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When is an increase in PSA alarming?

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Posted 10/13/2015 4:37 PM (GMT 0)
I find myself reading & reading stuff online, but it seems very little is definitive.

I just turned 60yo. Good health other than everything having "gone soft" from living the good life.

I've been on Angdro-Gel (T replacement) for well over 10 years, so I've had DRE and PSA on a regular basis. The past 5 years of records that I have, my PSA has bounced up & down from 1.5 to 1.9. This year (Aug) it was 3.6. Doc never called or sent a letter of alarm, but I was shocked when I saw that and sent an email. The word was to get re-tested.
30 days later it was down to 2.4. Not back to my consistent numbers, but lower.
Going to have it re-tested again this week (60 days). In fact, appt with urologist today.

Should I be alarmed (yet)?

I'm suspecting at some point to get the recommendation of a biopsy. That really sounds like an unpleasant (understatement) experience, esp if it's not necessary. (It seems that when they see I have great insurance, any and every procedure is recommended. Am I cynical?)

I see that many of you have been forced to become very educated on the subject and your thoughts are very much appreciated.

JH
Posted 10/13/2015 4:53 PM (GMT 0)
Welcome to HW.

First understand what PSA is and what it isn't. It's not a test for cancer, it simply measures prostate activity. A high reading simply means you need more tests to find out what is going on.

I am going to assume you're worried about having PC. Well, your PSA is acting more like an infection (prostatitis) than PC. prostatitis can cause rapid changes in PSA. PC tends to grow slower and almost PSA doesn't drop like that without treatment.

A retest is a good idea. A biopsy seems overkill right now. Before you go that route you need to elemiate all other possible reasons why your PSA went up and then down. prostatitis, BPH, the gel, sex, bike riding can all cause your PSA to go up. Cancer is very low on the list.

Check out the sticky threads at the top of the forum for more info.

Hang in there and keep us updated on your progress,
Andrew
Posted 10/13/2015 5:02 PM (GMT 0)
Thanks for your reply, InTheShop. From what you have said, I should add some pertinent info.

Worried about PC? -- Yes. That's why I'm checking in here.

BPH? -- Yes, I have that diagnosis. Doc says almost all guys my age have it. Said diagnosis got my Ins Co to approve Cialis (30- 20mg per month -- wife very happy). Very minor difficulty with slow urination sometimes.

Other factors? I had never been informed that any of these things could affect one's PSA, so I have no idea if I ever had sex prior to testing. Likely always had the DRE prior to the PSA test. The recent re-test (drop to 2.4) was def after no sex or vigorous activity.

I do apologize for "running scared" already when most guys here already have a Dx to worry about.

Thanks,
JH
Posted 10/13/2015 5:16 PM (GMT 0)
TRT can readily play into a PSA reading, TRT also tends to increase BPH which increases PSA, sex within 48 hours of test, various factors along with the phase of the moon and how you were holding your mouth when they drew the blood (ok, just kidding with those two) can affect PSA. I have read that prostatitis is notoriously difficult to diagnos and cure.

Things to look at before you go the biopsy route, probably better to get a PHI test, and possibly a PCA 3 test.

More reliable results than a simple PSA. However, you need to understand there is no definitive diagnosis for prostate cancer other than positive biopsy. Negative (blind, not targeted) biopsy is not necessarily definitive.

Suggest if you need more testing you obtain PHI, PCA3 and then if you need more diagnostics move on to 3T multiparametric MRI with Diffusion Weighted Imaging and a PIRADS score. This MRI can be then used (if something found to target) for a Targeted MRI or Fusion Biopsy.

Post Edited (Ken) : 10/13/2015 11:37:17 AM (GMT-6)

Posted 10/13/2015 5:43 PM (GMT 0)

IsItSerious said...


I do apologize for "running scared" already when most guys here already have a Dx to worry about.

JH

It's scary stuff, no need to apologize. We're here to help as we can. Ask all the questions you want.

I don't think you're at the point where a biopsy makes sense yet. Further monitoring of your PSA does make sense. You might look into the PHI test (search for it on this forum using the search bar at the top of the page). It might give you better information to work with.

Right now it sounds like your URO is on the right path.

Andrew
Posted 10/13/2015 6:05 PM (GMT 0)
Yep, I wouldn't get a biopsy until I was absolutely sure I needed it, and your doc will guide you. I didn't find it painful at all, but the side effects are pretty nasty!

For me the PSA and Free PSA ended up sending me to the uro, where a thorough DRE pretty much made very much aware a biopsy was necessary.
Posted 10/13/2015 6:51 PM (GMT 0)
Generally cancer will cause a consistent steady rise in the PSA.

One thing that can be considered is to take Avodart for a while. It is used to treat BPH. It will usually reduce the PSA by about a third in about 90 days. After that time a PSA increase could be more indicative of cancer and could prompt a biopsy. If the PSA stabilized it could indicate the recent change was not from cancer.

If you are having some urinary issues you could look at Jalyn which combines Avodart with Flomax. This could provide relief in each area. I was on Jalyn as part of my PCa treatment and didn't have any side effects from it.
Posted 10/14/2015 5:02 AM (GMT 0)
Also...different docs many times use different labs. Different labs will give different a different PSA on the same blood. I had my blood drawn by my pcp one morning and 2 hours later got it drawn again from my uro. A 25% difference in PSA readings that day. They used different labs.
Posted 10/14/2015 1:12 PM (GMT 0)
Saw the Uro yesterday. He's not alarmed (yet). Recommended re-test of PSA on Friday, after 4 days of no sexual contact.

I appreciate all the informative feedback. I have 3 close friends who have been Dx with PC in the past 5 years. One of whom is an internist (so you'd assume he's very informed). His PSA had never gotten as high as 4.0. He underwent robotic surgery (at 55yo) and 5 years later still requires a mini-pad for incontinence (even after AUS), and has given up any hope of ever resuming intimate activity (even after an implant).

It makes it a bit scary when you get a test result with a sudden increase, even if only 3.6.

Thanks!
Posted 10/14/2015 1:20 PM (GMT 0)

IsItSerious said...
One of whom is an internist (so you'd assume he's very informed).

My former next door neighbor a retired neurosurgeon had robotic surgery recently. He was a Gleason 6. I was surprised he had surgery as gleason 6.

He was a surgeon, surgeons cut.

Your situation is one you need to pay attention to, but is not yet suspicious or alarming.

Let us know what your new test results are.
Posted 12/1/2015 12:49 AM (GMT 0)
Just an update:
Aug 3.4 PSA (Doc's lab)
Sep 2.6 PSA (Quest)
Oct 3.0 PSA (Quest)
Nov 3.4 PSA (Doc's lab)

Yeah, I got them to re-test every 30 days there in hopes of achieving peace-of-mind. I've read that different labs can get different results, so trying to be consistent now. No one seems worried at this point. Guess I over-reacted. Thanks for your understanding. The unknown is scary. Re-test again in 90 days.
Posted 12/1/2015 12:53 AM (GMT 0)
It's scary stuff. Glad you got better numbers. Yes, different labs and different test methods can generate slightly different results. The fact that the doc's lab is reporting the same number is great news.

All you need to do is to keep monitoring.

and possibly never have to do anything about it.
Andrew
Posted 12/1/2015 1:03 AM (GMT 0)
" (It seems that when they see I have great insurance, any and every procedure is recommended. Am I cynical?)

NOT AT ALL...........
Posted 12/1/2015 2:21 AM (GMT 0)

Fairwind said...
" (It seems that when they see I have great insurance, any and every procedure is recommended. Am I cynical?)

NOT AT ALL...........

Since I have been on Medicare with supplement F (full) I have noticed it's like a Gold Card of some sort.

I know what Medicare pays is reduced, and reduced a surprising amount in most cases but it is like they need it to fill in the gaps on the overhead.

Not as great as great insurance probably but I do know the feeling.
Posted 12/1/2015 4:14 AM (GMT 0)
It is not you who is the cynic fairwind... it is the the paradigm.
Posted 10/23/2017 2:58 PM (GMT 0)
Reviving my original thread after 2 years (unfortunately) almost to the day. Now 62 years old. PSA has been in the mid-3's all this time.

I've been experiencing pain in lower left abdomen for 4 months along with a feeling of pressure behind my rectum and a significant change in bowel habits (which I attributed to Metformin for newly diagnosed Type II diabetes).

KUB Xray & CT scan eliminated possibility of kidney stones. Colonoscopy clear other than some "minor" evidence of diverticulosis. DRE is normal (slightly enlarged for years) but routine PSA came back 4.8 last week. Retested and results today are 5.8. Doc is prescribing antibiotics and scheduling PSA retest in 6 weeks.

As noted before, close internist friend had PC without ever having PSA over 5, so I'm again concerned. From my reading, I'm thinking (hoping) that this is more likely indicating prostatitis rather than PC. Just trying to further educate myself. Not that I don't trust my doctor, but every death certificate is signed by a doctor (who did their best).
Posted 10/23/2017 3:21 PM (GMT 0)
So now the PSA is outside the normal range for your age and is increasing. That may or may not be of importance, but certainly bears further investigation. Unless the PSA continues to increase, or the DRE is positive, it is probably early for a biopsy. I think the right track is to try the antibiotics and keep testing to find a trend. At that PSA level, it is unlikely that you would have any physical symptoms from PCa, if you have it. For most men PCa has to be pretty far advanced to be symptomatic and would usually see much higher PSA than you have. When I was diagnosed, my PSA was 59 and I did not have any symptoms.

To your original question as to when increasing PSA is alarming. Very simple. When it is your own PSA that is increasing. You have been properly alarmed and appropriately attending to the increase. Well done. Now let's hope the current treatment reverses the trend.
Posted 10/23/2017 3:31 PM (GMT 0)
Sound like you're on the right path. Retest is good. After that you can revisit the problem.
Posted 10/29/2017 4:10 PM (GMT 0)
UPDATE:
After one week on antibiotics I had a retest done, but this time at the same Quest Lab that I have always used. The high test (5.8) earlier this month was done at a different lab chosen by the doctor's office.

My new result yesterday was 3.1

Can a different lab really make THAT MUCH difference?
Or is that the antibiotics are working against something that elevated it?
I clearly need to do more reading on prostatitis.
Posted 10/29/2017 4:41 PM (GMT 0)
One other thing you should know...if it's cancer causing the rise in your PSA, it very seldom goes down without treatment that makes it go down..You might stop the TRT for a while and see what kind of response you get..
Posted 10/29/2017 6:18 PM (GMT 0)

ItIsSerious said said...
...which I attributed to Metformin for newly diagnosed Type II diabetes.....

I don’t mean to add more confusion to your understand of what is going on with your PSA test numbers, but I seem to remember that Metformin has an affect on PSA.....

/www.ncbi.nlm.nih.gov/pmc/articles/PMC5053259/#!po=41.3043

TG

Posted 10/29/2017 6:19 PM (GMT 0)
That zigzagging psa is not indicative of PCa, but rather typical of prostatitis.

Just keep monitoring it. You should ask your doctor use the PHI test in the future. PHI includes psa and free psa, along with a biomarker for cancer activity. It is more accurate than psa alone.
Posted 3/1/2018 5:56 PM (GMT 0)
I thought I had lucked out on this, but now my urologist is suggesting a biopsy based on my recent PSA.

DATE PSA LAB
---------------------
02/18/16 3.1 SLU Lab
05/05/16 2.1 SLU Lab
11/01/16 3.0 SLU Lab
06/27/17 3.4 Doc Lab
10/17/17 5.7 Doc Lab
10/26/17 3.1 Quest
11/17/17 3.4 Quest *
11/17/17 4.2 Doc Lab *
02/23/18 5.4 Doc Lab # Eosinophils= 13.2 (high)
02/28/18 3.5 Quest # Eosinophils= 5.8 (normal)

Notice the results from the Lab at the Doc's office are always higher. (???) Esp the two tests performed on the same day with results of 3.4 vs 4.2.

CBC on 02/23 also showed a high Eosinophils which can be an indicator for cancer (from what I read -- doc did not emphasize this) but was normal level in Quest Lab test 5 days later.

The nurse who called did not indicate what type of biopsy the doc was recommending, but I see there are two types -- transrectal and transperineal.

Some months ago I notice blood in my semen and was prescribed an antibiotic for prostatitis. No further indication at this time.

I'd appreciate your advice as to whether it is time for a biopsy (or a 2nd opinion), and the (dis)advantages of each type.

Also, I'm not thrilled with this particular doc and I'm near St Louis, so I have many many choices and would appreciate referrals if you give your doc high marks.

THX!
Posted 3/1/2018 11:50 PM (GMT 0)
I'm all for second opinions when you have many questions and you're not thrilled with your current doc. Surely there's someone at WUSTL or Barnes-Jewish you should consult -- maybe others will be able to give you names.
Your DRE in Oct 2017 was normal. Have you had one more recently, and same result?
Posted 3/2/2018 1:57 AM (GMT 0)
All DREs have been said to be normal.
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