Lower 40s with PSA > 4

I'm 42 with no family history of early prostate cancer although my dad at age 80 does have PC with a Gleason of 9 (his dr has told him he'll likely die of something else after he was seeded earlier this year.)

I pushed my GP into testing for PSA during an annual physical so that I could get a marker for future reference. I say pushed because he was very reluctant to do anything until I was 50 this despite the fact I had expressed to him that I was having urinary flow and frequency issues with some very mild infrequent ED which I had attributed to be more mental than anything.

I've always had issues at some level. I don't remember a time as an adult over 21 where I hadn't been getting up at least 1 - 3 times some nights to urinate and I've never had what I'd call a strong urinary stream unless I was drinking a lot of alcohol. I figured the increase in issues was related to getting older, less physically active and about 40 pounds heavier than I was 5 years ago.

My first PSA was taken 4/12/2010 and came in at 3.78. My GP never reviewed the results and contacted me. I figured everything was fine since I was usually only notified of other tests such as Cholesterol when there was an issue. I called and left a message 3 weeks later and got a call from the nurse early the next morning apologizing for the mistake and to let me know I should go on Cipro for 2 weeks and retest a few weeks after the final dose.

On 6/10/2010 my PSA came in at 4.86 which after reading forums such as these alarmed me due to the large increase in just two months time. I was sent to Urology but due to the Dr's busy schedule was seen by a Nurse Practitioner who apparently did most of initial consultations and DREs. Her conclusion after the DRE was that my prostate was enlarged yet soft with no sign of nodules and as she put it likely prostatitis. What was strange about her DRE was that it was very comfortable as if she wasn't even there. She ordered 4 weeks of Cipro and asked that I get retested immediately after completion.

On 7/19/2010 my PSA came in at 4.40 which while better than the previous isn't apparently what Urology had hoped for ( they wanted it to go to 0.x). This time I saw the Dr who performed a very uncomfortable DRE. His observation was that the prostate was normal in feel and size. He commented that because of my age and lack of family history with early prostate cancer I shouldn't have even been in his office until after I was 50. Yet here I was due to pushing for the PSA test and as it turns out my numbers are not in line with what is considered normal. His recommendation was to have a 10 core biopsy performed.

I cannot make rhyme or reason of the numbers since they are not steadily rising numbers that have been discussed as being related to PC. After reading articles such as the one New York Times one written by the individual who discovered PSA I wonder if I've done myself a disservice by pushing to get tested in the first place. I had no idea at the time that there was this debate occurring and was only looking for an indicator for future reference given my Dad's history along with a possible explanation for some of the symptoms I was having. To think that at age 42 I'd potentially have PC is still a bit shocking. I'm leaning towards getting the biopsy done but there is still that side of me that just wants to bury my head in the sand and wait it out.

That is my story and now I'd like to ask some questions regarding my current issues. The one that is creeping up the most lately is an urgency to urinate, especially while seated, even after relieving myself. The urgency feels a bit like a burning sensation about an inch to inch and a half in length starting at the tip of the penis and then back towards the groin. When I do relieve myself it is small quantities at a time and it almost feels as if some didn't fully come out and is now trapped in limbo. It sort of feels like the time I had what was likely a kidney stone 10 years ago and it took medication at that time to dull the pain. Some days I have this feeling and other days I do not. I was drinking at least 1 - 2 cokes a day for quite awhile and did have some last night. I'm wondering if caffeine could have this effect 12 hours after consuming it. It is this feeling that drives up the frequency. There are times during the day when I can go for hours upon end without urinating. One more comment. I have also noticed that since taking the Cipro the very mild ED problem I described hasn't really returned.

Thanks for reading.

I'm not so sure a biospy is not a good idea given your age. It might put your mind to rest and/or give you a more complete picture of what is taking place. Then you can go about your business one way or the other other with AS or Tx. or just enjoying the heck out of life without worrying about this. Keep us posted.
Michael

I agree with Goodlife you need to get a urologist who can spend time with you -- one who has the time and inclination to answer your questions fully. If you tell us where you are located, someone on this board may be able to recommend someone.

Your psa is very high for your age. I am 46, my psa is 1.5 or 1.6 (different assays), and that is within the top few percent of PSAs for my age. So - while your elevated psa does not necessarily mean you have prostate cancer - I would not ignore it, and I certainly would not bemoan the fact that you got tested. You did a smart thing and there is at least some chance that, by doing so, you saved and/or improved the future quality of your life.

I am not a medical professional, so take my advice (and all advice here) as just some things to discuss with your doctors, but these are my thoughts: Get a free psa test and see what the "free psa percentage" is. The higher, the better. Do not ejaculate within 48 hours before your psa or free psa test. Do not let a doctor give you a DRE prior to your psa test, since manipulation of the prostate can affect the psa reading. Consider getting a PCA3 test, another test that can provide information about the odds that you have prostate cancer. If your urologist has no idea what a PCA3 test is, or is unable or unwilling to discuss with you why this test is or is not a good idea, get another urologist. Unless both your free psa percentage and your PCA3 results indicate a very low chance of prostate cancer, get the biopsy. (Some would say get the biopsy anyway, and that would not be irrational). If doctor wants to do 10 core biopsy, ask him why not 12 cores or more. Ask doctor what he does to minimize discomfort during the biopsy. Also ask your doc whether there would be value to doing an endorectal coil MRI of the prostate with contrast enhancement, or a color doppler. These can sometimes identify problem areas in the prostate. Also ask about an MRI-guided biopsy. Your doctor should be knowledgeable about these things and able and willing to give you advice about them. I am not saying you need all this, but I would be asking about it.

Best wishes - I hope this turns out to be a false alarm for you.

Medved

Medved is giving you some good advice, get a free PSA and a PCA3 test and if they are abnormal then by all means get a biopsy, at least a 12 core.
JT

I agree with what have been said. A biopsy is the right thing to do. My son who is 43 has a PSA of less than 1.0. Yours is too high for your age. A biopsy should provide the answer. Good luck.

Thanks to all that have replied. I'm going to go ahead and get the biopsy if nothing more than to continue searching to the solution to my discomfort. Today has been a bad day as far as that is concerned, perhaps stress has something to do with it.

Some of you mentioned Free PSA and despite me bring it up the Urologist and GP thought it wasn't really necessary. I'm not sure why they will only do a 10 core biopsy but figure insurance and cost must be a part of it.

There were also comments about the types of things that could elevate PSA just before a test. DREs were always after the PSA draw and I refrained from ejaculation for the prescribed amount of time.

I was under the impression that PSA like many things are all relative to the patient so what might be normal for one person, lets say a 1.0, might be high for another. My family is very prone to swelling and I frequently have swelling issues myself. Hopefully my elevated PSA is a reflection of that.

As of now I'm scheduled for mid August and once the results are back I'll seek out alternative opinions.

Will keep you updated.

Sorry to hear about your mother. I lost my father last month but it was not from cancer. From my perspective, given the hx of cancer in the family, it would just be another reason why I would want a biopsy if the PSA remains elelvated. But keep us posted and hope this is just a false alarm.

Michael

You have not been diagnosed with PC yet..But you should read this book. "A Guide to surviving prostate cancer" by Dr. Patrick Walsh.

With the knowledge gained, you will be able to have an intelligent conversation with your doctors..

Your SYMPTOMS sound like infection. Take a look at my history..

Hi

I just wanted to add that I was in a very similar situation at 42 (four years ago), PSA close to 4, and my uro worried about it. The stats do not necessarily mean cancer, but cancer is a possibility especially if the PSA is going up and you have an urge tom urinate, so a biopsy is in order. If it is cancer, it can be cured with high probability by surgery or radiation with those numbers.

Although I am not a doctor, I don't think there is a sound basis for declining a patient's request for an fpsa test in your situation.  I also do not believe there is a good basis for doing a 10 core biopsy, rather than 12 (or more) cores.  I do not believe that has anything to do with the cost or insurance requirements.  I would at least consider consulting with a different urologist.

 

tivmod1 said...That is my story and now I'd like to ask some questions regarding my current issues. The one that is creeping up the most lately is an urgency to urinate, especially while seated, even after relieving myself.

Having been diagnosed with low risk PCa recently I also experienced some of these urination issues a few years before Dx. I may be wrong, but I believe your numbers do not indicate these symptoms are from PCa. They are probably from BPH, a less severe problem. Unfortunately that's not to say you don't have PCa. Either way FlowMax can help with this.

If you WANT a biopsy then ask for a 32 core biopsy. It will provide the most complete "look" at the little guy. If my biopsy had been a 10 or 12 core one, it may not have caught my cancer. If I were you I would be proactive and change my diet now. Good luck buddy...

Sorry been away for a few days trying to forget about this for awhile Had some nasty urinary issues last Friday. Had the sensation to go again immediately after going and had difficulty getting it out no matter how much I drank. It cleared up to some extent a few days later but then returned yesterday but not nearly as bad. I am guessing worst of it was due to very painful DRE and subsequent swelling. I've also been constipated from time to time and I'm guessing that is adding pressure.

Someone mentioned that my father's small cell carcinoma could have been from the prostate. I suppose that is true but it is very rare and Mayo (where analysis was done) indicated it was of unknown origin. They checked everywhere and could never find the source.

I appreciate all the support and it is good to hear from others my own age who are in the same predicament. I still want to believe that I'm dealing with a nasty infection along with BPH if such a thing is possible. You'd think if I had PCa it would be advanced due to the rapid jump in PSA, symptoms I'm experiencing and age. If true it would be a cruel joke after losing my mother to ovarian last August. The ups and downs of that experience are still too fresh in my mind.

And I hear you all regarding my urologist and the question of why 10 cores, why no free PSA test etc.. etc.. To be fair he may be a stellar doctor who is making all the right choices given the circumstances.

Here is an update. My 10 core biopsy shows a mild case of prostatitis. In addition one core from left side showed a less than 5% atypical gland (?) which was being sent to Mayo Clinic for further analysis. She categorized the results as negative but of course we have to wait and see what Mayo says.

If Mayo comes back and just says it is inconclusive or atypical I'm not really sure how to take that news. Based on comments from my doctor I imagine he is going to want a repeat in 6 months to focus on that area. Given my age, the fact that I do have prostatitis, the fact that this is less than 5%, I'm more inclined to forgo additional biopsies and just watch the PSA.

On a positive note all of my symptoms have been much better after a few weeks off Cipro. The pains I was feeling are gone and I'm starting to think a result of taking Cipro for 44 out of 60 days. Of course I'm back on the Cipro now but for awhile there things were working very well in the urinary department etc... I also drink many more clear liquids and try and space them throughout the day. And while I get up at night to still go it is in very large quantities, not like I'm struggling at all. The ultrasound revealed that I was emptying my bladder so it may just be that I drink too much.