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Question on PSA and waiting game

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Posted 4/25/2013 6:30 PM (GMT 0)

My husband has had his PSA last year at 6.8 and had a biopsy came back clear or ok this was in Novemebr of 2011

 Now in March his PSA is 7.2 ad his doctor is waiting until July to do another blood test, the waiting and see game. He has a "large prostate"?

 Should I be worried. I did ask the doctor about the MIR before anoher biopsy and he said maybe next time.

 Thank you for all the information I have learned and what to ask and any help from all of you.

Posted 4/25/2013 6:36 PM (GMT 0)
I'd say you shouldn't worry right now. First biopsy was clear, that in itself is the news the rest of us here had hoped for when we had out biopsy. Not a guarantee that your husband won't get PCa, but still no reason to worry in my opinion.

What did they attribute the high PSA to in Nov 2011 after his clean biopsy? And how old is your husband.

I wouldn't worry about it at this time unless you like worrying. Some people do.
Posted 4/25/2013 6:39 PM (GMT 0)
Thank you for the quick reply! My hausband is 61 and in good health. The reason they gave in 2011 was  nothing really other than you have  large prostate. No family connections either. I just hope that the waithing game willnot be in July you have a full blown cancer. I do like his doctor. We are in Athens GA.
Posted 4/25/2013 6:53 PM (GMT 0)
Hello.
Prostate cancer often grows slowly, if it is there.
One indicator is PSA density, PSA divided by prostate size in cc's, I think.
Another blood test is the free PSA blood test (higher is better on this test.)
Another thing to consider is PSA doubling time, the time it would take for PSA to double.
Good luck.
Posted 4/25/2013 6:54 PM (GMT 0)
Thank you for help
Posted 4/25/2013 8:03 PM (GMT 0)
Since no one else seems to have said it. Welcome to the forum.

It sounds like your husband's doctor has a sensible plan. With that PSA you want to keep an eye on things. But there is no need to be particularly worried at this point. A large prostate can explain that level of PSA but it could still be something else, too. Nothing bad is likely to happen in four months and rechecking things in July will let you keep an eye on it. Be sure to ask the doctor about checking the free PSA percentage (which I imagine he already plans to do) since that can help distinguish between a high PSA from having a big prostate and having prostate cancer.

Feel free to hang around if you want to. You are always welcome to ask questions. But be sure to come back in July and tell us what the doctor (and the PSA test) says.
Posted 4/25/2013 8:04 PM (GMT 0)
An enlarged prostate (BPH) often causes those kinds of slow steady increases in PSA. Proscar or Avodart are often prescribed for that. Using one of those would probably establish a new lower baseline PSA value, but one which is a more reliable indicator of PC. There's also some evidence that these meds may help prevent low grade PC. There are potential downsides as well. I think he might want to discuss that with his urologist.
Posted 4/25/2013 8:29 PM (GMT 0)
WOW. Thank all of you for helping me and making me feel welcome. I will check back in July after his appointment.
Posted 4/26/2013 12:25 AM (GMT 0)
Welcome:
The members of this forum have helped me a great deal! I would tell your husband to ask his uro about doing a Pca3 test, which involves massaging the prostrate and collecting a urine sample prior to and after the prostrate massage and then submitting the urine samples to the lab to get the Pca3 count. Also have the dre's been normal or has the uro found anything suspicious after the dre is done? When the Pca3 test is done the uro can also obtain a secretion to culture if he has not done so already. This culture may give uro information on what type of antibiotic might be prescribed to fight possible infection.
Good Luck!
Posted 4/26/2013 2:45 AM (GMT 0)
Welcome N R from one of the "warrior wives". The waiting is always hard and never gets easier, but it really sound as if you all are in a good place for now, and hopefully forever. BUT the waiting is nerve racking.
Posted 4/26/2013 3:16 AM (GMT 0)
I on the other hand, and trust me, I am not being contrary, would find someone who will do a saturation biopsy to get to the bottom of this. The real question is not what caused the high psa in 2011 ,but what is causing a 61 year old man , even with a " large prostate", to have a 7.2 psafrom a blood sample taken just a few weeks ago. I definitely believe an over treatment problem exists with Pca. A biopsy is not treatment ,however, but diagnostic. But firmly believe, without an infection, anyone with his numbers, prostate size include, needs to have his prostate thoroughly examined for the presence of Pca. Then we see more definitively whether treatment is needed. Im fully aware some men have naturally high psa,s. But that is outside the "norm" and has no prognostic value for the norm . The trauma of a biopsy is highly over rated, again realizing ,we are all different, but most of the trauma is between the ears. Totally my opinion and have zero desire to defend it. But am desirous of information that that would say a 7.2 psa is not atypical for a large prostate. that part is be beyond my knowledge, but gut says it is atypical ,but am persuadable.
Posted 4/26/2013 4:37 AM (GMT 0)
Normal PSA output is between 1-1.5 ng/ml per every 10cc of prostate volume. PSA density greater than .15 has been associated with PC.

NK, your husband's PSA was 7.2. So based on that rule of thumb, unless his prostate is smaller than 48cc, he's within the normal range for PSA. Usually, anything over 40 cc is considered "enlarged." So my guess is that he's probably within the normal range for his prostate size. You can ask his urologist what his prostate size was on the ultrasound exam, if he had one.

On top of that, there is an expected age-related normal increase of up to .4 ng/ml per year. That's also well within the increase he's had. These are just averages.
Posted 4/26/2013 5:16 AM (GMT 0)
Tall Allan, if a man is 42 and has a prostate volume of 30cc, does that mean he can have a psa of 3 to 4.5 and that would be considered normal for him? Or if he has a 38cc volume, normal would be 3.4 to 4.7 for that man , hence, no need for concern, no need for a trip to the Uro. Im not trolling here, Im looking for information. If there is need for concern with these numbers, for the hypotheticals I introduced. Can we indeed call them normal?
Posted 4/26/2013 6:22 AM (GMT 0)
logoslidat,

I know that my first PSA test was at the age of 52 and the normal PSA range for that age extended to 4.0. At that time my prostate was normal to the touch & normal size. This was 2001 and my PSA was 3.2.

When my PSA went over 4.0 in the late 2000s, I had also developed BPH. My urologist explained that my elevated PSA (it was around 4.6 by then) was one possible explanation for the reading. But both he, and a second uro I visited, stressed that it ALSO could be masking the presence of PC. Their warning was for me not to get fooled into assuming all was well by attributing the PSA reading solely to the BPH.

Turned out they were right and a biopsy a couple years later revealed my case of PC.

So, for whatever it is worth, even if a higher PSA reading seems to correlate with an enlarged prostate, there can NEVER be any guarantee that there is not also PC lurking within the gland.

Take care,
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.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & slowly getting a bit stronger.
Posted 4/26/2013 3:39 PM (GMT 0)
I am thrilled with all of the inforamtion I am getting and being made aware of all the questions I need to ask or have my husband ask. I want to thank all of you for your help and welcome to me. I will get the information and report back in July or before if something comes up.
Thank you again for your welcome and help.
Posted 4/26/2013 4:48 PM (GMT 0)
Thanks Highlander. I tend to see nuances in things that others ,even the posters themselves do not see. I bring them up to enlighten and/or be enlightened by the information I receive. This can touch a nerve here and there, but assure you and others, I am not counting " the number of angels on a the head of a pin." I use a flashlight as a light, not a hammer. Thanks so much for your response. on a reread of TA post, he did say it was a guess that it was normal, so apologize for missing that. I still believe a saturation biopsy could end the "agony' of the waiting game so, NR can get on with life as it was or possibly be taken down a road she may not like but has opened up.
Posted 4/26/2013 6:00 PM (GMT 0)
Hi logoslidat,

I'm glad you noticed that I stressed normal range and that they are just averages. Abnormal events can certainly happen. I'm just saying that those two readings by themselves don't raise any red flags for me. Now if the prostate were small, the DRE positive, family history of PC, African-American, more rapid PSA doubling time, and other biochemical tests positive -- those would all raise my alert level. I think NR's doctor is behaving rationally based on the limited info I've seen. I believe that it is the rushing into biopsy, rather than tracking PSA, that is the start of the slippery slope to overtreatment.

I think you are raising a good issue about how temperament comes into play in all of this when you mention the "agony" of not knowing. I am fairly comfortable with uncertainty, others are not. That's one reason that I found I could live without the certainty of a post-RP pathology report (which is sometimes uncertain anyway if there were positive margins, etc.). I, for one, would not want to be tested for the BRCA1 & 2 gene abnormalities although there's been much cancer in my family. I would also never want to have a full body MRI just to look for suspicious lesions that may or may not cause trouble in the future, as some people do. I'm just not a worrier by nature, and tend to live with things as they are and how they are most likely to play out, rather than how they might turn out under some improbable scenarios. Everyone's different.
Posted 4/26/2013 7:31 PM (GMT 0)
Thanks for your help I have so much to learn and I trying not worry at the same time.
Posted 4/26/2013 8:25 PM (GMT 0)
logoslidat,

Thanks for your kinds words. I was glad to offer my thoughts for you.
Also, your idea of a saturation biopsy is probably a very good one. Although not the way anyone would want to spend an hour or so, it really is better than a standard biopsy since it is far less likely to give a false negative.

N R,
Has anyone up above (I'm too lazy to reread everything, LOL) suggested that you purchase the 3rd edition of Dr. Pat Walsh's "The Guide to Surviving Prostate Cancer?" There is a wealth of information in this book and it is truly worth the read -- also to keep as a reference book.

Take care,
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.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & slowly getting a bit stronger.
Posted 4/26/2013 8:29 PM (GMT 0)
Great Idea! I will do that. My husband does not know that I have posted" His Stuff"
on line. I will tell him tonight at dinner! I am overcomed with everyones help. And I wish good health and happiness for everyone Thank YOU y'all!
Posted 4/26/2013 8:58 PM (GMT 0)
Make his favorite dinner….. tee hee
Posted 4/26/2013 8:59 PM (GMT 0)
Nope going out to our Mexican rest. We go every Friday night!
Thanks
Nancy
Posted 4/26/2013 9:05 PM (GMT 0)
Thanks Tall Allan for the well thought out and articulate response. Her doctor is being prudent with the information he has and they all are walking a fine line in balancing the pros and cons.. I honestly see you points.

NR, don't worry, your husband will do fine. Your concern is heartwarming. I like that in a human being...
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