4.6 PSA, advice appreciated.

Hi guys, I'm a newbie to the site. My name is Brian and I turned 50 in March.

Last week my doctor told me my psa reading came back a little high. He said below 4 is considered safe and I had a 4.6. This is my second psa test. I remembered him telling me a year ago that my psa test was good, or something to that effect. I didn't pay it much heed. Now he tells me to come back in 4 months(Oct 2013) for another test. He said if the reading gets higher it could indicate a cancerous growth. He didn't do any rectal examination. I guess there will be plenty of time for that in 4 months.

I hardly know anything about prostate cancer and am now starting to research it. Any advice here would be appreciated. For instance, did anyone get their psa down by natural means e.g. diet?

How serious is a psa of 4.6? Should I tell my family? I didn't as yet. I'm torn between telling them now or wait until October when presumably something more definite would show up. Hoping to get some help here. Excuse the English. Not my first language.

Thanks everyone!

Were I you I absolutely would find a urologist. There's really no excuse that I can think of for not doing a DRE, but on the other hand, since he obviously didn't feel comfortable doing one, he may not have the experience to tell if there's a small nodule or not. My PSA was 2.1 when I was diagnosed, and there are plenty of people who have PSA results of 7 or more who just have infections. Find a urologist and find out what's going on.

Hello Brian1s,

Retesting your PSA before you worry too much is a good idea. There are lots of things that can cause a one-time PSA reading to be elevated. Among those things are having sex in the 48 hours before your blood is drawn, bicycle riding, prostate infections, some cold medicines, and a digital rectal exam. You probably want to avoid those things before your next test. Did your doctor prescribe any antibiotics? Sometimes they will give you antibiotics to see if that makes your PSA go down (which would indicate that it was high because of an infection).

4.6 is definitely higher than you want at your age but there are lots of things that could cause it. If it is still high in four months you should definitely plan to see a urologist and get it checked out.

I agree with the others that you should absolutely have a DRE. At this point I'd find a good urologist and go from there.

Also, you should find out exactly what your previous PSA was so you can determine how much it has changed in a year. Although any rise could be due to non-PCa cause (infection, sex 48 hours prior, BPH, etc.) it is not something to ignore. The urologist will know how to make the differential diagnosis. If you do need a biopsy, it's no big deal.

Good luck!

I was at 3.6 when diagnosed and I went to the Uro on my own initiative, not on the advice of my regular doc who was not overly concerned since I was "under 4.0." (I have helped her with a better understanding of PCa in the past two years.) If I were in your shoes, I would not wait until October to see a urologist...I would start the process now.

By "family," I assume you mean extended family like parents, kids, siblings, etc. Probably too early to hint to them of any possible issues when there might be nothing there, although much would depend on how you all interact.

However, if you are married, seems to me that it would be good to clue your wife in early. If she is like many wives, even the thought of possible PCa will be a scare but she deserves to be brought into the conversation right up front. It is harder on the gals than on us cowboys. If there is cancer involved, this will be a journey for both of you.

Like the rest of the gang on here, I wish you well.

..

Brian1s,
I hope that you will just monitor this forum and not have to join us as a member. I'm not going to tell you to relax since you won't..We all have PC and don't want"new bees" to have to join our club..My recommendations:
1..If married--tell your wife; you are going to have anxiety until this is resolved.
2..Have you Dr prescribe antibiotics and make a URL appointment.
3..No reason to wait till Oct..Do it now.
The "age adjusted" top Psa for a man in his 50's is 3.5..You are well above that..The antibiotics and new Psa should tell the tale..Do find out what your previous Psa # was..get it done and you won't wind up like JetSki, Chris, or myself.. All the best to you.
Bill

Hi Brian, I'll too extend my hand and welcome you here.  You've gotten some great advice and I'll simply try to add to that.  Yes, hook up with a urologist and try to find one that has additional experience/focus on prostate cancer. 

He/she will do a thourough exam including DRE and blood draw for PSA - and as others have said there's lots of "Do's and Dont's" before a PSA test - no sex, horseback, bicycle, motorcycle riding, in fact I wouldn't do anything that would jostle you around down there - 48 hours before the blood draw. 

When you go to the uro get whatever history you have on any prior PSA tests as that will be helpful in creating a history and baseline.

Don't panic, you don't have enough information to know if you're headed down the path of needing treatment for prostate cancer or not.  "Get to a uro now" doesn't mean Monday morning, but sooner rather than latter would be best.

You've found a great group of guys and gals that are here to help, so ask ANY questions you may have.  It's all probably moving too fast for you right now, but we'll be here to help.  While none of us are medical professionals, we are those that have lots of experience and knowledge tht as you've seen we'd be happy to share with you.

Best to you and stay in touch!

Brian,

You said...
Thank you, everyone, for your very helpful advice and comments. I'm very grateful.
I'm now starting to get an idea of what I'm dealing with based on your experiences.

The silliest thing we say on this forum, and we say it over and over every day is not to worry. Of course you are going to worry. And one of the things you will worry about is that every man you hear from here who ever had an elevated PSA went on to be diagnosed with prostate cancer.

What your should bear in mind that the men who had elevated PSAs and their doctor put them on antibiotics and the PSA went back to normal -- there are hundreds of thousands of them -- those guys don't tend to wind up answering questions on this forum.

We tend to bear them in mind when we tell you not to worry too much. You should bear them in mind, too.

That said. Do stay on top of things. Get that PSA retested after a round of antibiotics. Get a DRE from a doctor with an experienced finger. (Usually that means a urologist). Better safe than sorry. We know that, too.

Hi Brian,

Good thing that you are going to see a urologist. My advice is to seek out a middle aged/older doctor with decades of experience.

At your age, the normal range for PSA would be anywhere between zero and 4.0. You are slightly over the high limit, so it is good that you are having a uro check you out.

As others have noted, there are several things to put on your "NOT TO DO" list before giving blood for your next PSA. DO NOT have sex during the 72 hours prior to the test. Also do not do any bicycle riding or anything that puts any stress on the prostate -- INCLUDING letting the doctor perform a digital rectal exam during this time period before the blood draw.

ANYTHING that stresses the prostate can trigger a temporary, artificial spike in the PSA reading.

The uro will definitely do a DRE for you. If you are told that you have a larger prostate, that could be your answer. Prostate tissue is what makes PSA. Hence, the more prostate tissue there is (as in BPH), the more PSA is created.

One caution: PSA is also created by prostate cancer. So it IS possible to have a harmlessly enlarged prostate and also have prostate cancer.

In any case, also be assured that, while your PSA is on the higher side, it is NOT terribly high. This would suggest that, no matter what is found, you are going to be just fine.

Good luck!
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 & VERY slowly getting a bit stronger.

HighlanderCFH said...
At your age, the normal range for PSA would be anywhere between zero and 4.0.

It is also important to point out that men with "normal" PSAs can have cancer.

Brian1s I will rephrase my last post. It is absolutely not true that 0-4.0 is normal for a 50 y/o healthy male period.

Thanks guys, I'll take your advices to heart. I'll post my results as soon as I see the Uro.

Getting a uro certainly isn't a bad idea, but first thing you should do is call you doctor and find out what the first psa was, just a number, 4.6 doesn't mean that much, IMHO, think trend. If it was "good" ie, 1.5 or something like that or anything considerably below 4.6 cancer does not make the most logical explanation for sudden jump like that, if it was indeed a sudden jump. I hope it turns out a false alarm and if it was lower than 2.something it could be just that. If it was ~4 and he wasn't worried then it would be time to take your uro business to a uro.

Good luck and I hope your next post will be the last we ever hear from you, we don't need new members!!