Thoughts on Elevated PSA?

I've been reading information on this board for about 6 months now. I'm 55 yo. In the past 15 years, my PSA has ranged from 0.9-1.9. In February 2016 it was 5.2. At this time I had an inguinal hernia that
was repaired in March 2016 fwiw. Since that time, I had a repeat PSA of 2.8 with a free of 13.2 in May. That was followed by a PSA of 4.6 with a free of 11.6 in November. My last PSA a few weeks ago was a 4.2 with no free tested. I've never had an unusual DRE which I've gotten for the past 15 years. My last DRE was done by my urologist in March 2016 an he said it felt normal. I feel well and don't really show signs of any symptoms. Any thoughts? Thanks.

at 54 my first ever PSA was 6.8. I had no symptoms.

ed

A bouncing psa is typical of prostatitis. Prostate cancer psa usually does not fall by half.

There are other tests, like PHI and PCA3, which can provide some predictions on the likelihood of cancer..

If those are suspicious, then an mp-MRI. If areas of interest are seen on that, then a fusion biopsy to target those areas.

ejc61 said...
Having had endocarditis 3 years ago, I'm a little concerned about having a biopsy due to risk of infection but that's another issue.

As long as you are properly pre-medicated, you'll be fine. Have a chat with the uro in advance, and ask them to do all possible pre-meds. I have had too many cardiac "procedures" (valve replacement, bypass, pacemakers (on the second one now), pacemaker lead replacement, etc.), so my uro did a rectal culture a couple of weeks before the biopsy. Then a couple of days before the biopsy I had to go in for an injection of antibiotics targeting the particular stuff living in my system, then I had the usual cipro for the day before, day of and day after the biopsy. Be forewarned, though, that the advance injection of antibiotics hurt more and for a longer time than the biopsy itself. (But my uro used a prostatic nerve block for the biopsy, so I felt almost nothing of that procedure.)

I'm going to tell you a little different—a little more—than what the others have said so far.

Yeah, you probably do have some prostate infection (prostatitis) which does, indeed result in some up-and-down results of PSA.

But you probably do also have some small amount of prostate cancer (PC).


Whoa...don't freak out at this news. I say this mainly because about 55% of men your age DO have some small amount of prostate cancer...and by far most don't know it, and most will never be bothered by it. It is a natural part of aging. (That data comes from autopsy studies of men who died in accidents; after about age 40, the percentage of men with measurable PC was about equal to their age...as in 80% of 80-year olds.)

In general, in men who do not have prostatitis, free PSA tends to be another general indicator of the likelihood of PC, and free PSA in your range would in those conditions indicate likely PC. BUT, for men like you who seem to be carrying around some prostatitis (due to the up-and-down), the free PSA is meaningless. Prostatitis can cause elevated PSA reading and low free PSA percentages...both false positive indicators for PC.

The American Urological Association (AUA) "best practice" guidelines encourages physicians in situations like yours to try to eliminate unnatural causes of PSA from possible infection BEFORE moving to biopsy...so I'd encourage that you make sure your doctor follows his AUA guidelines. But in the mean time, since PC is a natural part of aging, I'd also start to learn a bit more about it. Start with the sticky thread at the top of the page titled "Newly diagnosed with PC? - read this thread first." You haven't been diagnosed yet, but if for no other reason than you are 55, it might be in your future. Start learning now that most PC cases DO NOT need aggressive treatment...

ejc, that's interesting. While I was pretty panicked on the days leading up to, and after, my diagnosis of PC, it was the subsequent diagnosis of coronary artery disease that acted the bajesus out of mr, way more that pc.
I think it's because I realized it's highly unlikely that time.

CAD, on the other hand, can get me at any time without warning.

Like nothing, we adjust to our "environment", or our personal circumstances.

Well we are going to schedule a biopsy. He thought of me as less than the usual worry but not scot free. He's going to do a swab prior and he's aware of my previous endocarditis. Thanks all.

So, the biopsy was unremarkable? No lesions seen?

A size of 28 is basically normal. Nothing to worry about. I have read posts from guys with 98, 130, and even 210 gram measurements. Good Grief!

When the infection goes away, be sure to take time to celebrate. The rising psa will have to continue to be followed, but, for now, your lights are all green.

Well the covering urologist called me with the following information. 3 cores positive out of 12. She gave percentages of 5%, 20% and 5%. Gleason 3+3=6. I asked if anything else struggling to write it on a sticky note. I asked what she thought and she replied "not bad at all". I'm to make my follow up call to schedule a cancer consult with my Uro.