Age 40 PSA 12.7 DRE smooth

I am a healthy fit person, age 40, exercise 3 times a week, drink 4-5 cups of coffee and a glass or two of wine every day. Love extremely spicy food. No family history of prostate cancer, although many of my uncles/father all have BPH.

After a routine annual exam, I was shocked to find my PSA level to be 12.6. My doctor put me on Cipro for two weeks, then I saw an urologist. DRE was smooth although larger than normal for a person of my age. The second PSA came back to be 12.7. He recommended biopsy this Friday.

I read in an article that the second PSA should be taken 4-6 weeks after the first one. Mine was taken only two weeks after the first one. Is this still the recommended practice? Should I wait 4 more weeks for another PSA test?

I also read somewhere that physically agitating an organ (poking needles into prostate), can sometimes lead to the development/spreading of cancer.

Should I go ahead and do the biopsy? Shouldn't I rule out that the high PSA level is not caused by prostatitis or BPH first?

I am currently leaning on NOT doing the biopsy this Friday. I plan to wait another 4 weeks and do another PSA test. If the level is still high, I will consider doing the biopsy. In the mean time, what's the procedure for ruling out prostatitis and BPH?

Not sure if this is a right way to go. This sudden shock of finding I have high PSA is clouding my judgement. I am interested to hear your story. Thanks for your advice.

Speaking as one from the other side of the coin If I had the chamce to be one of the lucky guys here who found out early and are now for all purposes cured, I would be at the doctor before they open waiting for him to unlock the door. David g has it all. Sex drive continence function. I was diagnosed at 42. It is no small wonder that I am still here. I have no sex drive, marginal function, and my only hope is that another treatment is developed before the last one quits working. Advanced disease is not the place you want to be. If you don't have cancer there is nothing to spread. Do yourself a favor. Don't screw around with prostate cancer. Todd

NY1071,

You are the same age of my son. My husband is 53 and newly DX read stats below.
There is a formula for % of cancer within your age group Vs.PSA. We were told given my husbands age with a PSA at of 5.5 he had a 25% chance of having PC.

Don't want to alarm you, however if your Dr. recommends a biopsy run don't walk, as this is the only wat to rule out PC.

Find out the results then if necessary, make a decision after careful investigating. Visit HW often as others here are traveling down this possible path and will be here for support.

Good Luck and please keep posting

BOOGEE

I'm with John T, get a Free PSA test. It is more reliable than PSA, though not perfect by any means, and another indicator. Whether the results say likely or unlikely on the cancer, you and your Uro have to decide if the biopsy is warranted. It is not that bad of a procedure, and there is a low risk of infection (though I scored it and spent 3 days in the hospital).

What was your PSA last year. The rate of change could have some indication as well.

In any case, even if it is Prostate cancer, you have time. You don't have to rush to the biopsy table. Giving it a month is not an issue. If it is PCa, you also have time to decide on treatment.

Pick up a copy of Dr. Walsh's Guide to Surviving Prostate Cancer. That book will educate you quite well on all that you may be dealing with before biopsy, and if it is cancer, all the options and what it all means. It is the bible and well worth reading for any man with question about prostate disease.

NY1971,

I would be a strong proponent recommending you have a biopsy. Don't gambe with this, it is just not worth the risk.

The biopsy will give you all of the pertinent information you require to make an informed decsion on your next step.

i was sedated for my biopsy. really no pain at all and recovery was a matter of hours. drove to work the next morning. in the end the most annoying thing about the biopsy was being told to move and direct my bare ass in the direction of the doctor and two nurses. a few seconds later i was out.

You might want to check if the second test was already run with Free PSA % - an efficient doctor may have ordered that, given what your first test number was, but if they don't mention it and you don't ask, you won't know until you ask. They may have run it, seen it, and suggested the biopsy in part based on that.

Biopsy spreading cancer is pure mythology. Biopsy is the only way to be certain about cancer. At your age, a normal number is far below where you are. If your doctor thinks a biopsy is warranted, get the biopsy. Waiting is NOT your friend - you'll notice most of the official literature is all about how it's a disease that mostly shows up in men over 65, and you'll notice that you are 25 years younger than that - many of the other generalizations won't apply either, IMHO.

The thought of the biopsy procedure can be scary, but most guys find it to be uncomfortable, but really not painful.  There are exceptions to that, though.  My older brother has had three biopsies (they've never found cancer), and he says his were extremely painful.

I asked my uro about my brother's painful experiences, and he said that there is no reason a biopsy should be painful and promised mine would not be.  He was right.  I rated it  .5 on a scale of 1-10 in terms of pain.

But, if you're worried about pain, I would ask the uro point blank whether his patients find his procedure painful.  I would ask him exactly what he does to anesthetize the area prior to the procedure. 

A friend of mine at work just had a biopsy and was back at work the next day.  His  uro included both a local anesthetic and also a light anesthetic, similar to what they use during a colonoscopy, and he felt fine.

For your well-being, I hope you have the biopsy and get cancer ruled in or out.  I think you'll actually have greater peace of mind knowing your situation than you do now worrying about it.  Good luck.

Thank you every one for your support and advice. I am really grateful to be on this forum in my time of personal crisis.

Fact: This is my first PSA test done in a routine annual check up, so no previous value to compare with. No free PSA test was done. No PCA3 was done.

As of last night, I was so convinced that I'll delay the biopsy that I told a friend that I am 99.99% sure. Then, I told my doctor about my decision and he just chewed me out mercilessly...probably for my own good. Now I am wavering. Here is my thinking,

Reasons for delaying biopsy,
Pro: PSA level fluctuates, could be prostatitis, a delay of 4 weeks won't hurt even if it is really cancer, have time to do free PSA and PCA3 tests
Con: why delay the inevitable, unlikely the PSA level will drop significantly to not warrant a biopsy, the anxiety of waiting and unknown

Reasons for doing biopsy right away,
Pro: Find out for certain and deal with it swiftly, why wait
Con: could maybe perhaps accelerate/spread cancer

My biggest fear about biopsy is not if it is uncomfortable or painful. I am afraid that it will cause cancer or spread it years down the road. I know this theory has not been proven clinically, but there are evidences supporting this in certain types of cancer and conditions in animal models.

Am I being objective? Am I irrational? Or, am I using the biopsy-cancer-link as an excuse? I question my judgment constantly. I don’t really trust myself anymore. I think I am still in denial, perhaps angry.

I am leaning toward getting the biopsy as scheduled this Friday…as of now…almost as certain as I was about NOT getting a biopsy…last night.

Oh, I am so torn. And this is just a decision to get a biopsy. I don’t know how I will deal with it if it turns out to be malignant.

One step at a time my friend. You do what you have to do. Early detection is key to cure.

NY1971: Ok, like others have said, " if you don't have cancer, there is nothing to spread".  If other tests (free PSA and PCA3 tests) come back suspicious, then you will certainly have to have the biopsy. This is how your dr. will present your options for treatment since much will be based on the results of the biopsy. I too worried very slightly about the biopsy "spreading cancer". But don't forget, leaving it there to be fed by your blood supply and interacting with all of the "plumbing" and nerves gives it a real chance to migrate.   No one is saying that you have prostate cancer, but your numbers are suspicious. If you are really against the biopsy for now, you must at least go for a free PSA and PCA3 test NOW. This will give you more information. I think what you are experiencing is the same we all have. Anger & denial are all ways of dealing with hard parts of life.

I will be honest, you seem to be the same "type" of person that I am based on what you say in your second post. As my dr. said "let's find out for sure and go for the biopsy". Mind you my PSA was 3.3. I immediately agreed and it was caught in time with robotic surgery. I had immediate urinary control. After 8 months, my natural erections are coming back and it was like it never even happened!  You say that you don't know how you will deal with it.......I am sure that we all said the same (I did). But even if it does turn out to be cancer, your dr. knows exactly how to deal with it.  Put your trust in him. Put your trust in your faith  (if applicable).

You will get thru this either way.....everyone on this forum has been where you are now! We are here for you!

Bill from New Jersey

 

I was in the same boat as you just a few months ago.
40 no family history,eat well, don't drink much more than a glass of wine at night, a few cups of coffee in morning.My psa was high, took antibiotics, took another test still high, first biopsy neg w pin.Uro suggested a second biopsy that one came back 1 spot cancer less than 5%.
The surgeon I chose had me do a pca3, and a endorectal 3tmri with hopes of postponing surgery till it was time.The mri came back with a spot that biopsies didn't hit, pca3 came back at 75.
I was advised that it should be taken care of and I scheduled surgery for march 1st.The cancer was more involved than first thought, but still contained to the prostate, and so far so good.
I would suggest get a pca3, if you can get a color guided biopsy,this way they get a much more detailed picture and you may not need to go for a second if the first comes back neg.Your high psa for our age will be an issue if it doesn't come down, and they will want to investigate further.
The biopsies do suck, not that painful, just a little gross after for a while.
I also live in NY, I had my robotic surgery in the city, great hospital,great surgeon, and a great urology dept if you should ever need just ask.
My surgeon told me that out of the 4 surgeries he did my day 3 were under 50.

Thank you everyone again for the support. Your advice and suggestions have helped me greatly to reach my decision. I am surprised to see many young people here like me. Most research on Pca are done with older populations, so I am getting a lot of conflicting advice. C.a.c, which hospital did you go to?

Anyway, I went back and checked my record. I actually had 3 and half weeks between the two PSA tests and had 2-week Cipro (12.64 and 12.73 respectively). Since my PSA level is so high, I most likely will need to do biopsy regardless of the results from free-PSA and PCA3. So, I will go ahead and do the biopsy tomorrow.

Another reason to do it tomorrow rather than wait is that I can't stand the anxiety of not knowing any longer. I have already convinced myself of the worst and it has depressed me. I need to be strong and find out what I have...whatever it may be.

Please continue to give me your support and advice, I find them to be extremely valuable.