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Prostate Cancer
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Posted 8/18/2011 3:55 PM (GMT 0)
I am 37,have been having urinary issues for about 4 years,problems include weak stream,spraying,dribbling,have had bad back pain for about last 2 month,all symptoms are not every day,sometimes its perfectly fine. I went to urologist 3 years ago when it started,was told prostitius(sp?) given antibiotics,everything went back to normal,psa was 1.0 3 years ago. Symtomps returned within months,went back,psa 1.0 again,given ct scan(clear),cystocopy(normal),given more antibiotics. let it go,wasnt going to obsess. Now 3 years later still having symptoms,went in for full pysical with my regular doctor,psa 4.2. Sent me to uro,all DRE fine. Retook psa test and levels 1.66 and free psa of 15,had another ct scan(all clear). My doc says free psa score means nothing when psa score is only 1.66, is this true? She is not seeing me again for 3 months and will take psa again,i am going nuts,everything i read says 15 free psa score is not good,she says it is not used based on 1.66 psa score and that I do not have cancer,in her opionin.
Posted 8/18/2011 4:34 PM (GMT 0)
Htown,

Not all prostate cancer manifests itself with a high PSA value. If your are really bugged by all of this ask for a biopsy. That is pretty much the best way to find out but even with a biopsy cancer can be missed if it is small. I have a friend who'e PSA has bounced around from 3 to 7 fo years and he has had four biopsies and nothing has been found.

Have you talked to some other doctors about what else may be causing the symptoms? Get a full blood work up and urinalysis if you have not done so.

Hope you find that all is well.

Don

Posted 8/18/2011 4:39 PM (GMT 0)
Hi there!

I am no doctor, so I am not qualified to give medical advice. However, what you are describing does not sound to me like prostate cancer at all. Prostate cancer at your age is extremely rare. Your symptoms do not match prostate cancer,which mostly does not cause any symptoms early on. Finally, in prostate cancer PSA keeps increasing, not bouncing around.

Cheers.
Posted 8/18/2011 5:28 PM (GMT 0)
Inflammation of the prostate will cause a rise in Psa. You may have chronic prostatitis. If pain persists, or urinary stream gets messed up, go back to doctor. If you aren't satisfied with doctor's treatment, get another opinion.

Just relax a little, and don't be afraid to see another doctor, preferably at a well known medical center.

Good luck. Welcome to HW.
Posted 8/18/2011 6:16 PM (GMT 0)
I have had full blood work done,only thing found was my "good" colestrol was low,also my main questionfor the forum is my doctor(uro) and family doc BOTH say that your free psa test is NOT ACCURATE when your regular PSA reading is below 4(some say 2.5) so they say the 15 is nothing to worry about. Everything I read says 15 is bad
Posted 8/18/2011 6:29 PM (GMT 0)
Although I am not a doctor, and am not qualified to give medical advice, my understanding is that the free psa test has not been validated as having diagnostic significance where the total psa is lower than 2.5. Just based on what you have written (and keeping in mind that I am a layman), I would suspect prostatitis.
Posted 8/18/2011 6:33 PM (GMT 0)
I agree with the sentiments of the others posters here, but of course, as state, none of us are qualified to know one way or the other in your case. If it really bothers you enough, you could see if a urologist would order a prostate biopsy, but even then, you might not get a definitive answer, in my case, it took 3 biopsies spread over 15 months to confirm my cancer, by then, my PSA was above 16 and I had no signs of any infections. Sounds like a second opinion, at least, is in order at this point. At your age, while not impossible to have PC, it would be unlikely.

David in SC
Posted 8/18/2011 7:07 PM (GMT 0)
Get Dr. Patrick Walsh's Guide To Surviving Prostate Cancer. Page 147 talks about Bound and Free PSA. Page 148 says: "The higher the free PSA, the more likely that you are free of cancer. Men with prostate cancer are more likely to have low levels of free PSA.....
If the percent-free PSA is lower than 15 percent, a man islikely to be harboring more tumor than a man with a higher level of free PSA."

My husband's free psa ranged from 10-13% and his psa was between 2.4 - 5.1. The nurse at the urologists office said that they would like the free psa to be above 18%.

Dr. Walsh's guide says on page 149 that "some urologists, guided by free PSA measurements, recommend biopsy only when the percentage of free to total PSA is lower than 25 percent. It may come down to what bothers you most - the thought of missing cancer at the earliest possible diagnosis or having an uncessesary biopsy because of a false alarm."

My husband's first urologist said that the PSA is a fuzzy test. Sometimes a further test, the free vs. bound PSA test is needed.

I would say get the biopsy.

Post Edited (I use to be a fish) : 8/18/2011 5:16:45 PM (GMT-6)

Posted 8/18/2011 9:34 PM (GMT 0)
 ((My doc says free psa score means nothing

    when psa score is only 1.66, is this true?))

Yes

Posted 8/19/2011 8:46 PM (GMT 0)
Free PSA was meaniful for me at PSA levels below 4.

I was sent for a biopsy when PSA was 3.48 and Free PSA was 10%. Cancer was found is 3 of 10 cores (G6). Went on AS and in a year had a follow up PSA which found more cancer (G7). Had RP surgery and 6 months out all is good.

Had I waited for PSA to rise above 4 (while having low Free PSA) to go for a biopsy I could have missed the progression to G7.

Posted 8/19/2011 9:02 PM (GMT 0)
Correction - I had a follow up biopsy in a year that found more cancer (G7)
Posted 8/20/2011 1:40 PM (GMT 0)
It is common practice to use a PSA of 4.0 as the threshold.

We all know, and studies suggest, that it is possibly too high and should be lowered to 3-3.5.

Same is true with free psa. I have read studies that suggest a free psa should be valid

with PSA's as low as 2-2.5.  In either case your below that.

Posted 8/20/2011 2:48 PM (GMT 0)
The advice above is spot on. Did your uro mention any other treatments to address your original problems? If the antibiotics are not addressing these, has he mentioned any type of meds or surgerical procedures to widen your urethra. Google 'BPH treaments' for some options. Dont ever be afraid to get a second opinion, its the smart thing to do.
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