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Rapid rise in PSA

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Posted 11/20/2018 12:27 AM (GMT 0)
Newbie,

I’ve been reading all the posts for several weeks, and finally got up the nerve to post. Wasn’t sure if where I am in this process was too early for requesting thoughts, however, value the information that I have been reading, and trying to get as much info. as possible.

Here’s my journey so far -
Just turned 55.
8/2017 had blood work PSA .942
2/2018 routine physical PSA .9 with free percent 44
8/2018 PSA shot up to 8.0
Went on Cipro for one month then new blood work on 10/2018 PSA 6.3 with free down to 11 percent

Referred to urologist with DRE clear. He requested a 4Kscore test. November 1st test was submitted. Results came back with PSA at 6.3 with free percent down to .9 with Elevated risk at 20 percent.

Based on all the numbers, decided to have a T3 MRI. Results came back severe hypertrophic changes prostate 55cc, and no lesions.

I have another appointment scheduled next week with urologist. Based on this information, any thoughts regarding a biopsy is necessary. Again, just trying to gather as much information as possible.

Thanks in advance for any thoughts or similar scenarios.
Posted 11/20/2018 12:43 AM (GMT 0)
Welcome to HW.

PSA due to PC rarely drops. More likely it's prostatitis as that is more likely to have wild swings in PSA levels.

It could take awhile, but it's likely your PSA will drop more in the next couple of months. In your place, I'd just retest in a few months and see. Still there are worse things than a biopsy, but you don't want to rush into that.

At this point I'd wait and see what the URO says.

Andrew
Posted 11/20/2018 12:45 AM (GMT 0)
Thanks Andrew. Appreciate the feedback.
Posted 11/20/2018 1:57 AM (GMT 0)
My personal experience was different.
Psa=11. Admitted to hospital for inflamed prostate( prostitius). A month later went to 9. Biopsy reveals cancer. 2 months later I had RP. my psa the night before the operation was 6. Your situation can be different. My URO told me when my psa went down from 11 to 9 that becuse it went down, then it’s 10% cancer and 90% just inflammation.
Posted 11/20/2018 2:04 AM (GMT 0)
Thanks AK123 for the reply. Appreciate the information.
Posted 11/20/2018 2:25 AM (GMT 0)
As already stated, elevated PSA being caused by PCa usually doesn't drop, especially not in response to Cipro. Also, PSA doesn't usually rise rapidly and out of the blue due to PCa. Both of those situations are usually due to prostatitis.

However, it is possible of course that you have both prostatitis AND PCa, like I did. As it is, you probably do not know if you are in that category, although the MRI is encouraging. Most likely, your PSA rise is due to prostatitis and/or enlarged prostate(I had that last one also). So sort of relax while keeping an eye on it, because you may well not have any PCa at all, and even if you do it is probably not causing your rapid PSA rise. Y'all correct me if I have that wrong.
Posted 11/20/2018 2:32 AM (GMT 0)
Generally (and there are always exceptions), PSA rise due to cancer is "slow but steady"--as in my case, where it was non-detectable for several years, then started a rise that lasted 4 or 5 years. And the rise was following a doubling curve: each year, it doubled from the year before.

Typically, infections cause dramatic fluctuations. Unfortunately, antibiotics are not all that successful at treating prostate infection.

I'd suggest keep checking , perhaps every 6 months, and actually track the values. And try to relax. You probably don't have PC--or if you do, it's not causing the swings.
Posted 11/20/2018 3:23 AM (GMT 0)
Thanks everyone for taking the time to respond, and provide some insight on this. I wish my UR would respond as quickly. Idle time makes the mind wander. Appreciate the information, and knowledge.
Posted 11/20/2018 4:08 PM (GMT 0)
Your negative T3 MRI (assuming it is multiparametric) should give you some confidence there is not a significant desease inside the prostate. I would wait some months and check PSA again. It can fluctuate with prostatitis, even when it is treated. Anyway, as others said, there is not a fixed rule for anything in this business. Biopsies are not fun, though they usually are carried out without major problems. And they often give false negatives.
Posted 11/20/2018 5:25 PM (GMT 0)
Yes, it was a multi parametric, and the results definitely eased the anxiety a bit. It was the free PSA falling so much that has me concerned. When reading on prostatitis, and BPH, I do not see anything that mentions free PSA dropping below 10 percent. Usually the opposite...doesn't effect the free PSA. At this stage (but still need to meet and discuss more with URO next week) I am definitely leaning towards no biopsy, and recheck again in a few months. Again, appreciate all the feedback.
Posted 11/20/2018 5:35 PM (GMT 0)
Ask about the PHI (prostate health index) blood test. I might give you better info.
Posted 11/20/2018 5:48 PM (GMT 0)
I will definitely bring up the PHI blood test. With your knowledge, have you seen situations where the free PSA drops so drastically, so quickly?
Posted 11/20/2018 6:02 PM (GMT 0)
prostatitis, infection (UTI, kidney), urinary retention, starting meds for BPH (enlarged prostate).

Without specific treatment or medications, PSA due to PC almost never falls.

While you need more monitoring and maybe a few more tests, I'd be surprised to find you have a case of PC that requires treatment. It's possible, but I wouldn't expect it.

Andrew
Posted 11/20/2018 6:04 PM (GMT 0)
I should have said where free PSA drops so drastically, so quickly, and it's related to prostatitis or BPH?
Posted 11/20/2018 6:05 PM (GMT 0)
Ok, great...thanks Andrew
Posted 11/20/2018 8:55 PM (GMT 0)
Prostatitis is also associated with low free psa. Only BPH shows higher free percentage. I would not be much worry about free psa while having an infection.
Posted 11/21/2018 12:14 AM (GMT 0)
Thanks jmadrid.
Posted 11/29/2018 6:36 PM (GMT 0)
Update from URO appointment - 100mg Doxycycline 2x per day for 10 days. Wait 10 days, and then recheck PSA. Also requesting a PHI test.
Posted 11/29/2018 6:58 PM (GMT 0)
Good. The PHI test will give you more info than just the PSA.

Andrew
Posted 12/15/2018 2:10 AM (GMT 0)
Quick question - in SoCal and scheduled for another PSA test on Monday with Quest Diagnostics. I also requested that my Urologist write an order for the PHI test. Informed by their office today that they do not write orders for PHI tests. Being that I am already giving blood on Monday for the PSA test, I would really like to get the PHI completed too. Any sugestions on how to get the PHI completed at the same time?
Posted 12/15/2018 3:22 AM (GMT 0)
First off Quest does not do uPSA that you will want in the future if you discover you have PC. Ditch Quest and use Primex labs. They are more convenient to use anyway. Where are you in So Cal. We have some of the finest Universities in the country here, and City of Hope. Sounds like you are not dealing with top notch people if they can not do a PHI. USC, UCLA and City of Hope all have satellite facilities in So Cal.
Posted 12/15/2018 4:28 PM (GMT 0)
Thanks oldbeek for the reply, but not sure why Quest would not be acceptable for completing the bloodwork? There’s a location less than a half mile from my home. I’m in Orange County. The results then get sent to my Urologist. At this stage (based on the rapid increase) i’m probably dealing with BPH and maybe some Prostatitis. I’m just trying to find out how to get the PHI completed at the same time.
Posted 12/15/2018 4:47 PM (GMT 0)
If you have PC surgery, you want to see any movement in psa if it starts to rise. Quest test only goes down to <.1. At .1 you may want to be seeing an RO when prostate has been removed. The Primex lab reads down to<.01. You may want to track any rise, like .02 then in three months .04, three months later .08. See it just doubled in 3 months. You may have a problem. With Quest, you are in the dark till.1. Now what do you do? Wait till it reaches .2, to see what the doubling time is. By .2, you definitely are in trouble and need to find an RO. Primex has no lines to get in either. Just friendlier. A good urologist can get you a phi done. How do you get one done? Get to one of the university hospitals. Loma Linda also in Orange County.
Posted 12/15/2018 5:15 PM (GMT 0)
Ok, thanks. I will check into Primex.
Posted 12/15/2018 6:52 PM (GMT 0)
This is not correct, Quest measures down to .02. I had a bad experience with quest, so I don’t use them, although it could happen at any lab.

Bianca, as an FYI, labcorp measures down to 3 digits, if want to get REALLY granular. But .01 or 02 should be sufficient
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