Question About PSA Test.

I am 53 years old and will be 54 in September...another six months.
I do NOT have any history whatsoever of prostate cancer on either my father's side of the family or my mother's side.

When doctors started checking my PSA fifteen years ago it was always a fraction of one percent, like 0.05, etc.
In My mid forties it fluctuated steadily between 1.0 and 1.2 and never went higher that 1.2 and that's how it has been until now.

I have had four recent blood tests since November 2016 that just happened to include a PSA check even though none of the doctors nor myself were concerned with the prostate. The doctors just happened to check for the purposes of being thorough.



1) The first test was on November 29th, 2016 and the total PSA was 1.11 ng/mL (Reference Range 0.0-4.0) with the free PSA at 0.18 ng/mL. The total to free PSA ratio was 16.22%.

2) The second blood test was on December 9th, 2016 and the total PSA was 1.2 ng/mL (Ref. Range 0.0-4.0) with the free PSA at 0.18 ng/mL and the free PSA percentage at 15.0%.

3) On February 9th, 2017 a Gastroentrologist ordered complete bloodwork. This time the total PSA was 1.01 (Reference Range 0.00-4.00) but the free PSA was not checked.

4) On March 02, 2017 a GP performing my annual physical ordered complete bloodwork and this time the PSA was 1.6 but no free PSA was tested. On the day I got my results (yesterday) it was a Physician Assistant who gave them to me instead of the doctor. The PA said that the PSA's jump to 1.6 is nothing to worry about as it's way below the threshold of 4.0

I would like to know what those of you here think, as many of you have a lot of experience with this.

I recently began walking at a very brisk pace to whip myself into shape after being somewhat sedentary and I walk two to three miles every day. Could the sudden return to exercise make it jump like this? Or perhaps from having sex with my wife? I may very well have had sex just before the blood was drawn and no doctor has ever told me that ejaculation can effect PSA numbers....I learned this by reading on the internet last night.

Any information or advice would be GREATLY appreciated. Thank you.

Medvetz,

Several studies have shown increase in PSA levels after ejaculation, especially within the first 24 hours. Recent exercise (especially cycling) has also been found to increase PSA levels. If your blood was drawn after a digital rectal examination of your prostate, that could also increase the PSA level. And apart from these, as Manfred noted, there are lots of non-prostate-cancer causes for an elevated PSA.

You don't have enough PSA to count. Go enjoy life and check it next year, or the year after.

PSA is not a test for cancer. It simply shows general prostate activity and when elevated indicates you need to get evaluated about possible prostate problems. Sex, bike riding, heavy lifting, infection, enlarged prostate, and just getting older all raise you PSA number. Lab error is always a possibility. Sometimes it just goes up and done for unexplained reasons. Note that rapid large jumps are more often due to prostatitis (infection) rather than PC. PC raises PSA slowly over a long time.

Before you even think PC, you check out all out other possible reasons for an increase.

Over treatment of PC is a real problem right now and you don't want any treatments or even go down that path unless truly needed. What you have is a number that should be duly noted and checked at your next normal checkup.

If it's increased, then you'll want to see a URO and get an evaluation for prostatitis (infection), and BPH (enlarged prostate) and all the other reasons it might have gone up.

So, go enjoy life. Adopt a healthy life style with exercise, proper diet (lots of veggies) - oh and plenty of sex while you still can.

Andrew

JackH said...
Hi, and welcome!

Some good questions! I'll help you sort things out. As I'm not a doctor, just a well-versed lay-person, I can only share my own experiences and learnings...but here's my thoughts:

• Why are you here? Is it simply because of the differences between your last 2 PSA tests a month apart?
  
• PSA values jump around for non-cancerous reasons. If (as you now know) you had sex within a day or so of your test, that'll be a contributor to bumping up (temporarily) your PSA value. But just know that one measurement to the next will reveal some naturally occurring variation.
  
• You are well within (below) even the age-adjusted PSA threshold of 3.5ng/mL for your age group. (4.0ng/mL is an overall guideline for all ages, but a refined perspective uses the age-adjusted thresholds. Google "age adjusted psa") You have no reason to have another PSA test within 6-months...that seems just silly to suggest; you've got no reason to obsess over it. The standard protocol is to get benchmark data (which you've done...and your results are good), and then follow-up with testing based on those results. Discuss with your primary care physician, but based on all the great data you've got so far, retesting in a year or 2 is probably his/her recommendation. You've got nothing which is any sort of flag that I see.
  
  
  
• All that being said, you are now at the age where you should start getting familiar with diseases and issues of the prostate...starting around this time and as you start to get older is when they start popping up. There's a few PSA/PC basics that I like newcomers like yourself to first be aware of, to start their education on stuff they need to know...
  
• I already mentioned there's several non-cancerous causes of PSA in the blood. Infections are really common, and most men don't even know they have them. They cause the PSA levels to bounce up and down.
  
• Prostate cancer (PC) is incredibly common among men starting at your age. Many doctors call it a "ubiquitous" disease...that it, it's just about everywhere. Your comment about family...throw that out; hereditary PC is a very small fraction. Instead, realize that just because it is so common, it tends to appear to run in families. PC is primarily a sporadic disease, based on environment and lifestyle...same as most cancers.
  
• How common? An autopsy study of men that died of accidents revealed that 50% of 50 year olds had a detectable amount of PC. 60% of 60 YOs, 70% of 70 YOs, etc. So we know MOST men over 50 HAVE PC, and most don't know now and will never know that they have it, and it will cause them no bother. So we know the vast majority of cases of the disease is essentially harmless. It's true that in the US, 26K men will die of it this year, but that doesn't change that most cases are harmless...in fact, it sheds light on important-to-know aspects of the disease.
  
• Know that the harder one goes about looking for PC, the more likely it is that they WILL find some tiny, minuscule about of the disease...stuff that doctors in the past used to (for good reason) simply ignore. Many doctors today argue that these low levels of PC should not even be labeled as "cancer" because it tends to "brand" the patient and put undue pressure on taking (unnecessary) aggressive action.
  
• Men just learning about PC should realize that there's been terrible "overtreatment" of PC in the last 20 years. This is beginning to subside, but every man needs to be aware that there are shady clinicians still out there who are eager to perform lucrative procedures on hapless men who are uninformed/uneducated about PC. Buyer beware. Your education starts here, now.
  
• Sedentary lifestyle--that's bad for PC, but it's worse for other aspects of living a long healthy life. Did you know that the number one of killer of men with PC is not PC? It is heart disease.

Again, welcome. Your PSA test results are good. Nothing to worry about; but nonetheless, start learning things about your body that you didn't need to know before now. You should have a follow-up PSA test...in a year or 2, same as every other man in their 50s with good baseline results. Good luck!

JackH,

Thank you VERY much for your response.

Yes, the reason I came to this forum was because for the last seven years or so the PSA had remained the same, fluctuating between 1.0 and 1.2 and then in a span of just 22 days, from February 9th and March 3rd, it jumped....for the FIRST time ever...to 1.6

Had it crept from 1.2 to 1.6 in the span of 18 months to two years I wouldn't be concerned, but it seemed to be a substantial jump to take place in just 22 days, after being so stable for so long.

It's hard to relax after seeing that, but what I have read here between you and the others has helped.