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Should I be concerned about my brother?

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Posted 10/28/2014 2:49 AM (GMT 0)
My brother just turned 40. I convinced him to discuss PCa with his primary care physician due to his family history (me) of PCa.

The doc did a PSA test, which came back 4.65. The doc told my brother that 4.65 is fine, and would use that as a baseline number for comparison with a follow-up PSA test in 6 months.

The doctor's nurse also told my brother that other meds my brother takes for emotional disorders (lithium, etc) might be causing the slightly high value.

How concerned should I be here? Is it OK for my brother to follow the PCP's plan (PSA again in 6 months), or should I be pushing my brother to go to a Urologist to discuss further?

-Gedman
Posted 10/28/2014 2:55 AM (GMT 0)
At age 40 with PSA 4.65 , I would go see Urologist for further evaluation. James
Posted 10/28/2014 3:24 AM (GMT 0)
Tough call - have you looked into the question of what the other meds might be doing to PSA? I'd want to confirm if the nurse is right in the suggestion that the drugs might be pushing the PSA up. Personally, I'd want that question answered first.

I would think a retest to confirm would be in order. Six months seems a bit long to wait, but I can see the PCP saying six months (feels like a standard answer). Given when you were DXed, I'd erroring on the side of caution. A URO trip before the retest might be premature.

I might suggest a retest in three months and the decide about the URO.

and don't worry too much, you've had a rough time but that doesn't mean he will. Still, he is your brother and you're watching out for him.

Hang in there,
Andrew
Posted 10/28/2014 6:53 AM (GMT 0)
Gedman,

My PSA was 3.7 when my GP and I agreed its probably best to have a DRE, which led to a Biopsy. Mind you I did complain of being over serviced whilst I waited for the results. Getting a Gleason 9, caused me to change my tune. In fact, I think I got lucky finding this small amount of PCa(G9) so EARLY.

.
Posted 10/28/2014 12:12 PM (GMT 0)
I agree that a second opinion from the urologist is a good idea.  Let the urologist determine if more is needed.  Better safe than sorry..
Posted 10/28/2014 12:31 PM (GMT 0)
At age 40, 4.65 is not "fine" from what I've learned over the years.

Three months seems like a long enough time for a retest. Also, he should be sure to avoid some of the known things that can increase it temporarily, like sexual relations within 48 hours or so, vigorous bicycle riding, things like that.

Another possibility of course is prostatitis, and it might be worth considering a round of antibiotics to knock that out. It can be hard to eradicate prostatitis, but it will cause PSA increases too. In fact, that's one of the biggest flaws of the PSA test. It can be elevated for several reasons that aren't cancer related.
Posted 10/28/2014 12:32 PM (GMT 0)
There is no harm in having a Uro check him out. Do keep us posted.


Cajun Jeff
Posted 10/28/2014 4:07 PM (GMT 0)
Get it checked... Nothing to lose.
Posted 10/29/2014 5:14 AM (GMT 0)
Thanks for your viewpoints. I'll discuss further with my brother. I agree that there is nothing to lose in a Uro visit, but getting my brother to actually do that might be challenging based on his personality and emotional disorders. I would personally take him to the Uro to ensure that he goes, but I live 600+ miles away.

-Gedman
Posted 10/29/2014 6:00 AM (GMT 0)
Do you have access to Ash Tewari? He would be a good ask about whether your brothers meds are the cause of his elevated PSA. I can only find information on Lithium Carbonate that indicates that "Free" PSA can be lowered in patients on lithium. I cannot find any indications it would cause an elevated PSA.

Do you have a more complete list of his meds? I can look it up or ask one of my advisory panelists about it. But you can do that as well with Tewari.
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