Newbie question about psa spike

I've found my way to this forum after some early, worried googling, and I'm grateful for what looks like a well-informed and very caring community. I write in hopes that somebody out there will be able to shed a little light on my own, odd test results. I'm 63, in good health, and have historically had psa levels between 2 and 4, thus no cause for concern. I'm also taking monthly testosterone injections. Doing some blood screening for other conditions altogether, I asked that my testosterone and psa levels also be checked, in anticipation of an annual physical at which I talk my general health over with my doctor.

All the other levels were just fine, but the psa had suddenly jumped to 19.1 and the testosterone level was way high at 2400--after years of reading subnormal, which was what occasioned the testosterone injections in the first place.

I was referred quickly to a urologist, whose nurse practitioner did a rectal exam and found the prostate very slightly enlarged on one side, but without any suspicious nodes or irregularities. I'm scheduled to recheck the psa and testosterone levels in 2 weeks and for a biopsy in 4 weeks if the psa hasn't suddenly come back down.

My hope, of course, is that the sudden high psa is an anomaly and that it's somehow related to the high testosterone and that both will come down when I stop the injections (I had the last one about a week before the blood test). On the one hand, it's hard to believe that it's a complete coincidence that the two levels spiked together and for the first time; on the other hand, nobody I've spoken to thus far and nothing I've found on line has suggested that elevated psa is sometimes caused by artificially elevated testosterone.

I know that I've chiefly got to just wait and see what happens; and I know, too, that even if I should have prostate cancer, there are lots of you out there who are living well and happily with it and that a positive diagnosis doesn't have to be the end of life as I know it--or the end of life altogether.

But in order to help me with my waiting, I do wonder if anybody out there has had similar test results or knows anything about the correlation between testosterone and psa levels that would help me to have a more educated hunch about what's going on.

Thanks in advance for any light that you can shed--and just for being out there.

Hello, welcome to the forum.

Even for guys who don't have prostate cancer PSA tends to vary a bit with testosterone. Not usually that much, though. On the other hand 2400 is a lot of testosterone. So, I dunno.

It could be that the high testosterone level is a red herring that is distracting us from another possibility: you could have a prostate infection. That is the other frequent cause for a PSA spike. Often one's doctor will prescribe a course of antibiotics and retest the PSA to see if the antibiotics make it go down. If the rise is caused by prostate cancer it will just keep going up so the antibiotics do provide some useful information and can sometimes help avoid an unnecessary biopsy.

Did your doctor talk about the possibility of prostatitis?

Hate to say it but a 19.1 PSA isn't a bit scary so I understand why she jumped on it. Still, waiting for the test results is annoying. Glad to hear she did the urine test. Guess you won't hear about that until tomorrow.

Andrew

@Aging Prof -
First think I would suggest, if you haven't done so already - get a second opinion on the pathology. Its very easy, your urologists office gets those requests all the time. Just call them and tell them to send the slides out for second opinion to Dr Jonathan Epstein at Johns Hopkins or David Bostwick at Bostwick Laboratories. Reading the slides is a very subjective thing, and these two docs are recognized experts whose FOCUS is prostate cancer cells. Local hospital or lab pathologists tend to look at many different types of slides, not just PCa. My original path report showed Gleason 8 (3+5), and Epstein downgraded it to 3+3=6, later that was reconfirmed by MSKCC Pathology/

Second, as anxious as you are, it is advisable to generally wait at least 6 weeks from biopsy to get the MRI done. I had mine done after 5 weeks and while they are pretty sure about certain things, there was a comment in the report that post biopsy hemmorage made for a limited assessment of the proststate.

Regarding your mental state.... To be expected, and I say this as someone who was just recently diagnosed 2 months ago. Most here will tell you that for the first month I was a mental wreck. But you go through stages, and the first stage is shock and awe. Eventually you come to acceptance and the realization that PCa is not like other cancers. Not fun, but you can live a long time with a good quality of life, EVEN IF you are confirmed as G8. Look for posts here, there are guys here that were diagnosed with advanced cancer, bone mets, etc, who are doing fine. Look for posts from Todd1963, an active poster, who was diagnosed with advanced stage, and a PSA OF 3200, at age 42. He just turned 51, has everything pretty much under control and is doing well, living his life. That's inspiring. Focus on those stories

But first you have to give yourself time to let things sink in.
I'm doing surgery first week in January, I cant tell you I'm not anxious, but I've come from where you are now, to being out of the fog, and even enjoying watching an occasional movie, in a relatively short time.

Knowledge is power. Learn everything you can about disease ,by reading here, and elsewhere, talk to many doctors, don't let any of them push you one way or the other without knowing all your options. Knowledge will go a long way to calm you down. We are all here as a resource and as support for you.

Many thanks for the kind and wise words, Dan. I'll do my best to take them to heart. Be well yourself, and enjoy the season.

Yours,

Tim

Tim,
Sorry to hear about the biopsy results. That's a kick in the teeth. Take some time to deal with those emotions, it's more than a bit of a shock.

Do get a second opinion and start making the rounds to figure out what treatment to get. The raw numbers can look scary but you've got plenty of treatment options to go for and every hope of keep the beast at bay for a very long time.

Not going to be fun, but it's doable.

Hang in there and know we're most days if you have questions or just need to vent.
Andrew

Dear Prof,

I just wanted to send you a note of encouragement today. So many here have been where you are today --- the sudden news, the anxieties, the restlessness, the sleepless nights, the worries, and the fears.

It takes some time, but you will start finding your way down the path. Find those activities that bring you some solace --- family, friends, exercise, an old movie, a favorite TV show, a good book, a walk in the park, a visit to church, a visit to the coffee shop, some volunteer work ... something that moves you forward. Do your best to follow your normal schedule and routines ... stay connected with all your friends, family, colleagues, and neighbors.

Along the way, you are going to find some fellow travelers on this path who can help you. It might be family, someone from church, a colleague, an old friend ... or a new friend that you meet. Friends and family and colleagues and neighbors that you have now will CONTINUE to be important to you. However, you will begin to connect with some NEW people who are also traveling on this same road that you are now traveling upon, and they are going to enter your life in unexpected and meaningful ways. This has happened to me ... I've met new friends who understand this kind of diagnosis and have formed new bonds with them over time. Cancer brought us together at the beginning ... but our friendship extends way beyond health concerns as our friendship has developed over time. I predict that this will happen to you ... and it happens in unforeseen ways and at unexpected times ... but can be very meaningful when it happens.

You have ALREADY found this website and you can already begin to see that you can form bonds with the hundreds of members who visit this website. They can answer questions for you, listen to you, and provide solace for you in whatever circumstances you are facing. They are here day and night, weekends, and holidays ... this is Christmas Eve as I am typing this ... that's the power of reaching out to others like you have already done by joining this website for advice and support. We have all experienced the peaks and valleys that a cancer diagnosis brings. I just wanted you to know, I am standing right beside you at this time in your life and you have already heard from others that are also standing right beside you. It's amazing how powerful that feeling of support can be ... people from all across the country ... you don't know their faces or their names ... but you CAN feel their support and can instantly be encouraged by them.

All you have to do is look back at past threads formed over the course of years to see the powerful bonds of support that exist here among members ... they listen, they care, and they are walking right beside you in everything that you are facing today ... and tomorrow.

Stay connected and stay in touch by continuing to post on this website. Meanwhile, I will remember you in thoughts and prayers tonight on this Christmas Eve.

Sent with caring thoughts,
Cyclone

Post Edited (ISU-CycloneFan) : 12/25/2014 9:27:27 AM (GMT-7)

Tim, Honestly, this stuff sucks. There are some smart guys who drop by here and will offer advice much wiser than mine. I just wanted to offer some encouragement. Feel free to vent... It really works to get some of this off your chest.
All the best!

Hey Prof...welcome.

Waiting is no fun. DX'd a month ago myself. Still awaiting my 2nd opinion from Dr Epstien @ Hopkins. Had a bone scan today. Will know more soon.

Listen to the guys here. There's a wealth of knowledge and hope abounds.

I'd only echo to be your own best advocate and don't be afraid of what others think. It's your body...not theirs.

Be cool. And...busy when you feel like it and not when you don't.

David