On AS - Do PSA results which move up AND down signify anything?

I'm 54 and currently on Active Surveillance. No family history of PC, all DREs normal and otherwise in very good health. My first PSA test ever was done 4 years ago at age 50 which was 3.7. One year later it jumped to 5.8 which led to first biopsy done at Mass General in Boston by a well regarded urologist/surgeon there. 14 cores taken with only 1 positive showing <1% of Gleason 6 cancer. As an additional gate to AS, that was followed by a Prostate MRI on 3T, again at Mass General, which showed no evidence of any cancer, marks, lesions, etc. completely clean. My doctor's advice was to go on AS.

Since then I’ve had the following PSA and other results:

10/13 - 5.1
4/14 - 6.0
5/14 - 5.5
7/14 - 2nd follow up biopsy as part of my AS program. 19 cores were taken, with again only 1 positive at 5% Gleason 6.
12/14 - 6.6
3/15 - 6.7
6/15 - 7.1
9/15 - I had another MRI (on 3T) which again was completely clean showing no marks, lesions or any evidence of any cancer. My doctor felt this result was very positive.
10/15 – 7.9
11/15 – 5.9
4/29 – 8.2

As you can see from my results, the MRIs are very encouraging and the biopsies indicate low risk cancer. Based on that, I'm comfortable staying on AS.

My PSA results trend up overall but also have dropped fairly meaningfully at certain points. Do PSA results which move up and down vs. just moving up, signify anything? I never seen anything on that topic and would be curious if anyone else has.

Thanks in advance.

Thanks for your reply Tall Allen

Inflammation was never noted on biopsy reports. That said, my PSA has risen more and I've sensed a bit more urgency to urinate on occasion after my 2nd biopsy. Nothing substantial but its something I hadn't ever experienced before.

It's just a hunch, but I there's a chance the biopsies may have created some inflammation

Psa varies naturally by up to 20%. It also varies by the time of day and by season. The trend is important, not any individual reading.

Also do you have a whopper of a prostate?? that could explain psa along with the very likely answers the gents have responded with…as well as the urination problems..are they recent..

Your PSA is in the gray-area where it can be significantly affected by infection. The up-and-down is a clear indicator of possible infection, and one cannot identify separately the PSA contribution from your small amount of PC from the co-existing contribution from prostate infection. Have you taken anything to combat the infection that appears to be present?

Thanks for the responses to all.

My Uro has never suggested antibiotics, so have not tried that to date.

Paul65, I think you may be on to something with respect to my situation. I typically avoid sex and exercise for only a day or so prior to my PSA tests. For exercise, I do cardio and lift heavy weights (like bench press 300+ lbs.). In the cases when my PSA has jumped up more than typical for me, the first thing my Uro has me do is re-take the PSA test after holding off on exercise and sex for at least a week. 6 mos ago, my PSA jumped up to 7.9 at my annual physical, so my Uro had me re-take and I held off on lift weights, exercise and sex for 2 full weeks. That PSA taken only two weeks later showed a big drop down to 5.9. I had a similar meaningful drop after holding off on sex/exercise for more than a week a few years ago.

Hearing something similar from you makes me think this could be my issue as well.

Rick I am in the same position as you are- numbers that bounce around quite a bit- not quite as high as you but given that I am a bit younger still concerning. Would like additional thoughts on the issue but here are a couple of principals that I have reconciled myself with- whether accurate or not:

1. PSA increases evidence that something is going on with the prostate....either cancer, BPH, prostatitis or something that cannot be identified.....one of the four.
2. If cancer is the culprit for continued increases in PSA, then ones PSA should be always trending upward---ie, an elevated PSA followed by a couple decreases suggests that the initial elevated number was not due to a cancer response but one of the three other reasons.
3. As someone asked you, what size did the MRI note for your prostate....I have seen a formula (perhaps too simplistic) of multiplying size by between .10 and .12 to get a good sense as to what your PSA baseline should be (based upon size only). Has anyone else encountered similar numbers?
4. I have not undergone any biopsies but did have a 3T MRI...it did evidence prostatitis....meaning there was evidence on the MRI attributed to inflammation.

I was wondering given that you brought up your two MRI's whether anyone has any comments regarding the approach I have taken---no family history of PCA, 47 yo, PSA's bouncing around a bit from 2.5-3.9 over a 6 year period. Rather than go the biopsy route, just went with a 3T MRI at a teaching hospital in CA....which apart from evidence of prostatis showed no issues with prostate capsule, no lesions, tumors in prostate, no lymph node issues, etc....well respected California MD went this route late last year....will 3T MRI serve as an appropriate screening method for low risk candidates in the future in lieu of a painful biopsy??? The key is what method of screening can give one the best guidance....a biopsy which could produce a false negative result or an MRI which can see clinically significant cancer but may miss small tumors that a biopsy (if luck would have it) may randomly find....?

My understanding is that you should continue to be reassured by the MRIs Rick....nice that we have advanced scanners out there....hope the insurance companies continue to allow you to use this tool with AS.

Thanks Rick...your case is actually very informative to me given my approach...because if I understand you correctly, two 3T MRI's were not able to pick up your low grade PCA...and I am assuming that given you are at MGH and at least the second MRI would have been after a biopsy showing trace cancer....that the radiologist would have (a) known same and (b) been looking very carefully at the imaging. Thus your case is testament to the limitations of an MRI....by the same token appears consistent with the objectives in my case...namely to see if there is any clinically significant cancer....which while never 100% can give one some comfort level.

Although this may sound a bit foolish...given a few scares over the last few years with some higher numbers than I hoped for...I may be the only one who considers himself on AS, notwithstanding no current diagnosis of cancer.

I agree with you, while prostatitis is a much better diagnosis than cancer...it does, if chronic, as likely the case with you and I, make continued screening through PSA a nightmare...and likely very ineffective.

Thanks again for your thoughts!