What is equally important to know is that the PC that most men have at that age is absolutely tiny, only microscopic, and never causes a threat to health. Prostate cancer is most frequently a very slow growing cancer—in contrast to other types of cancer—and so an aggressive treatment may be unnecessary, unwarranted, or inappropriate.

Prostate cancer is very different that almost all other forms of cancer.  With other forms of cancer, we have been taught to "get it out, fast."  That often may not the best advice for treating prostate cancer.  In fact, lifestyle changes (in diet, exercise, stress reduction, etc) proven to slow the growth of PC, and a commitment to carefully monitor one's health status (through regular PSA testing, which he will do anyhow from now on), may be all many men need to do for their "treatment"...for a long time, if not for the rest of their lives.

 

You are, I believe, following a solid course of action with the urologist follow up.

 

best wishes...


Posted 3/17/2010 2:29 PM (GMT 0)
Hello all,

It is now two days till the visit to the urologist.

I have managed to keep it all together till now and think about it all logically but I am starting to get nervous.

What if his DRE goes badly? What happens if he is one of the unlucky ones to have a high gleason score/low PSA tumour that has flared up?

How I am going to be able to support him if I am a mess? Its is so hard to think of my super fit husband as potentially very ill.

The sad thing is that I am currently going through IVF, I am in the middle of an IVF cycle in fact and this is all getting a bit difficult. What if this results in a baby? And he's sick? I am finding it hard to take it one step at a time as you can see.

An

 

Posted 3/17/2010 9:36 PM (GMT 0)
An,

Every day is a step. You and your husband really need to get your support group in line. This would be friends, family, anyone who will listen and care. The caregiver needs care and the troops need to rally.

Face to face contact with the real world, as well as this or other online communities. What stands out to me is the fact that your husband is "super healthy" and that suggests to me that he will have positive outcomes whatever course of action needs to be taken. This is positive.

Keep active with things that take your mind off of stuff. Read (or write) a book, draw a picture, watch (or make) a movie. Keep your mind active and get out of the house for a walk or other activity.

And a baby? Just the miracle you've been waiting and hoping for! Focus on the positive. As other have mentioned and written, PCa does not automatically mean a death sentence. Sort of a detour in the road of life.

Keep us posted.

Best wishes.
Posted 3/18/2010 11:18 AM (GMT 0)
Oh An, I am sorry that you're doing through such a difficult time.

There are always "what ifs" no matter the situation...and for me one of the hardest things to learn was that there are simply some things we have no control over.

Cancer is a scary word. I don't care what form of cancer it is, once it touches your life, things change. But, you don't know yet that your husband has prostate cancer. I know it's hard - believe me I know - but right now, just focus on putting one foot in front of the other.

Should your husband be diagnosed with PCa, even a high Gleason score, this doesn't mean that your husband is "sick."

As I've stated before, my gut tells me that everything will work out. Stay with us - we're here to help you through this challenging time.
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