40 yr. Old Male With A PSA Level of 5.5

Sammas-

I'm 8 months past my initial PSA test. My first one was 3.4, which is high for a man at 44 yrs, and surprised both my PCP and I (I do have family history by the way - father.) My PCP and I agreed to do a second test four weeks later, which was higher at 3.7 (I made sure to abstain from the activities mentioned above that can affect PSA.) Having two tests that confirmed the result made me more comfortable in submitting to the biopsy that eventually identified my PCa.

Thought I'd share what I went through, since it's so fresh.

Rich

thank you so much, Rich G.

Here's a couple points the American Urological Association (your urologist is undoubtedly a subscribing member)publishes regarding Early Detection of Prostate Cancer, and what patients should be aware of before moving forward: First, they should be aware that their risk of dying of prostate cancer is about 3% over a lifetime on average. Although many men may be diagnosed with prostate cancer, only a minority will ever progress to advanced disease and even fewer will have a fatal prostate cancer. From 1977 to 2005 the life time risk of being diagnosed with prostate cancer rose 2.3 fold from 7.3% to 17% [due to rapid increase in PSA testing which uncovered many more low-risk cases which don't need treatment]. During this same period the life time risk of death from this disease decreased by 20% from 3% to 2.4%. Men should consider the threat posed by prostate cancer and weigh this against other potential life-threatening conditions.   Second, no screening test is perfect. Some tests like the DRE are not very sensitive and will miss many early prostate cancers. Other tests, like the PSA test can generate a significant number of false positive results due to low specificity. The performance of a screening test is determined in part by the cut point utilized. This is the value that separates positive tests from negative tests and therefore predicts whether a cancer is present or absent. For PSA, a cut point of 4.0 ng/mL has been the historic threshold. When lower cut points such as 2.5 – 4.0 ng/mL are utilized approximately 80% of PSA tests will yield false positive results. Estimates from ERSPC (using a cutpoint of 3.0ng/mL) suggest that PSA screening will correctly predict the presence of prostate cancer in about one of every four biopsies.   Third, PSA values can be elevated for many reasons. Normal physiologic variation often occurs and as many as 20% of elevated values will return to normal within one year. Serum PSA levels also vary with age, race, BMI and prostate volume. They can increase as a result of benign prostate hypertrophy, prostatitis [infection] and any prostate manipulation such as prostate massage and biopsy. Finasteride and other 5 α reductase inhibitors can decrease PSA values by approximately 50%.   Fourth, prostate biopsies and treatments targeting localized prostate cancer carry risks. For every 1,000 men tested, approximately 100 to 120 will have an elevated PSA value. Most of these men will undergo a prostate biopsy, and approximately one third will experience some type of mild to severe symptom including pain, fever, bleeding, infection or problems urinating. Approximately 4% will be hospitalized within 30 days after biopsy. Among those men who are diagnosed with prostate cancer approximately 90% will undergo treatment, although over treatment rates may decrease with greater acceptance of active surveillance in the US. Treated men will experience one of three outcomes: 1) recurrent cancer that will progress despite their treatment, 2) no evidence of disease recurrence, but no benefit from treatment either because their cancer was never destined to progress and 3) no evidence of disease recurrence because their cancer was cured. While only some men benefit from treatment, all who are treated are exposed to the complications of treatment. For every 1,000 men screened, two will develop serious cardiovascular events, one will develop deep venous thrombosis or pulmonary embolus, 29 will develop erectile dysfunction, 18 will develop incontinence and less than 1% will die from treatment. The reader is reminded that these are estimates for men deciding on screening, not men deciding on treatment after diagnosis. In cases like yours of slightly elevated PSA with negative DREs, Urologists should eliminate possible contributions to PSA by prostatitis (infection) before proceeding to biopsy. It's never too early for men to start learning about their bodies, and how prostate cancer can be a natural part of aging.  There are a small percentage of cases of PC which are dangerous, and a large percentage of cases that are not.  Start your education.

Samuel,

I agree with everything JackH just said but I must admit I have never found that argument particularly useful for men in your situation. There you are, sitting at your computer, scared half to death and you are given this argument that starts with "for every thousand men...." What's with that? First you are told that your PSA is up and now you have 999 more guys to worry about. A handfull of them have prostate cancer, most don't. A couple of them will die of it. You have no way of knowing which kind you are, you just have some statistics about the whole thousand. It's just too hard to wrap your head around when your hair is on fire. It's an excellent argument to convince urologists, who may have a thousand patients but not as clear for the patients.

Here's an easier one: Currently you are stuck half-way between things. You have an unexplained high PSA level but you haven't been told it is prostate cancer. It might be, and it might not. There are three ways things can go in your next step. 1) you can get good news, 2) you can stay where you are, and 3) you can get bad news. The only good news available here is if your PSA responds strongly to antibiotics. That explains you elevated PSA and you can be released back into the wild. A biopsy will only give you bad news or no news. If it comes back positive you will have explained your PSA but you will have prostate cancer, which sucks. If it comes back negative then that doesn't mean you don't have prostate cancer, it just means they didn't find it. You'll still have that elevated PSA to explain and, while your urologist will pitch the negative result as good news he'll want to see you back in a couple of months. So, the antibiotics and a retest is the only things that can give you outcome 1). The best you will get from the biopsy is outcome 2) -- which is the most likely -- or 3) -- which is unlikely but possible.

Sam, be careful. We don't like to praise PeterDa too much otherwise he starts thinking he is smarter than the rest of us. Well, maybe he is, but we don't want him to think so!

Jim

Roy Rogers mosies up on Silver, and seeing that Gabby has the situation well in hand, turns tail, wondering what Dale is up to.

Sammas- please ignore the above - just a personal joke with PDA. All I can add to the excellent advice from the moderators is that the current rate of biopsy infection is 7% and rising. Unlike Jim, I did experience significant pain on my biopsies. It's just prudent to eliminate other sources of elevated PSA before resorting to a biopsy.

- Allen

Sammas -- I meant all 12 cores were positive for cancer. the highest was 70%. my prostate was not enlarged nor was it hard.

ed

davidg said...
I'd bet you don't have it and that your high PSA is a result of something else.

Thank you for your input. With all that you went through in spite of what you were told, why would you bet my high PSA is a result of something else?

sammas said...

davidg said...
I'd bet you don't have it and that your high PSA is a result of something else.

Thank you for your input. With all that you went through in spite of what you were told, why would you bet my high PSA is a result of something else?

Because 40 year olds with PCa make up less than 0.6% of men diagnosed with PCa. The chances that you have it are extremely thin. Of course, like me, you could be one of those remarkable 40 year old men that defies the odds, but no betting man would bet that you in fact have it. As people have mentioned above, there are many reasons for a higher than normal PSA.

At your stage I didn't think I had PCa and neither should you. Follow through wiht al testing, but don't drive yourself crazy with angst.