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Young man with high PSA

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Posted 1/15/2011 8:50 PM (GMT 0)
Hi, guys
My own PSA remains 0, 15 months after DaVinci surgery. However, my nephew, 40 years old, just had a PSA test and it came back at 11! He saw a urologist who felt nodules on the prostate and has put him on antibiotics for a couple of weeks before repeating the PSA. He doesn't have symptoms of prostatitis, so PC is a real concern, but at his age it would be very unusual. Has anyone else had a PSA this high, without many symptoms, and been found to not have PC?
Posted 1/15/2011 9:01 PM (GMT 0)
In reading Walsh's book, I got the clear message that PSA is to be considered only a part of the puzzle. He cites patients with below-average PSA who have aggressive cancer, and very elevated PSA with no cancer.

I would wait for the antibiotics to kick in, and the next PSA.

Posted 1/16/2011 12:43 AM (GMT 0)
I had no symptoms, negative DREs, no record of PCa in the family. But my first PSA (age 56) was 17. Of course prostatitis was assumed and antibiotics started but my PSA continued to climb faster than the national debt.
The biopsy confirmed what we already knew.

From what I have seen here there were very few lucky guys who had numbers that high and did not have PCa. Another PSA and a biopsy is in his future.

Jeff
Posted 1/16/2011 1:00 AM (GMT 0)
I have a friend who has a PSA of 16. Had a 24 sample biopsy, no PC.

But, I also know a guy whose PSA was 4 and had aggressive PC (that would be me.)

So, by itself, the PSA doesn't mean much. Sounds like a biopsy. My hope is that your nephew is like my friend.
Posted 1/16/2011 1:07 AM (GMT 0)
My first PSA test at the age of 44 was near 19.8...Unfortunately it was advanced disease. But in my observations over the last four years as a survivor I have learned that these younger guys can do well. I'm in that category and for that I am very thankful.

Tony
Posted 1/16/2011 1:59 AM (GMT 0)
The nodules would be more of a concern than the high psa. These are two red flags. At the very least I would get another psa test after the antibiotics and definately another DRE to verify the nodules.
JT
Posted 1/16/2011 3:22 AM (GMT 0)
I must agree. No symptoms here only PSA jump. Not unheard of to be young and have PCa. The PSA is only a red flag that something is not just right. The 2 nodules are much more concerning to me. Do keep us posted.

Cajun jeff
Posted 1/16/2011 3:35 AM (GMT 0)
I am 45 - my PSA was 10 on my first blood test - and had advanced PC. My Brother is 38 and his PSA was 6 and has PC. Neither of us had any symptoms and no detectable issues from the DRE.

Best of luck to your nephew. Being young really works on his side for things like incontinence should it come to surgery.
Posted 1/16/2011 8:59 AM (GMT 0)
Nodules felt during a DRE can be calcium build ups and are harmless. But antibiotics for a couple of weeks – another PSA then it’ll probably be biopsy time.
Posted 1/16/2011 1:25 PM (GMT 0)
Thanks for all the responses. I'll post when the results of the next PSA and/or biopsy are known.

It's been a few years since I went through the decision process and I'm trying to recall, in the case he has PC, what is the best course of action for a younger man. In my case I was in my mid-60s, so cancer control was most important, followed by continence, then potency. I'm sure that priority doesn't change with age, but potency and continence are of greater concern. Is there a shift towards or away from any particular treatment method for younger patients?
Posted 1/16/2011 9:08 PM (GMT 0)
i was mid 40's. There was unanimous agreement among the five surgeons i saw, that surgery at my age was the best way to go. Even talked to a radiologist who talked me out of radiation at that young age. He said, they can kill this cancer dead. But, I had the genetic markers, had the lifestyle already for 45 years, and the chances are another entirely new batch of cancer would show up in the next 40 years - not a reccurance. And the treatment for that second cancer? It has not been invented yet.
The treatment for younger guys is usually different thinking than for the older guys. chances of his recovery of sex and continence are really pretty good. Have him email me.
Paul
Posted 1/17/2011 1:43 AM (GMT 0)
Thanks, Paul. For men still interested in children, can the sperm be frozen prior to surgery for future use?
Posted 1/17/2011 4:53 AM (GMT 0)

Reachout,   Yes to answer you question.. If you have any thoughts of wanting children in the future.  By all means make a deposit for future use.  People do it all the time. 

That is a great questions and hope this answer helps.

Cajun Jeff

Posted 1/17/2011 5:50 AM (GMT 0)
My advise for anyone with a PSA above the norm, watch it close, don't take chances it not worth and the pain and suffering.

NED +2.5 (no evidence of disease)

HIFU 2 1/2 years ago PSA .03 / Gleason (4+4)

Dave
Posted 1/17/2011 10:22 AM (GMT 0)
HI reachout, i was found to have advanced pc last year no symptons and fit as can be at 44 yrs old.My psa was 144,from the research that i did i concluded that psa over 10 is a likely hood of pc BUT!!! not certain by along way which takes us to the only place that will give any true results and that is the BIOPSY ROOM.
If it were me id have the biopsy to find out for sure.
Posted 1/17/2011 2:45 PM (GMT 0)
I had no problems just had my PSA checked at the age of 40 as a base line check and found it to be 2.6 repeated next two years till this past year when reached a 4.0 then biopsy and RRP! I know someone who found a high PSA and then Pca at the age of 34! I wish I had been more agressive and had the surgery back when I was 40 than to wait till 44....
Posted 1/24/2011 2:43 PM (GMT 0)
Well, what about this? After two weeks on antibiotics his PSA dropped from 11 to 1.6! That certainly indicates an infection as being the cause of this high PSA, but the urologist also felt numerous small nodules on the prostate. Hopefully the nodules are also the result of infection. He had an ultrasound, and has a return visit to the uro in a couple of days. We'll see but I think the drop in PSA is very promising!
Posted 1/24/2011 3:58 PM (GMT 0)
Thats good news with the PSA drop!!! just needs to keep an eye on it.
Posted 1/27/2011 3:41 PM (GMT 0)
After another visit with the urologist, he said the ultrasound looked fine and he couldn't find any nodules. So it's just another PSA in 6 months to double check. After all the bad news on this board, it's good to hear of a good news case. This is also a good example for those who think a high PSA is a direct route to PC and its treatment.
Posted 1/27/2011 3:51 PM (GMT 0)
Further tests you might do for the 40 yr. old mentioned:

fPsa ('free unbound antigen testing)- check the percentages levels
PCA3 urine detection test for PCa (considered fairly accurate)
Color doppler ultrasound imaging (Dr. Bahn, Lee et al....some are masters on using this)
Maybe monthly walkin psa testings somewhere for further comparison as to velocity
PaP and Prylinks testings (some oncologists use these, may find nothing in your case)

Hey if the glove don't fit you gotta acquit...maybe others can look at this list, in case it is not that useful in his case.


Word (LOL)

Posted 1/27/2011 9:09 PM (GMT 0)
Good news! It is nice to find a new visitor who doesn't need us as badly as feared.

Report in on that next PSA.

Posted 2/13/2011 4:08 AM (GMT 0)
Hi everyone - here's my story, slowly unfolding   50 yrs old just received a 12.76 PSA with DRE results smooth and firm - I've been referred to a urologist Feb 23rd.   I did a LOT of reading and well...I'm pretty much completely terrified but with a first-time 12.76 PSA who wouldn't be. I'm having trouble emotionally dealing with this avalanche.   Younger patients (me) apparently tend (quite often?) to have more aggressive PC. My doctor ordered a second PSA and also a fPSA (1st PSA & 2nd PSA are about 2 weeks apart).   The whole ordeal unfolds kind of slow with a HMO - Clearly the urologist will do another DRE and order a biopsy.   I'll get a Gleason score, all the data will be run through the Partin table and then sometime after that my Prostate will be in a jar ( if I'm lucky enough to be a candidate for surgery).   Like a most guys I'm willing to live with the likely (almost certain) unfortunate side effects - my concern is purely longevity.   Baring divine intervention (a possibility I never discount) this is my likely future.   So my questions are: I'm still trying to sort out the efficacy of radiation/chemo options and whether they should/could be done before or after the prostate is removed?   I read one article saying efficacy of radiation/chemo after removal was suboptimal but isn't that what salvage treatment is?   I read another article stating that is was statistically beneficial to have the prostate removed even if the PC is locally (locally confined means outside but near the prostate?) but I don't know - it was one study.   The higher higher the PCA (assuming PC) the more aggressive the cancer?
Posted 2/13/2011 4:35 AM (GMT 0)
Hi K2, and welcome to the forum.

I think you are jumping the gun a little. While it's possible you have PCa, maybe even probable, it's by no means certain. It may be just an infection and not necessarily one that has obvious symptoms.

For your next PSA test, make sure you abstain from sex and bike riding for two days beforehand, and also make sure you have the blood draw before the DRE and not the other way round. Surprisingly some docs don't do this.

Generally higher PSAs mean more serious cancer, but not always so. Gleason 8-10s may not generate much PSA -- for example I was a Gleason 9 at biopsy but with a PSA of only 5.7.

As far as treatment options are concerned, from what we know so far, all options are open to you. The actual treatment you receive will be very much determined by your next PSA and biopsy. Good luck -- lets hope this is a false alarm and we never see you here again :-)
Posted 2/13/2011 7:17 AM (GMT 0)

Jerry L. said...
I have a friend who has a PSA of 16. Had a 24 sample biopsy, no PC.

But, I also know a guy whose PSA was 4 and had aggressive PC (that would be me.)

So, by itself, the PSA doesn't mean much. Sounds like a biopsy. My hope is that your nephew is like my friend.

And that's the problem Jerry. The higher grade cells a tumour contains the less PSA they produce per CC of tumour. For example a normal prostate of volume 40cc should produce a PSA reading of 40x0.066 ng/mL i.e. 2.64. As the Gleason grade increases (ie aggressiveness) the yield of PSA per CC decreases. Grade 3 tumour cells will produce about 4ng/cc while grade 4 will yield 2ng/cc and grade 5 yield 1ng/cc. So a prostate of 45cc with 40cc normal tissue and 5cc of Gleason 6 may show a PSA of (2.64+{5x4}=22.64). Jump up to Gleason 8 and it changes to (2.64+{5x2}=12.64 while going to Gleason 10, it becomes (2.64+{5x1}=7.64. Gleason 7 and 9 yields approximately 3 ng/cc and 1.5cc/cc respectively.
Bill
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