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I am 44 with a 4.6 PSA and a 6% Free PSA, and 12 core biopsy is clear of all Cancer

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Posted 6/29/2013 1:59 AM (GMT 0)
I have had a 4.6 PSA for 3 different blood Tests over one years time, and my Urologist suggested a 12 core biopsy in which all came back negative today :). The Lab notes on the biopsy were listed as this

Sections confirm multiple needle cores of benign prostatic tissue containing acini and stroma. Mild Chronic inflammation is present. No granulomata are seen. A small focus of atypical glands is seen in the biopsy from the right lateral apex in specimen D. Immunostaining for p63 and P504S confirm the presence of benign glands. No high grade PIN or adenocarcinoma is identified.

I am happy with the results, but still confused as to why my PSA numbers are bad. My Urologist suggested I get another PSA in one years time, and not re-biopsy unless my numbers break a 7.0 PSA Level

What do you Think?
Posted 6/29/2013 2:13 AM (GMT 0)
welcome Brad and sorry you have to be here. Sounds great the test came back negative but I'd be cautious of the PSA...seems kinda high for a 44 year old. Were you ever put on antibiotics to rule out infection?

How was your DRE? It seems to me waiting until 7 is kinda high....but that's just my opinion. perhaps a 2nd opinion would be a good idea. Lets see what some other members have to say...Once again welcome and good luck...chris
Posted 6/29/2013 2:33 AM (GMT 0)
Hi Brad,

It's good that the biopsy was negative but, unfortunately, false negative biopsies are common. If I were you I think I would ask for the PCA3 urine test before just forgetting about it all for a year.
Posted 6/29/2013 2:44 AM (GMT 0)
Since the biopsy indicated a mild inflamation this is the most probable reason for your psa. Free psa is used to eliminate BPH; I don't know if inflamation would affect it.
The good news is that your Psa is stable and your biopsy was negative.
Posted 6/29/2013 3:14 AM (GMT 0)
I had a PSA of 3.8. Age 56. 12 core biopsy neg. 33cc gland.
6 months later PSA was 17!😨 No symptoms.
6 weeks later it was 14. 14 core biopsy and MRI was then done....biopsy negative, except inflammation.
PSA is a vexing test sometimes.
Posted 6/29/2013 3:21 AM (GMT 0)
That is exactly the boat I was in 11 years ago. Same numbers, same negative result.

I then had 3 biopsies over about a year, including courses of antibiotics that didn't affect the PSA level at all. The final biopsy was a color doppler with Dr. Fred Lee in Rochester, MI, reputed to be the best with that technique. He found only inflammation, and affirmed it's been found that PSA can be elevated with low free PSA. The PCA3 test wasn't available back then.

I started aspirin daily for the inflammation. My PSAs came down over the next 3-5 years, becoming less than 2 for three years in a row. So, I figured great, that's done and dusted. Check again someday. I didn't bother with even annual PSAs for 4 years after that when we moved to a new state.

Well, upon turning 55 I had a physical, with PSA, only to find it's high again at 4.1 with 15% free. 6 months later, it's 5.2 with 12% free. PCA3 was 31, so slightly indicative of PCa. Finally, biopsy confirms a rather disastrous diagnosis of high volume Gleason 9 with PNI confirmed. Yikes!

During all those middle years I don't think I could have convinced anyone to do another biopsy since there were no indications. Now, in the 4 years I missed having PSAs, anything is possible.

Interestingly, the mass of PCa I have is in the same lobe Dr. Lee focused on finding only inflamed tissue. Was PCa lurking in there even back then? I think it may have been, but just not detectable.

If you've had elevated PSA in your mid-40s, I'd suggest the antibiotic approach since that's much more likely to be the issue. A PCA3 test lookng for PCa indication is easy, and certainly should be covered by insurance. If it's over 25, a biopsy might be worthwhile. If nothing else, definitely get your PSA checked every single year. It's never been clear what the best follow up strategy is for someone with elevated PSAs and normal biopsies. They say, "Repeat biopsies should be performed". Ok, but when? How often? It was really frustrating back then, and infinitely frustrating to think I may have ended up where I am now as a result of not having a good re-test strategy.

At anything over 4, I wouldn't want to wait a year. That's indication enough by itself to do something investigative.
Posted 6/29/2013 6:23 AM (GMT 0)
Thanks for all the great information. I am afraid I will never be clear of what to do with this, except keep up on checking my Levels. I will say that I passed my DRE completely. My Father had prostate cancer at age 60, and had the radical surgical removal of his prostate. I will probably re-test the PSA in 6 months, but I am not to excited about multiple Biopsy's as I feel this procedure to be quite Invasive and could cause problems down the road. I have heard of people getting Prostate Cancer with PSA levels of 1 and others with levels of 6 successfully passing thier biopsy 3 times. It's a bit of a guessing game right now. Hopefully more accurate tests will develop with my years to come.
Posted 6/29/2013 6:48 AM (GMT 0)
Waiting a year for a PSA is not a good idea because of your father. I am in the same boat as you regarding my father. I agree that those biopsies are unpleasant things and like you I am not convinced that they can introduce more problems. I'm in my third month following my positive biopsy and am still trying to get back to normal. Unfortunately, until they come up with something better, that is the only way they can draw tissue samples for slide viewing. Regarding the high PSA number, having sex within 2 days or less prior to your blood test can also elevate the number.
Posted 6/29/2013 3:39 PM (GMT 0)
Hi Brad, and well so far so good with the results! I would not wait a year to be re-checked for PSA - with your history of PSA readings and your Father having had PCa I would be active in staying on top of this.

Not sure if you are aware of the "Don't do" list before a blood draw for PSA test or not - but for at least 48 hours prior to the blood draw you want to avoid sex, bicycle riding, motorcycle riding, horseback riding, and generally anything that will jostle things around down there. You should also be sure the uro does not do the DRE before the blood draw!

Also you should have a conversation with your uro about ruling out the potential of infection - has that been discussed at all?

You've found a great place, and all questions are fair game. While none of us are medical professionals we do offer a fair amount of experience and knowledge.

Best to you.
Posted 6/29/2013 4:35 PM (GMT 0)
Welcome to our world.

You're just going to have to keep an eye on it. It's possible that inflammation, BHP, might account for that PSA or that it's your normal number. Or - who knows. That's the real problem you have, uncertainty.

The question in my mind is if a one year retest is soon enough. In any case, you don't need another biopsy unless the number is rising.

I'd say, just go live some life until the next retest.

All the best,
Andrew
Posted 6/29/2013 4:45 PM (GMT 0)
Again, while also potentially inconclusive, PCA3 would be another easy data point to get.
Posted 7/1/2013 7:57 PM (GMT 0)
In my opinion, allowing a doctor to perform a blind biopsy when a DRE is negative is a poor choice.  My PSA has been rising over the last few years and is now 4.3 with a first time biopsy suggested.    I elected to travel 200+ miles to a major city (NY) to get  a 3T MRI of the prostate.  It showed one lesion of 6 mm in size, contained within the prostate of 71 cc.  I am scheduled for a biopsy where they will use the MRI and Ultrasound to locate the lesion and biopsy it and the rest of the gland.    I am quite sure that had I gone along with the blind biopsy it would likely come back negative, as finding a small spot in a large gland is pure luck.  Based on the MRI results they believe there is a 60% chance that the lesion is cancer as it could be scar tissue from prior infections.  The biopsy will determine if it is cancer and how aggressive it may be.   I would suggest that you wait 6 months for the prostate to heal (required) and have the same type of MRI that I just had.  There is no sense in throwing darts blindfolded.   Post Edited (Prowler6B) : 7/2/2013 5:26:19 AM (GMT-6)
Posted 7/2/2013 6:50 AM (GMT 0)
Well, I already had the biopsy and it's begining to look more and more like I should be getting one done every year if my PSA is still high untill I hit 3 of them. The statistics show that after 3 biopsies the odds of the urologist missing the spot are slim or under 10 percent. I also read that of 36 patients diagnosed with Prostate Cancer only one on average dies from it. Sounds like alot of fear and money rolling around in this disease. However, in 6 months I will check my PSA and if it remains at 4.6 I will just assume this is my number, as it has been that for over a year now.
Posted 7/2/2013 10:28 AM (GMT 0)
Yooper indicated 48 hours after certain activities. Some suggest three days (72 hrs.)

I would suggest waiting no longer than 6 months before the next PSA test. Three months wouldn't be unreasonable. Better to catch a trend as it starts, if it does start to rise.

For what it's worth.
Posted 7/2/2013 11:12 AM (GMT 0)

I'm not sure how the 1 in 36 statistic comes about, probably results from many people who are reluctant to talk about having cancer and you only hear of it when it becomes terminal. Personally, I know about as many who have died of prostate cancer as have survived or living with it. One friend, who never had a PSA until seeing blood, did not make it to his 40th birthday. The ones who have survived PCa were aggressive in seeking out the best of the best, in doctors, treatments and diagnostic tests.

No one wants to go looking for a problem, but getting all the information you can about a possible issue will never hurt you. It's up to you and not a doctor to decide what if anything you do with that information. Having a family history of PCa and your PSA numbers would make me be very aggressive in seeking other doctors inputs.  Waiting until your PSA elevates to 7.0 could leave you with very few options. 

You stated you had three PSA readings of 4.6.  Are you sure of those numbers as I would expect some variation between test results?

In your second post you mentioned that you wish there were a belter option for you other than more biopsies.  THERE IS, I suggest you seek out a facility that performs a 3T MRI. It is a painless one hour of your time that may either put your mind at ease or save your life.

Good Luck.

Post Edited (Prowler6B) : 7/2/2013 5:56:27 AM (GMT-6)

Posted 7/2/2013 11:17 AM (GMT 0)

Bradmt said...
Well, I already had the biopsy and it's begining to look more and more like I should be getting one done every year if my PSA is still high untill I hit 3 of them. The statistics show that after 3 biopsies the odds of the urologist missing the spot are slim or under 10 percent. I also read that of 36 patients diagnosed with Prostate Cancer only one on average dies from it. Sounds like alot of fear and money rolling around in this disease. However, in 6 months I will check my PSA and if it remains at 4.6 I will just assume this is my number, as it has been that for over a year now.

Don't give up after 3. I did. Eventually disastrous.

Develop a follow up plan. I wish mine had been better.
Posted 7/2/2013 12:56 PM (GMT 0)
BradMT,

You have a point that repeated ultrasound guided biopsies tend to get into diminishing returns, especially if not spaced out. On the other hand, cancer grows (if you have it) and it does get harder and harder to miss with a biopsy needle after a while. I've seen your results about the unlikeliness of repeated biopsies to find anything but there are a lot of guys here on this forum who have been part of your ten percent.

A better plan would be to talk to your doctor about throwing in an occasional MRI among the biopsies to rule out the rare, but not that rare, cancers in places that tend to be missed on biopsy.
Posted 7/2/2013 5:38 PM (GMT 0)
Peter... Very well put. I agree 100%.
Posted 7/2/2013 6:31 PM (GMT 0)
That's the thing; this disease is as variable as we are.

My DREs were normal, my prostate was normal size, and the only indication was a PSA of 6.6. I had no symptoms. Thank God I asked my doc for a PSA in January, since I hadn't had one in over 2 years.

Uro doc said let's do a biopsy, and I agreed, since I wanted to know one way or the other. He said the ultrasound looked homogenous, with no obvious foci. The 12 core biopsy found cancer in 6 cores, with 5% involvement.

The path report after DaVinci showed clear margins with 50-60% of the prostate showing cancer. Interesting, to say the least.

It is horribly maddening when you're trying to make a life altering decision, but keep an eye on it. The MRI guided bx are a good tool.
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