At Age 43 High PSA - what to expect?

Hi,
Age 43. Went in for a regular annual checkup and my PSA turned out to be 4.96. Doc suggested a redo and the second time it turned out to be 4.68. Then went through a course of antibiotics for 3 weeks and then retested and it turned out to be 5.26. These tests were done over about a 2 month period.

My urine tests have been normal without any infection. The only other RECENT (4-6 weeks) symptoms I've had are some feeling of not emptying out completely, some dribble after I zipup, mildly achy lower back and ED/lack of sexual appetite.
Am seeing a urologist and he has suggested an MRI and a biopsy after that. From what I'm reading online (mayo clinic), it sounds like it could be Prostatitis, but the urologist doesnt seem to think it could be bcos of the lack of infection.

I tend to worry and am super anxious about this. Any thoughts on what I should expect and if the BPH/Prostatitis diagnosis is only done thru ruling out cancer through a biopsy?

Another minimally invasive test is the PCA3. It's a urine test, following a rather vigorous prostate massage. (That part is even less fun than it sounds). It can indicate probability of a positive biopsy, and may justify doing one or not.

Ten years ago I first had an elevated PSA at age 45, much like yours, at 5.0. Over the next two years I had follow up PSAs, free PSAs, and even 3 biopsies each about a year apart. Never found anything then, and the whole protocol for follow up in that situation was not well defined. Not sure where that stands today.

Biopsies are uncomfortable, and carry some risk. They are however the only way to really confirm if there is anything going on in there to be concerned about.

You are right that prostatitis is very hard to diagnosis. There is seldom an infectious agent found in the urine, even after a prostate massage. And more often than not, antibiotics don't work. BPH is diagnosed by the size of your prostate. If your PSA divided by your prostate size is around 0.15 or less, BPH may explain it. Another way to diagnose BPH is to take Proscar or Avodart. After a few months, if your PSA drops (typically by about half) and stays low, BPH is the culprit. On the other hand, if the medicine does not lower your PSA, or if it drops, but then rises while taking it, other causes are suspected.

There are several biochemical tests that can help you decide if a biopsy is worthwhile. The lowest cost, and perhaps better than the others, is called the "prostate health index" or PHI. It includes both PSA and free PSA. It is FDA-approved and covered by insurance (cost is $125 if it is not). Your doctor can order it for you through the following site:

/www.accureference.com/phi/

PCA3 is expensive and is probably not covered by insurance before a first biopsy (because the FDA only approved it for after a first biopsy). 4Kscore is also expensive (around $400) and not covered by insurance. There other tests: Apifiny, EPI, TMPRSS2:ERG fusion, etc. All are expensive and not FDA-approved, so insurance is unlikely to cover them.

Welcome to HW.

Prostatitis or BPH are more likely, but prostatitis can be hard to determine.

More testing is a good idea. An MRI might give some good info like prostate size and anything obvious. I am not so sure that a biopsy is really needed at the moment, but there are worse things.

Hang in there and keep us updated on your progress.
Andrew

Hey Man, as one early 40 yr old to another --- welcome to a great resource and forum. I've learned a ton over the last 4 months since I joined.

I agree about getting a biopsy ... also a MRI prior is a great idea ... it could help target any suspicious areas.

I'm at the point where I was randomly stabbed and it came back positive in only 1 area ... I then got a MRI after, showing a area that we probably should have targeted specifically... this left with me a sense that my urologist was just playing from a old outdated playbook, making me feel like a number, so at least it seems like you have a good doctor.

welcome again

Best
Zzarth

Thanks folks for all the responses and support. Will update the forum based on what comes out of it. Sounds like the MRI->Biopsy route is a reasonable next step. I'll talk to my doc about the PHI based on the outcome of the MRI. He did talk about the 4K test and said that it does not really help with diagnosis and wasnt in favor of this test.

Hi there 47 with PSA's which have bounced back for years between 2.5 and 3.8.

Went to a urologist at one of the best teaching hospitals in the country. He was not overly keen on doing a retest (after CIPRO) because as many have noted, many bacteria's which may not respond to CIPRO can cause prostatitis. Thus even if a retest comes back high- still could likely be prostatitis...which is undoubtedly the most likely cause statistically for you.

Given my age (and bouncing numbers) which did not evidence a pattern, we simply started with a mpMRI 3T...to see what it would show. Findings were consistent with prostatitis and there was no evidence of rupture of capsule or any lesion. I understand from many that while these findings suggest no virulent cancer, ie, greater than G6, one still cannot definitively rule out a small lower grade prostate confined cancer. My plan is two more PSA's over a one year period- and then re-evaluate. Given my uro's thought that I do have chronic prostatitis, the bad part is my PSA numbers are not going to mean a lot going forward.

In any event I would recommend the MRI 1st (make sure it is a mpMRI and 3T); and see what it shows. Hopefully it comes back not completely negative (negative obviously for cancer- but I hope it does show indicia of inflammation/prostatitis- to lead to a more benign diagnosis for you) which could explain your higher numbers. After this, you can consider what to do next.

If is shows something, the biopsy will be much more targeted...one cannot be totally reassured by a negative biopsy- even though it is the only way of showing cancer/it cannot entirely exclude it...given that it could be a sampling error....but no need to worry now (though I know you will, because we all do!)...one step at a time.

Good luck...hope this was of some help.

I had a biopsy first and the results came back clean. Two years later PSA was on the rise. Then it was an MRI and what they called a Fusion biopsy. They used Ultra sound with the MRI results to target the tainted area and then took a biopsy during the procedure. My cancer was on the upper part of the left apex which was missed by the samples taken on the first biopsy.

Prostate Cancer at age 43 is extremely rare, thought there are some folks (like me) who defy statistics. More info about me at links below, if you are interested.

Let us know how it goes.

-Gedman

I was diagnosed at 43 after years of suspecting it.
It is unusual to be diagnosed at that age, for sure. Less than 1% of diagnoses are made in the 35-44 age bracket (seer.cancer.gov/statfacts/html/prost.html), but it does happen (gedman and me are prime examples). The age thing continued to intrigue me so much that I named my blog "PCa Before 50" although I soon changed the focus of it to salvage radiation when I needed that.

In the end, everything worked out for me. Prostate cancer is no longer high on my list of health concerns.

I would seriously consider the biopsy, if I were you. It provides your doctor and you with a considerable amount of information.

I hope you continue to keep us updated.

Best regards-

Quick update: The 12 core biopsy came back negative. So now my Drs advice is to monitor the PSA levels in 6 months and assess.

Good deal! Now take a deep breath and go back to your regularly scheduled life. You are, of course, welcome here any time, but so far, there is nothing to panic about.

Just do this:
1. Do NOT miss your follow-up PSA screenings.
2. Keep a record of the dates and PSA levels. Trends and timing may give you or your doctors some additional insight if PSA continues to rise.

You may have BPH. If so, often the treatments are purely medicinal, and have few side effects. Unless your prostate is very enlarged, the symptoms may remain stable for many years.

If libido is not your friend, have the doc check your testosterone levels. Low T really does happen. . . sometimes. Maybe not as often as the TV would have us think, but when it happens the symptoms are real. Current research is showing that there is no link between the use of T supplements and the occurrence or progression of prostate cancer, so T supplements do make sense where needed and warranted.

If things stay stable, consider this an interesting exercise in higher learning. If things go badly in the future, you have a place to come back to for advice, where folks are super-willing to help and know what they're talking about.

I'm happy for you, too!