PSA 4.2 and asymmetrical prostate 3 weeks ago... advice on criteria for next step?

Most PCP's don't do PSA tests or DRE's before age 50, that is typical, unless there are other issues or a history of prostate cancer in the family. However, glad it was done, and seeing a uro with your psa of 4.1 is the right step to take. On what you said, and based on my own history, I would go for the biopsy, if nothing else, to give you some peace of mind.

Good luck, and hoping you don't need to join our club for real.

David in SC

Velonut,

My husband was just about your age when DX.
Didyour Urologist recommend antibiotics first to be certain it isn't an infection.?

Our Urologist however did state the scale of normal PSA is 1-4, but at my husbands age the psa should be closer to less than 1. Wait to see what your blood test results are and perhaps they will be low enough your Dr. will put you on antibiotics.
Do keep us posted!

BOOGEE

Velo, welcome to HW and I hope you don't have to be here long.

I'm not a doctor but before you agree to a biopsy, I would recommend that you request four things:

1. A short treatment with antibiotics to see if you have an infection that may be causing the PSA level.

2. A PSA-free test that goes along with the PSA test.

3. An analysis from the urologist of PSA density to determine your "normal" PSA for your prostate size.

4. A PCA3 test.

Rushing off to a biopsy is not necessarily the right thing; learn about your situation first.

Good luck,

Jim

Gp's are, arguably not the best at giving DRE. they do it as protocol. When a uro does one , you know you have had one. Your logic on the assymmtry and psa connection is faulty in this instance, which does not mean it doesn't connect in another scenario, not yours. Also because your Gp found it abnormal and your uro found it normal, does not mean that it magically gained symmetry between the 2 appointments. Your'e uro found it normal. We are talking fleshy organs here, define asymmetrical. The psa is related to an infection. BPH or PCA. The sex on a bicycle, while exercising, {can never resist that way of putting it] would push it up a little. Also just because a dre is normal, does not mean prostate is not infected, Just as a abnormal dre does not necessarily mean it is infected. Also prostate infections do not always cause noticeable infections, but will show a high psa. Anyhow velonut, stick with the uro if he says biopsy above 3 go with that. Logic is a great quality, but it must be melded with knowledge of the data points. Doctors have that knowledge. Alota, alota folks here at HW do also to a much lesser degree, more or less. Since you are on the road with us. Read books, Walshes is a good start, ask questions, so you also will have the knowledge and logic to better connect the data points. This last point is not a scold, just information so as not to drive yourself velnuts,worrying about stuff that is not there. Stay with us,welcome and let us know about progress. On a reread I see you took note of the symmetry issue yourself

Good luck VeloNut, I hope your stay with us is very brief indeed.
Let us know how you get on.
Susan
x

I just turned 60 and my PSA climbed from 4.2 to 5.0 over the course of a year with a free PSA value of 10 (very bad). My urologist (faculty at a medical school and believes in conservative approach to diagnosis) put me on doxycline and my PSA went down to 4.1 (not significant) but my free PSA went up to 20 (good). Six months later my PSA went back to 5.0 so the urologist did an ultrasound to measure the prostate. (He doesn't believe in jumping into biopsy since about 4% of the patients get infections, some of which can be severe.) Larger prostates put out more PSA so by dividing prostate volume by PSA you get PSA density. Well, my prostate was normal, but he found many prostate stones which he said would cause the PSA to be all over the place. He did mention that these stones are typically asymptomatic.

With that said I would first want to try antibiotics first. Several weeks of treatment and retest can possibility save you from an unneeded biopsy.

Hi VeloNut,

Based on your initial post, it appears that your latest blood test was taken just AFTER the doctor performed the DRE? If this is so -- and if your PSA is still over 4 -- I would still not necessarily agree to a biopsy.

Instead, I would insist that you have ANOTHER PSA test in a couple weeks in which you are completely clear from having any sex, bike riding & DRE's for at least 48-72 hours before the blood is drawn.

Then you can feel more assured that you are getting a "true" PSA reading without any activities that put stress on the prostate. As the doctor said, those activities can cause a small boost in PSA readings -- but I've also heard urologists say it can sometimes cause more than a "small" boost.

Good luck to you!
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1.
Semi-firm erections now happening 14 months post-op & slowly getting a bit stronger.

I just got the results for my PSA, and it climbed to 5.4. The doctor recommends a biopsy. I asked about antibiotics, and he said I have no symptoms to make him think there's an infection. S I asked about the free PSA, and he said that the rate of rise from 4.2 to 5.4 in 3 weeks is significant, and based on that alone, I need a biopsy.

There are a few things causing alarms for me.
- Both times my blood was drawn, it was after the DRE. The urologist said PSAs don't raise much from a DRE, which I am cynical of.
- According to several reputable sources, a UTI is sometimes asymptomatic. My wife gets UTIs a lot, and I wonder if I we each react differently to them.
- The two DREs were 3 weeks apart, but the guidelines say that the tests should be 6-8 weeks apart.
- I don't have any symptoms of anything, and am very active. This morning I ran 3 miles in 22 minutes.
- I'm concerned that pushing a needle through my intestinal wall to pull samples to test for cancer, may I corporate sludge into the prostate that shouldn't be there.

I made an appointment for the biopsy for the 18th, but will call to cancel it tomorrow. I'll try to get a second opinion, preferably from Sloane.

Does this sound prudent? Thanks everyone, you are keeping me from getting too nervous about all this.

Being that it is known that having a DRE prior to the PSA test can cause an increased PSA level, why not simply draw the blood first and then assault you with his index finger? New Uro time?

My father in law worked in medical education (as did I) for several years (pharma PhD). I found out last night when I called him to discuss my situation that he focused on prostate cancer. He said two PSA readings three weeks apart, and then a biopsy recommendation is way too fast. He also said there's quite a lot of disagreement on whether PSAs are a diagnostic tool, or if their real value is in monitoring after a cancer diagnosis to inform the doctor on treatment. There's also a lot of disagreement on the impact of the biopsy on the health of the prostate. Having multiple puncture wounds isn't low impact.

He recommended I look at Pub Med to locate any research related to DRE impacts on PSA, and I found this: http://www.ncbi.nlm.nih.gov/pubmed/10565747. This study shows the average total PSA increase after a DRE to be at 0.9 points for a pool of 91 men.

This morning I cancelled my biopsy, and had the urologist send his notes to Memorial Sloan-Kettering. They will review the numbers and call me back to schedule a consultation.

But for today, I watch the snow fall, hug my wife and speak positive, and be thankful for all I have. My perspective on life changed in a matter of days. Thanks again, I hope my stay with you is short.

Good luck.

So, VeloNut, you are saying a PSA of 5.4 was caused by infection and DRE performed before the blood sample was taken ? Do you plan on another PSA test anytime soon? My brother had a PSA of 5.0 then in 6 months 1.8 and 6 months again 5.6. Anecdotes don't prove the point I know...but still.