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Rising PSA after negative biopsy, how worried should I be

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Posted 10/7/2015 2:08 PM (GMT 0)
Having been struggling with urination problems for 8 years, my GP recommended a PSA test which I had in April of this year. The result was a PSA of 9 so I was referred to Urology and following a consultation I had a TRUSS guided 12 core biopsy at the end of May. The result of the biopsy was negative, however a high grade PIN was found in one of the samples so a follow up consultation was arranged for 3 months with another PSA test. I have just had the results and my PSA was 14. As the biopsy result was negative, the consultant didn't seem worried but has referred me for an MRI scan to get a better look at the prostate.

Although my GP and consultant don't seem concerned, my question is should I be or am I worrying about nothing. 14 seems like a very high score and an increase of 5 in 5 months seems considerable. Has anyone else experienced results of this type?

Alan
England
Posted 10/7/2015 4:07 PM (GMT 0)
I actually ended up with PC, but my doc explained that benign prostate enlargement can raise PSA - basically, the bigger the prostate (without cancer), the more PSA is made. Keep up with the docs advice and tests, but it can be as simple as that. Best of luck!
Posted 10/7/2015 7:10 PM (GMT 0)
Hi Alan -

Did the biopsy report mention anything like chronic inflammation or BPH? How big is your prostate on ultrasound?

There are a couple of biochemical tests that may be worth trying - PHI and PCA3.

An ordinary MRI isn't likely to tell you much other than if there are any big lesions or bulges. If you can get it, an mpMRI might be more useful for you.

- Allen
Posted 10/7/2015 7:25 PM (GMT 0)
I didn't get much information regarding the biopsy, as we don't pay for medical care in the UK, we rarely get to see any reports. All the information I got in a letter was there was no trace of cancer, just a small are of high grade PIN. There was no mention of inflammation, but I do have BPH and I have been taking Tamsulosin since April to alleviate urination problems but I am not sure how enlarged it is, at the time I think the urologist said about 50% larger than expected. Had my PSA stayed the same I would have had no concerns, but a rise from 9 to 14 in 5 months says to me that there is a problem. I was thinking of asking for a free total % PSA test to see what % is free PSA which may point to malignant or benign causes. I can get this done privately at a reasonable cost if my GP doesn't agree to it.
Posted 10/7/2015 7:40 PM (GMT 0)
As I said, get PHI - it includes PSA, % free PSA, and -2ProPSA - better than any of those alone. I know it's been available in Europe for years. You can ask for PCA3 as well. It's probably a prudent next step before a second biopsy.

What happens when you ask your doctor for a copy of your biopsy report? Does he really say "no, you can't have a copy."? Even in the US, the report belongs to the doctor, but if you ask nicely, I can't imagine one turning down such a reasonable patient request. Most are available online, so it's just a matter of forwarding an email or running a couple of pages of photocopies.
Posted 10/7/2015 7:41 PM (GMT 0)
You mentioned urinary problems. While you have the ear of your consultant you might want to talk about the possible causes and treatments for those problems. Often the same sort of problems that cause urinary difficulties can cause an elevated PSA as well. If your symptoms are caused by an enlarged prostate then that can be treated and, with that out of the way, your PSA will be more meaningful.

The PHI and PCA3 tests that Allen mentioned are worth doing, too, but while you are fretting about your prostate you might as well see if you can't arrange to pee better.
Posted 10/7/2015 7:57 PM (GMT 0)
I have been on Tamsulosin for the BPH since April and it has helped. Obviously I am hooping that the PSA level is as a result of BPH, and had it remained stable at 9 I would have no worries, it is the rise of 5 in 5 months to 14 that has me worried that it is not just BPH but something else
Posted 10/7/2015 8:15 PM (GMT 0)
You should be worried...The high-grade PIN very often is a sign cancer is not far away. The needle biopsy has limitations. They cannot reach the entire prostate using this method so it's possible to miss a cancerous area...A second biopsy may be necessary or even a saturation biopsy which is performed under general anesthesia in a hospital setting..It takes up to 40 samples from places the TRuss biopsy can not reach....

My cancer was not found until the third biopsy......
Posted 10/7/2015 9:03 PM (GMT 0)
Before you get too worried about the HGPIN, please read up on it. Here is a good article for you.

http://www.cancer.org/treatment/understandingyourdiagnosis/understandingyourpathologyreport/prostatepathology/high-grade-prostatic-intraepithelial-neoplasia
Posted 10/7/2015 10:31 PM (GMT 0)
BTW, just ask for the complete test results. Under the UK NHS regulations, I believe you are entitled to all information. I recently asked for a copy of the biopsy report and this was provided, albeit not to happily.

Good luck
Posted 10/9/2015 12:18 PM (GMT 0)
Just had my MRI scan date through. despite informing urologist that I am away 21st to 28th, as usual appointment came through for 28th, so that has been cancelled and now got a new date of 5th November. I also spoke to my GP and got more details about my previous tests

PSA in April 8.9
Ulrasound biopsy, prostate volume calculated at 54cm (so just over double the size of normal)
PSA is September 14.7

Is it possible that the biopsy in May could have caused prostatitis which could explain the rapid increase in PSA?
Posted 10/9/2015 1:36 PM (GMT 0)

alan55 said...
Just had my MRI scan date through.

Suggest you try to ascertain and ensure if at all possible that the MRI is 3T multiparametric, which includes Diffusion Weighted Imaging, and you will get a Pirads score.

All 3T MRI's are not equal, and the above has the resolving power you need in order to get a more definitive answer.

I asked "this will be multi-parametric won't it?" of the nurse and was told yes. What I got was 3T, multisequential, multiplanar without DWI which came back negative yet did not have the resolving power I hoped for. I know I don't have a large lesion, but don't know what I need to know.

In the US, the necessary equipment is only likely to be found at a major hospital.

I am now in the process of scheduling 3T multiparametric at a larger facility.
Posted 10/9/2015 1:54 PM (GMT 0)
Unfortunately, in the NHS in the UK, the likelihood of having the latest equipment is slim. I will ask what type it is, but I suspect it will be the one that is cheapest and least effective, although I may be proven wrong
Posted 10/9/2015 2:16 PM (GMT 0)
I think these have been around a good five years or more.

In the US, it is more the size of the hospital, whether or not it is a teaching hospital, or possibly a major care center that determines whether or not they have the ability. Would be very surprised if not available in London. I realize however, that if it is there it doesn't mean you will have access to it.

You will gain some knowledge from an MRI, you will gain more knowledge from 3T multiparametric.
Posted 10/20/2015 10:30 AM (GMT 0)
I was having a blood test last week for another reason and asked the GP if they would repeat the PSA test which they did. It has shown another increase, although not as large this time.

13/04/2015 8.9
16/09/2015 14.7
16/10/2015 15.0

So an increase of 0.3 in a month and an increase of 6 in 6 months. Could this level of increase be caused by protatitis or is it more likely that the biopsy missed a malignancy? I have a contrast MRI scan booked for 5th November but I am obviously concerned about the continuing increase in PSA levels
Posted 10/20/2015 11:10 AM (GMT 0)
I think a .3 increase, BY ITSELF, is a meaningless and normal variation to be expected from test to test. I wouldn't put much weight to it. Now if you had another two tests over the next two months and each one rose by .3, that would be evidence that the trend is continuing upward
Posted 10/20/2015 2:02 PM (GMT 0)
Alan, Yes a biopsy can increase your psa. One biopsy doubled my psa, and another one tripled it. Both spikes lasted for almost six months, and then went back down without any medications. It can, and does happen.
Posted 10/20/2015 3:24 PM (GMT 0)

ASAdvocate said...
Alan, Yes a biopsy can increase your psa. One biopsy doubled my psa, and another one tripled it. Both spikes lasted for almost six months, and then went back down without any medications. It can, and does happen.

Wow, that is the first bit of good news that I have had in months. Lets hope that is all that it is. My Biopsy was 4 months ago.
Posted Today 10:38 PM (GMT 0)
Well after a two month wait I finally got my results of the MRI scan today, but only after I called the consultants secretary for the 5th time. All the letter says is that there was nothing of concern on the scan but that he still wants to keep an eye on me so he is arranging a follow up telephone consult for 6 moths time. No explanation/speculation as to the possible cause of my seriously elevated PSA, no further investigation planned, not even a repeat PSA test. I have said that I am not happy with that and I am not prepared to wait 6 months with a PSA of 15.0, so he is asking the consultant to give me a call this week or next. I will ask for a Free/Total %age PSA test as a minimum. It could be the issue is prostatitis but I think an increase of 6.1 in 6 months should at least get some further investigation
Posted 6/29/2016 11:55 AM (GMT 0)
Hi Alan, New to this forum and I am waiting at the moment for some test results (blood and urine) hoping for prostatitis or UTI as I also have had a sudden rise in PSA....doing a lot of research at the mo My PSA went from 3.1 to 7.5 in 14 months I'm 58 and also in the UK....was interested in how your story turned out.....Hopefully all good (need some good news at the moment)
Regards
Tony
Posted 6/29/2016 1:15 PM (GMT 0)
Hi Tony. Not a lot of news but at least some progress, but after six months of worrying I decided I had had enough and decided to just live life until something happens. PSA still at 15 or was in January which was the last time it was tested. After a number of letters and threatening to raise a complaint unless I got a response to my questions I eventually got to speak to the consultant over the phone. Because there was no explanation for the elevated PSA he said to do a template biopsy which was done in April. The results letter said nothing to worry about and discharged back to GP. So still no answers and then I got a call for a survey on the care I had received for my biopsy which I couldn't fault but I said the feedback on results left a lot to be desired. She was excellent and actually read out the results of my biopsy. Still some PIN but also some evidence of prostatitis which could explain the rapid rise in PSA. At this point I did feel some relief as it was the most information I had been given since this all started. I will be having six monthly PSA tests and I am not even thinking about it. I am on holiday in Cyprus this week but if you want to PM me feel free. I know how worrying it can be and what I went through. Best wishes Alan
Posted 6/29/2016 2:04 PM (GMT 0)
Hi Alan, Thanks for taking the time to reply, especially as you are on holiday. The one thing I would ask you is did you have symptoms with your prostatitis?....you dont mention it....I have a fairly new (month or so) dull ache in my lower back where it joins with the pelvis and I am freaking out.....Good luck to you for the future anyways
Tony
Posted 6/29/2016 2:43 PM (GMT 0)
No my prostatitis is totally asymptomatic. I have problems urinating and have had for 10 years but I also have BPH. I also have mild lower back/hip pain but put this down to getting old.
Posted 6/29/2016 3:16 PM (GMT 0)
Funnily enough just had a text message from the surgery saying my results are back "and no further action needed" cue another freak out as this means the psa isn't down to an infection (although I know that chronic prostatitis wont show up)....have just rung surgery and been told to call back for an appointment in 2 weeks....Good old NHS....I have asked the receptionist for an emergency appointment (played the potential cancer card)....going in an hour....what will be will be......Thanks for your help and have a good holiday
Tony
Posted 6/29/2016 4:27 PM (GMT 0)
If they say no further action required that's a good sign they are just not giving you any details which is the problem I had. Good luck
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