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Bouncing PSA - Back to where I started

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Posted 12/4/2015 3:27 PM (GMT 0)
I havn't been here in a while - I tend to come around when worried....so here goes. This all started for me in 2011 with a PSA of 4.98. A week later i went to a urologist at NYU and PSA at that time was 5.4. After a course of Cipro it was 4.8. Because I had a low fpsa (12) I then had my first PCA3 - 8.7. a month later I had a 12 core biopsy which revealed only "Benign Prostate Tissue" some "focal glandular atropy" amd a couple of cores with "chronic inflammation". No HGPIN, No atypia. over the last 4 years my PSA has bounced all over from 3.6 to 4.7 to 2.9 to 4.7 to 3.5. second PCA3 was 12.3 Now I found out yesterday its back to 5.4 with a fpsa of 15. Quite frankly, I dont know what to make of all this. I'm seeing my URO next week. I imagine he will just want to retest in 6 months. any thoughts would be greatly appreciated.

Well, that was my post over 6 months ago. Just went for follow up psa and its 6.1...somewhat higher again. Fpsa is still 15. I just don't know what to make of this... Any advice or help is greatly appreciated

Post Edited (bobecus) : 6/17/2016 5:49:56 PM (GMT-6)

Posted 12/4/2015 4:56 PM (GMT 0)
Your PSA is really only telling you "something is going on"; it's more likely that not that the 'something' is chronic prostatitis e.g. inflammation, which is more often than not non-bacterial and hence unresponsive to AB's. The ostensibly negative biopsy confirmed that.

Your situation is similar to mine (I actually have a small amount of G6 - as do many men my age). My PSA is all over the map and the consensus in the medical community I have polled pretty extensively is 'your PSA is largely worthless'. Only mpMRI read by an expert can tell us anything else useful at this point and repeated biopsies aren't good for you, mentally or physically.

So... I think I would read little into your PSA and would discuss getting a mpMRI now and as a baseline for future comparison should your PSA go wildly out of its already mildly wild range.

I will quote an oncologist who reviewed my case this week:

"Oh my God, I am so sorry about what we have done to you and your life and your wife, you are the poster-boy for why people, especially Doctors should not get hysterical about PSA without context, I am so sorry we put you through this; ignore your PSA, call me if it ever goes over a 12, keep riding your horses more than ever, get an annual or two yearly mpMRI but in the meantime, go and live your life and try and put this out of your mind, we should never have put you through this, look at the damage we have done to you, I am so sorry"

I kid you not...

...relax, get an mpMRI next and go from there. IMHO.

yeah

Post Edited (Paul65) : 12/4/2015 10:13:19 AM (GMT-7)

Posted 12/4/2015 5:04 PM (GMT 0)
prostatitis is notoriously hard to Dx and treat. I know you'd like a better, more conclusive answer, but retest in six months is likely the thing to do. Or you could retest in three months.

Andrew
Posted 12/4/2015 5:43 PM (GMT 0)
I am in a similar position. Did a biopsy back in 2012 and it came back clean so we have been monitoring PSA since then. Just did another check last week and PSA was 5.43. I see the Urologist on Monday and will be asking him what he recommends going forward. I am comfortable with going back to doing an annual PSA during my physical just to keep an eye on it but not too worried about PC right now, though it will always be on my radar.

Paul65 I can relate to what you were told because four years ago when this all started I was on the verge of retiring and was wondering how I would spend my last few years on God's green earth! I have since retired and now my biggest fear is outliving my stash smilewinkgrin

"Oh my God, I am so sorry about what we have done to you and your life and your wife, you are the poster-boy for why people, especially Doctors should not get hysterical about PSA without context, I am so sorry we put you through this; ignore your PSA, call me if it ever goes over a 12, keep riding your horses more than ever, get an annual or two yearly mpMRI but in the meantime, go and live your life and try and put this out of your mind, we should never have put you through this, look at the damage we have done to you, I am so sorry"
Posted 12/4/2015 6:49 PM (GMT 0)
Thank you for very useful information. Thinking that "plan a". Will be to just have it retested in 6 months. Very possible the urologist will want another pca3 however not sure what we could gain by this.
Any further thoughts would be greatly, greatly appreciated,
Bob
Posted 12/4/2015 7:17 PM (GMT 0)
Unfortunately, prostatitis ("chronic inflammation") is often a condition that men have to live with. You didn't mention any symptoms, so at least that's a good thing. On the upside, you don't have detectable PC, and if it's any consolation, a recent analysis showed that "Baseline acute and chronic inflammation were both found to be independently associated with a lower PCa risk." I agree with you that further testing is likely to be inconclusive. It might be better to annually track with a PHI test, rather than just PSA with %fPSA.

Baseline prostate inflammation is associated with a reduced risk of prostate cancer in men undergoing repeat prostate biopsy: Results from the REDUCE study
Posted 12/17/2015 9:13 PM (GMT 0)
Thank you all for your thoughts. I went for my follow up with my Urologist at NYU. His thoughts were even though elevated, things appear stable over the last four years. DRE normal, and 6 month follow up and retest in 6 months.
Bob
Posted 12/17/2015 9:32 PM (GMT 0)
Sounds reasonable to me.

Hang in there,
Andrew
Posted 12/17/2015 10:08 PM (GMT 0)
Thanks Andrew
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