PSA Spiking in Such a Short Time

I want to be begin by saying how grateful I am for the support offered by this site. I've taken great comfort in reading many of the posts and educating myself from the experience of others.

I'm 62, in good health--vegetarian, eat right, walk my dogs 4 miles every day. My PSA has been going up slowly for the past 10 years. about a year ago it went to 4.2 and then 8 months later 5.3. A month later it's now at 8.3 and my Free PSA went from 7 down to 6.1. I was shocked at how quickly these numbers are moving. I'm waiting for results on a PCA-3 test.

After results, I plan to advocate for an MRI of my prostate prior to getting my biopsy in the hopes my urologist will at least be somewhat guided.

I guess my first question is: does my plan make sense and seem logical. I'm on my third book on prostate cancer--trying to educate myself as best I can so I can be a partner in decisions to be made.

Next question: Does Free PSA necessarily indicate the aggressiveness of cancer or merely that cancer likely exists? My understanding is that the PCA-3 is used for determination of the aggressiveness of the cancer.

Final question: What criteria do I use to decide between surgery and radiation? There's a lot of conflicting info out there.

My greatest fear about all this was the catheter coming out so I've taken great comfort in reading from others that it's not so bad at all. Another fear I have is about the biopsy. I can deal with discomfort. But I've read it can be very painful so hoping to hear from others on their experience pain-wise.

I hope I can be helpful to others once I have experience to share once I have this behind me. I'll be posting my PSA stats soon in my signature. Thanks for your time in responding.

Hello Brad-

You seem to be getting ahead of yourself here. Take a breath - slow down.

Before you plan a biopsy, I think you'll want to rule out other sources of rising PSA, like BPH. How big is your prostate? How has your urinary function been? Your PSA is rising very rapidly, and rapid rises like that often indicate prostatitis. You'll want to rule that out too.

I'm surprised your insurance agreed to pay for a PCA3 test before a first biopsy - most won't. Another biochemical test that insurance probably will cover is PHI. It includes both PSA and % free PSA. Your urologist can order one at the following:

/www.accureference.com/phi/

With very rare exceptions, all of the biochemical tests are more likely to be a true positive if one has more aggressive disease (i.e., they are more sensitive to it). But they don't tell one if he has more aggressive disease. Only a biopsy can do that.

Only a third of biopsies are positive, which is why getting an MRI first is probably not a good idea. Save it for if suspicion still remains after a negative first biopsy, or if you need it for treatments like active surveillance or radiation planning.

It's way premature to discuss treatment options before you even have a diagnosis.

Hi Brad. Sounds like you're taking on your numbers well. Great plan. For me catheter removal was a non event - didn't realize it was already out. Felt nothing. I do recommend some anaesthetic for biopsy. I went without and it was unnecessarily interesting - though in the end no big deal. Most of us can handle far more than we know and anticipTion often magnifies.

Had I thought through things more clearly a couple of years ago, I'd have taken your approach.

Best to you,
Wilderness

Hi all,

Answers to posts so far:

I live in Albuquerque (lived in Chicago most of my life and in Miami 7 years before moving here). Part of my homework is finding an experienced doctor I can trust. That may mean looking out of state. There's a shortage of doctors here.

I'll likely pay for the PCA-3 test myself since I didn't think to check with insurance prior (about $600!). It seems my insurance will pay for the MRI.

Upon DRE 2 weeks ago, my doctor reported an asymmetrical prostate but with no palpable lesions and that it did not appear at all enlarged (no BPH). (I researched and, so far, have found that asymmetrical prostate is not always unusual)

I'm a member of Life Extension Organization which offers a variety of blood tests so I've been monitoring my PSA and Free PSA through them; that's how I initially caught the fast-rising PSA. My regular doctor wanted to wait until March of 2017 for the next DRE and PSA test; told me "I'm not concerned you have PC!". That raised a red flag to me about him; now I'm so glad I didn't wait.

For the last year or so, I've been getting up 2x or 3x to urinate at night but I often drink a lot of water an hour or two before bed. (I try to drink 3 quarts of H20 daily on top of a pot of coffee and herbal teas.) My urine stream seems to have slowed down but I attribute that to my age (62). No pain or blood. Feels like my bladder empties each time; no strain. Have rarely had trouble with urine stream starting.

I also had a PAP test (rarely used anymore except sometimes after surgery or radiation treatment to check for PC recurrence when PSA goes up again). That came out 1.0 which is low. I realize this has little significance for now.

It's in my nature to be comforted by information and statistics. Not knowing makes me feel helpless. That is why I am collecting information and planning for what/if scenarios. As Mel points out, I know I will not be in a logical state of mind if/when "THE CALL" comes so I want to prepare now.

I've had extreme moments of terror followed by moments of extreme gratitude that I have good insurance and that possibly this has been caught in time without spreading. It's also taught me that every single day is a gift not to be taken for granted. My whole attitude has changed for the better. And I've lost about 10 lbs. which has brought my weight down to what it was in my 20's so I feel healthier. I'm hoping to go into these biopsy and treatment, if necessary, as healthy as possible. I'm learning to use fear to my advantage.

To those who took the time to respond: thank you so much. This site is really the only place that has alleviated some of my anxiety while keeping me informed.

Brad, welcome. I hope your stay with us is brief.

Unfortunately, the only true diagnostic method for PC, flawed though it is, is to have a biopsy. The various blood tests, MRI, etc. only give maybe's.

From the perspective of which treatment is 'better', well, it's a matter of opinion. And you'll hear some pretty solid opinions, both ways, on this forum. Here's my take:

Surgery (and I'm a 'surgery guy'):

Advantages: Immediate knowledge of true pathology. Immediate drop of PSA to zero. Psychological benefit of "having it gone". For many men, "once and done": a day or two in the hospital, 4-6 weeks of intense recuperation, then sail on.

Disadvantages: Potentially immediate side effects. Depending on pre-treatment profile, ED and incontinence can be long term issues. The statistics are not encouraging..but many men (like me) have no long term issues with either. As with any major surgery, any number of issues can spring up, from infection to debilitating pain, etc.

Radiation: Radiation comes in multiple flavors, if you will.
Advantages: Generally better side effect statistics. Minimal pain and discomfort. With some diagnoses-particularly if EPE, SVI, or LNI is present, some form of external beam radiation is just about mandatory with or without surgery, so bear that in mind.

Disadvantages: never knowing what your 'true' pathology is. That is important to some men.Treatment takes anywhere from 5 visits (SBRT) to 30-40 visits for External Beam. This can be an issue if you're a long way from the treatment location. Some studies suggest that side effects can appear long into the future. Others contest that finding.

So, anyway, that's my understanding.

compiler said...
Halbert:


You can get overwhelmed with facts, when you might not need them.

Mel

All too true, Mel. I'm an information junkie, and it took me almost 2 months to get to a comfortable spot where I felt I could make some informed decisions about my path. The situation gets even murkier when you have a couple of related conditions. I live near Chicago (BIG city) and I'm still seeking out-of-state consultations. . .

So grateful for all these responses!

A bit of GUARDED good news today: my PCA-3 test came back at a score of 13 (under 25 means less chance for positive biopsy results). Now, this test is usually not intended for use to decide on initial biopsy. It's mostly used to determine the need for 2nd and 3rd biopsies when the first comes back negative. But, some do include it as one of many factors for decision-making on next steps. So, spiked free PSA and PSA numbers but a low PCA-3 test.

I'll discuss all of this with my urologist, of course. I suspect he may want to put me on antibiotics to rule out prostatitis although I have no symptoms. I knew here is one asymptomatic form of prostate infection difficult to rule out.

Frankly, at this point, I'd rather just get the MRI and do the biopsy and have that added information now rather than wait.

Tall Allen: I see the wisdom in your words about not elevating anxiety. The information doesn't really make me anxious though; I'm actually comforted by knowing as much as possible. So I'm not planning now for treatment options as much as I'm just collecting information and educating myself. It's something I CAN DO so it makes me feel less helpless. For Type-A's that feel the need for some sense of control, it helps.

Hey Tall Allen,

Yes, I see what you mean. All of this, of course, I'll discuss with my urologist. He'll know what kind of MRI would be best to help him do a more-guided biopsy IF one is needed. I do know my insurance covers an MRI of the prostate; I already checked. And they said they also check to make sure it's covered.

From what I'm studying, an MRI of the prostate identifies aggressive tumors and typically does not identify more indolent ones. And I'm okay with that. In my mind (and I suspect my doctor will agree), it makes more sense to have an MRI map of the prostate with identified lesions, volume of prostate, etc. rather than simply rely on the TRUS.

Again, I'm not a doctor and not an expert; I'll run all this by him.

But, yes, I see what your mean. What you're saying is not lost on me. As for being in the present moment, I've never been MORE in the present moment than since this all happened.

If I may ask: did YOUR doctor put you on antibiotics for a few months to rule out prostatitis? I asked my Urologist: How do you rule out infection of the prostate as the cause of high PSA/Free PSA? His only response: "That's a good question." He said it's difficult to rule out. Frankly, I'll take my chances with a biopsy rather than wait 4 months while on antibiotics to rule out prostatitis.

But, again--I'll rely on the expert's advice, maybe get a 2nd opinion, collect as much info as I can on my own, and then HOPE I can make an informed decision. I'm not putting myself 100% in the hands of one doctor. Been there; done that.

You've spend considerable time counseling me and I appreciate it, Allen. Thank you.

Hey Halbert--the only sex I have these days is self care, alas. But yes, I'm abstinent for 2 days prior to any blood test. Thank you!

Brad,

I didn't explain the insurance conundrum well. Insurance will usually pay for an MRI. But let's say, for example, that you decide on active surveillance, will they also pay for a second MRI within a year? If you decide on say, EBRT, will they pay for yet another MRI for that? Sometimes a surgeon will want an MRI close to the time of surgery - will they pay for that too? Because only a third of first biopsies are positive, most would save the MRI for when it is more needed. But if your insurance will pay for unlimited MRIs, why not?

In my case prostatitis was not an issue. My PSA was very stable, yet moderately elevated (not a typical pattern for prostatitis). My prostate was enlarged - 55 cc - and I took Proscar for several months to see if I could eliminate BPH as a probable cause. When my PSA did not go down, this was a pretty good sign that there was PC. I had an equivocal % free PSA, and this was before PHI was available.