HealingWell
Search Close Search
☰

3.9 Dilemna

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
12
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 6/24/2013 5:19 PM (GMT 0)
Hi:

I know that there is quite a bit of controversy on psa values, what constitutes norms, what exceeds normal and how  to respond to a signle elevated reading.

I am a 45 male.  Prior PSA's including one 16 months ago in the 2.5 range (as was one a year prior to that).

Recently had a PSA of 3.9 (which i am aware most would consider elevated for my age group).

MD pointed this out and suggested a follow-up PSA in 6 months and if trend or elevated reading a referral to urologist.

The question is (and i would like to get some feedback from those of you who are neither overly conservative or liberal about this question, to the extent possible) whether this is a reasonable response.  My own thinking over the last week is that i could either request the referral now; do a retest in 3 months as opposed to 6; or follow MD advise and wait the 6 months.....appreciate comments....and i know there is no easy answer....

thanks guys

Posted 6/24/2013 5:22 PM (GMT 0)
I'm not a doctor but 6 months seems way too long.

I would recommend 3 months.

Is there any other reason your PSA might be high? (Infection/prostatitis symptoms, doing the blood draw after a DRE, or...)?

Mel

Posted 6/24/2013 5:24 PM (GMT 0)
Hi, and welcome!

 

Yes, seems reasonable.  You should expect (or inquire about this) that the doctor may also try to eliminate the possibility of a common prostate infection, which temporarily elevates PSA; he may prescribe a round or two of antibiotics.

 

best wishes...

 

 

 

Posted 6/24/2013 5:26 PM (GMT 0)
Bob,

Welcome to HW.

My GP is not one to practice outside his comfort zone. When I had an abnormal PSA, he added a Free PSA test. When that came back abnormal, he immediately shipped me to a good uro.

And there is the crux of a problem in my community - good uros have openings for new patient appointments months off in the future, even on referral.

My suggestion, after having sweated out that situation, is to go ahead and get that uro referral and first appointment BEFORE it becomes "critical". Guys all need a good uro if they live long enough, and if your insurance covers it, go on and get established with one who has good reports now.

Posted 6/24/2013 5:43 PM (GMT 0)
I was a little older than you when I started tracking my PSA, but had the same trend as you.  I started out my first psa at 2.9.  Over a period of 4 years it went to 4.5. At that point I went to urologist and was diagnosed with Gleason 6  where 2 of 12 samplescame in  with <5% cancer.  I probably could have waited a few more years to decide on treatment, but i decided to get it quickly. Pathology still showed G6 , but with a lot more cancer then biopsy found, 20% of prostate had cancer found. 
Posted 6/24/2013 5:44 PM (GMT 0)
Hi Bob. There is probably no single "right answer" to your question. But if I were you, I would not wait 6 months. Instead, I would go to a good urologist as soon as you can get an appointment and get another psa test, a free psa test, a DRE (after the blood draw; not before), and if the urologist is willing to do it, a PCA3 test as well. Once you get those test results, I would decide, based on the results, whether to schedule a biopsy. If it is a close call, I would get the biopsy. If I were going to have the biopsy, I would discuss with the doctor, in advance, the possible use of MRI technology (there are various uses). But, as I said, there's no one right answer, and I am sure other people will say waiting 6 months is OK. Would not be my choice, but I am just one random guy on the internet. Best wishes, whatever you decide.
Posted 6/24/2013 5:51 PM (GMT 0)
Every option you mentioned is sensible. In your place I would probably retest in three months making sure that for 48 hours before the test I avoided things that can elevate the PSA reading -- those include sex, bicycle riding, motocross, digital rectal exams, bull riding, nasal decongestants and appearing on America's Got Talent! as a novelty act breaking 2x4s with my scotum.

If that didn't bring down the reading I would then try a round of antibiotics and test again. Then, if it still remained elevated I would request that referral to the urologist.

You can also add a "free" PSA test to your next bloodwork. It tests for the percentage of circulating PSA that is "free" as opposed to attached to proteins. It gives a bit more information since men with prostate cancer tend to have less free PSA as a percentage (so it is a higher-is-better test).
Posted 6/24/2013 6:01 PM (GMT 0)
Thanks for all the responses so far and sound thoughts from everyone.  I had no idea how quickly people would chime in...this is truly a wonderful resource....and it is nice (a) to not feel alone and to (b) get some input from people who like me I would imagine struggle with the fact that there are so many different options and things to consider....and one size does not fit all.

Thanks to all...and to all the survivors out there....i am sure you know you are an inspiration to those interact with both in your lives....and those you will never meet who like me stumble across your postings!

Posted 6/24/2013 6:08 PM (GMT 0)
That's higher than the PSA I had.

Of course a PSA is not cancer specific, it is prostate specific and you could simply have an infection.

Do you have any other symptoms? Like urinary issues? If so, I'd say don't wait.

If not, my GUESS would be to do a course of antibiotics then retest in 2-3 months.

It's a personal decision. I'm sure 6 month interval wouldn't change much short of the very minimal and outside chance you have very aggressive PCa, but if I were in your shoes I personally wouldn't wait more than 3 months for another test. At our age that is an elevated PSA. Doesn't mean it's cancer of course.

Best of luck.
Posted 6/24/2013 6:15 PM (GMT 0)
My take on this is more up to you. Everything mentioned is reasonable but how do you feel about it. If being anxious for 6 months is going to degrade your quality of life maybe 3 months might suit you better.
Don't be afraid to bring this up with your GP too. All this enters into decision making.
All the best, and I hope it's nothing.
Posted 6/24/2013 6:26 PM (GMT 0)
I would insist on an an antibiotic, retest in 3 mos, read up on disease, as you probably are and go on with your life, unfettered, if you have that personality type. Not all of us do. One caveat, if you are afro-american or have Pca in your family history I would get an appointment with urologist as 142 's point is a good one, the appointment backlog. 2 years ago your GP would have sent you to uro right away. Everyone,arguably, is on the over treatment bandwagon, and over treatment is a legitimate problem. I feel now however, the docs are all trying to do their part in reducing over treatment, As always in life, however the pendulum always swings farther than warranted. as someone mentioned all the options are good, though the 6mos retest concerns me because younger guys, as with woman with breast cancer, tend to, not always have a more aggressive disease. I'll tell you Bob, you seem to be right on the power curve here, in terms of "good sense" and that bodes very well with this situation. One more thing a uro knows how to perform a DRE, Gp's , not so much. I very much like your GP and his sense also. You are going to be fine. Oh my opinion on biopsy is that it is just a simple diagnostic tool, much overhyped as something to be avoided if possible. I do not consider pre diagnosis tools as over treatment, the over treatment comes after the diagnosis. Keep us in the loop if you have time and welcome to the forum, " your'e going to like the way you look" tee hee Logo
Posted 6/24/2013 6:28 PM (GMT 0)
Hi Bob:

Welcome to HW but sorry you need to be here even for inquiries.  45 is very young to have prostate cancer but, unfortunately, there are a number of guys on this forum who did get in that young (and younger).

If I were you, I would follow the advice provided by 142 and medved.  Namely, move on to the urologist now rather than waiting.  Re the urologist I think you should reasonably expect to get a round of anti-biotics to see if you have an infection, get another PSA test with a free PSA included and have a PCA3 test as well.

Good luck.

Jim

Posted 6/24/2013 6:29 PM (GMT 0)
Hi Bob,
My PSA was 3.1 and I waited the 6 mos...then it was 3.5...then the Uro did the biopsy and projected a Gleason 8...some PCAs are more aggressive...in my case that was the deal...fairly low PSA but wish I had acted 6 mos. sooner...maybe could have avoided things getting as far as they did. Not saying what to do...just my experience for whatever it's worth. Best of luck to you.
Posted 6/24/2013 6:37 PM (GMT 0)
Welcome to our little corner of the world.
My case as a bit like yours. My PCP recommended a retest in 3 months to confirm the rise and then when confirmed did a referral to the URO.

If it were me, I'd be a touch more aggressive than six months on the retest.

Andrew
Posted 6/24/2013 6:44 PM (GMT 0)
Hi and welcome

For what it is worth, I was refered to a Uro at PSA 4.4, urinary flow good, DRE negetive, biopsy = gleason 9.....in other words too late. My advice would be not to wait around.
Posted 6/24/2013 6:55 PM (GMT 0)
If it was me I'd get another in three months and it still high I'd get a biopsy.
Posted 6/24/2013 7:07 PM (GMT 0)
In my situation, I went from a PSA of less than one to 4.6 within 18 months. A follow up PSA a couple of months later confirmed the 4.6 reading. DRE exams came back clear even after the second PSA. Uro recommended biopsy as opposed to antibiotics...I trusted his judgment on this issue. And, of course, the rest is history.
Posted 6/24/2013 7:21 PM (GMT 0)
I would ask to be put on antibiotics now, re-test in 3 months, not 6, and if it still up/or higher, get to a good urologist for a biopsy, just to be on the safe side.

david
Posted 6/24/2013 8:21 PM (GMT 0)
I'm with the camp that says take antibiotics and retest in 3 months. Plus make sure there's no sex, bike riding or other activities that could throw off your reading. Good luck!
Posted 6/24/2013 8:51 PM (GMT 0)
Understanding your PSA test results from zerocancer.org.

http://zerocancer.org/education/testing/results/


Test at the same lab, same method, same machine and calibration, for more meaningful comparison.
Posted 6/24/2013 9:17 PM (GMT 0)
You've gotten some good answers and suggestions.

I couldn't help noticing you spelled the word "dilemma" as "dilemna" (with an "n.") in the title of your thread.

This reminded me of a $10 bet I lost to my son 25 years ago. I have a Master's Degree in English, have taught English, and have always been an excellent speller (I've been captain of a team in a corporate spelling bee that has won the local bee two years in a row). I'm not saying that to brag, but to show how chagrined I was when my son correctly informed me that dilemma is NOT spelled dilemna. I was sure I had learned to spell it dilemna in Catholic elementary school and had always spelled it with an "n."

Anyway, I've since started spelling it "dilemma," but if you Google "dilemna," you'll find that many, many people, and especially those of us who were in grade school in the 50's, swear they learned to spell the word with an "n." So many people swear to this that one must conclude there's some truth to it. And yet, it's impossible to find a spelling book or dictionary that shows the word spelled "dilemna. In fact, I had to go back over what I just typed, because auto-correct keeps changing "dilemna" to "dilemma." :)

It's a very strange phenomenon, and news articles have even been written about it. It felt good to see it spelled that way in the title of your thread.
Posted 6/24/2013 9:40 PM (GMT 0)
I would retest in 3 months for sure.  You have to be your own advocate. Your PSA at your age should be below 1.5 in my opinion. Ask for a course of antibiotics to rule out infection.  Something is indeed going on.

Good Luck.

Bill K. from NJ

At age 50, PSA 1.5; 51 PSA 1.7; 55 PSA 2.5; 56 2.6.

PSA at 58 years old was 3.3, free PSA 21%.

Gleason 3+4, 1 core of 12 +

DaVinci robotic surgery July 2011, downgraded to Gleason 3+3

All PSA since surgery <0.01.

  

Posted 6/24/2013 10:09 PM (GMT 0)
very interesting side note, clocknut. After reading a lot of other postings and based on some of the higher gleasons responding i am now suggesting uro now, biopsy now. The biopsy bias is all between the ears. Just don't count the clicks and make sur he does plenty clicks so you don need another one. Not being a pessimist but 3.9 is pretty high for your age. I am not a big fan of the 0 to 4, age dependent being normal any way, it more complicated then that, but makes everyones job easier in medical system. Be your own advocate. imo, biopsy is in your future, why not just do it and stay ahead of the power curve. Now go ahead, before I change my mind, tee hee
Posted 6/24/2013 11:01 PM (GMT 0)
Why are you screening at age 45? Any family history?
Posted 6/25/2013 2:27 PM (GMT 0)
Hi Bob -

Just wanted to chime in with the others - if it were me (knowing what I now know), I would see a Uro for an exam including a DRE sooner rather than later. My Uro was very calm and reassuring that my elevated PSA would turn out to be nothing - up until the point when he did the DRE, and then everything changed. Just my 2ยข.

Best of luck - and keep us posted -
✚ New Topic ✚ Reply
12