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Posted 12/17/2012 10:15 PM (GMT 0)
Hello!  I have had an interesting experience over the past year and have been lurking on the forum to educate myself as I've been going through testing on my prostate.  This forum has been very helpful but I am now at the point where I could use some advice from people who have been through this before. 

October of 2011 I went to my doctor because of a problem with frequent urination (18 times a day....mostly at night).  I was 44 years old at the time.  I had a PSA test and it came back a 2.6.  My regular doctor said that was ok but he referred me to a urologist because of the frequent urination. The urologist seemed concerned that someone my age would have a 2.6 PSA and so he ordered a biopsy.  I had the biopsy in January of 2012 and the results were negative for cancer. 

On my next follow up (in April) they did another PSA test and it was 2.8. They scheduled me for another PSA test which I had last week and got the results today and the PSA was 4.76.

The urologist wants me to come back in 6 months for another PSA.  Should I ask for a second opionion? It seems like my PSA has been rising pretty regularly over the past year and I wonder if he is being as agressive as he could be.  Or am I just being overly cautious.  Believe me.....nobody wants another biopsy as that wasn't a pleasant experience for me but I would realy like to know what is behind this rising PSA.

Thank you in advance for any advice you could give me. 

Todd

Posted 12/17/2012 10:28 PM (GMT 0)
Welcome and glad you came out of lurker mode. That's a fast rise. I'd get that second opinion something isn't right. When was your last DRE? Was it normal?

I wouldn't wait six months. Three maybe just to make sure the last PSA rise was real and not just one of the many PSA weirdness that can happen.

The other question I'd ask is, have you ruled out other things that could rise PSA like infection or BHP?

No one likes biopsy but if it's likely another doctor might recommend it.
Posted 12/17/2012 10:28 PM (GMT 0)
You may have a low grade infection from the biopsy. Did the uro. put you on an antibiotic after the biopsy ?? Even if he did, maybe a month on cipro might bring the PSA down and rule out suspicion of CaP.
Just my non-medical opinion. Cipro is cheap.
Posted 12/17/2012 10:46 PM (GMT 0)
Ask for a percent free psa test. That will either be suggestive of cancer or it won't.

Read here en.wikipedia.org/wiki/Prostate-specific_antigen#Free_PSA and note the chart on the right hand side.

At a minimum I would do a retest in 3 months rather than six. The worry is that a fast moving PSA in a young guy can be a sign of an aggressive cancer and if that's what it is you don't want it to slip out of the bounds of curability. First thing to do is rule out an infection as other posters have said. Get a dre if you haven't had one. Next thing is free PSA test, a cheap quick blood test. Find out the size of your prostate (which is evident on the ultrasound images used to guide the biopsy.) If the prostate is unusually large for someone your age, then the PSA might not be as concerning, but if the prostate is small or normal size, and the PSA is high and rising, and infection has been ruled out then further testing is in order to find out what's going. False positives happen in biopsies.
Posted 12/17/2012 10:47 PM (GMT 0)
Thank you for the replies.  I don't think it's an infection since I had the Biopsy in January and had the 2.8 since then.  He did put me on cipro after the biopsy.

I have had two negative DREs the second was today.  She is suggesting I wait 6 months for another PSA test but I just feel that something is not right.  I also don't have insurance which is a problem.  She did say she wanted to make sure that this wasn't just an anomoly of a PSA reading but I think waiting 6 months might just make me crazy.  idea

Posted 12/17/2012 10:55 PM (GMT 0)
Todd,
Are you aware that ejaculation will raise your PSA? Did you abstain?
Make sure you do next time - and every time after that.
Jeff
Posted 12/17/2012 10:57 PM (GMT 0)
Todd - the percent free psa test should be relatively inexpensive. (see description in my prior post just above, which crossed with your latest.) The PSA density calculation is free, since the data is already there from the biopsy. The PSA test itself costs less than $100 at Labcorp even if you're paying privately.
Posted 12/17/2012 11:09 PM (GMT 0)

I wouldn't wait six months

me neither.

ed

Posted 12/17/2012 11:22 PM (GMT 0)
Thanks everyone. Your information has been very helpful. I've not been terribly thrilled with this urologist from the beginning actually. I started with the head of the practice who did my biopsy and right after the biopsy was over (while I'm still bleeding on the table) he asked me what I did for a living and when I told him that I owned an art gallery he decided to pull out his iphone and show me pictures of his paintings! Honestly! While I was laying there in pain after an embarrassing biopsy. Now I'm only dealing with his nurse practitioners and they don't seem too interested in listening to me. It's horribly frustrating. I felt that that leap in PSA in such a short time might have warrented some concern. I'm not sure if they've ever done a free PSA test but it's doubtful.
Posted 12/17/2012 11:41 PM (GMT 0)
Did you have antibiotics to treat a possible prostate infection? A family member had the same history as you're describing, and antibiotics brought his PSA down. It came back after a while and he had to go on another series of antibiotics. The fact that your biopsy was negative is not complete reassurance, but I'd be inclined to go with your uro's recommendation and get another PSA. But I'd ask to be placed on antibiotics first.
Posted 12/17/2012 11:57 PM (GMT 0)
I was actually on a course of antibiotics this fall because of an infection related to poison ivy. That was before the 4.76 reading last week.
Posted 12/18/2012 12:54 AM (GMT 0)
Change Urologist.  There are too many Urologists out there.  Don't stay with one your not comfortable with.
Posted 12/18/2012 2:08 AM (GMT 0)
I would not wait 6 months.....maybe 3 months...better 2 months...that is a fairly quick rise....if your urologist is not on board "you're  fired"    I've had to fire my first urologist...then later my oncologist (who was at a center of excellence in the SF Bay )
Posted 12/18/2012 3:29 AM (GMT 0)
There are several causes for elevated PSA. Has your doctor ruled out infection or BPH? Also have you checked the free PSA? You may want a second opinion and I don't think you should wait 6 months.
Posted 12/18/2012 3:36 AM (GMT 0)
Todd,

Glad you came out of the shadows and joined us. Hopefully you are just visiting and do not need to be here.

I agree with the others, I would have another PSA in 3 months.
I would also look for a new uro. They should be more concerned about you and the biopsy you just went through than "their" art.
I remember oh so well how I felt having my last biopsy, sitting in a pool of blood with no pants on, weak and dizzy within 3 feet of my uro and his female assistant. No modesty!

Stay in touch
Bill
Posted 12/18/2012 2:36 PM (GMT 0)
Thank you all for your help.  On the hunt now for a new urologist!  Looking back on it he really was horrible throughout this ordeal.  Luckily I have friends who can give me good referrals.  I'll keep you posted!  You were all very helpful. 

Thank You! 

Todd

Posted 12/18/2012 9:15 PM (GMT 0)
Just got an appointment with my new urologist for January 4th!  Thank you all for your support and suggestions.  You are awesome!  I'll keep you all posted.

Todd

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