PSA Level Concerns

Do what you have to do to get a handle on your feelings. My best talks were with a work friend who went through this at age 49 and still plays hockey. It is a personal issue that is hard to talk about except with others that have been there. There are support groups in most cities if you want to find others to chat with.

I still have trouble getting to sleep sometimes as my thoughts return to my PCa and the future. The situation never converges on a solution in my mind and the gears keep whirring. It sucks but gets better with time. It is a shame that the doctors cannot have have you come in and do everything possible in one day and then give you all the results. As it is, there are many steps in the process so it always seems like you are waiting on something thus some anxiety is always there.

Good luck

Sounds like you're in good hands and he's given you a smart plan.

Andrew

Nice, I am sure your JH doctor has seen a lots of PSA’s and done lots of DRE’s so if he is feeling good about everything, you should also. Hopefully the fancy 3D MRI does not turn up anything significant and you can skip the biopsy for a year as he recommended. That would be really good news so hope for the best.

The problem with this journey is that there will always be a next test, next appointment, etc so many things to get anxious about. You have pretty good news so far so enjoy it and play a video game.

I think its a good treatment plan. My PSA rose from 0.7 to 4.3 over about 8 years before I had a biopsy. The Endocrinologist who ran the PSA test was monitoring me for other issues and never thought to raise the alarm. When I eventually saw the Urologist, he felt that a rise over 8 years from 0.7 to above 3 would have warranted some further investigation and he would not have let it go so far as the Endocrinologist. I had a MP MRI, which showed PIRADS 5 followed by a MRI fusion biopsy. I was fortunate that although the Gleason 3+4 cancer was already causing the prostate capsule to bulge, it had not broken through. I was lucky.

From the age of about 40 to 54, my PSA ranged from 0.9 to 1.9. Always under 2. Then at 55, boom 5.2.

You are doing the right things in a good place. Stay calm.

Leah77 said...

k9guy said...
Well hello everyone, it’s been awhile since I posted about this. I have been watching my scores and now I’m a little worried and have a consult with a urologist next month. I’m 48 now and my PSA just came back at a 3.00, last year is was 2.4 and the year before that it was 2.2. My father had his prostate removed when he was 57 and is doing fine so I have the family history. I’m just very worried about the whole situation, any words of wisdom and/or encouragement would be much appreciated.

Hey K9 Guy, my hubby is going through diagnostics right now. He is 44 and his PSA levels are similar to yours. 2 different urologists told him he was fine ( he may be) But I pushed for an MRI- It came back with a suspicious mass... Biopsy is tomorrow. The mass is in an area of the prostate that is not typically reached by biopsy or felt by DRE. So having the MRI is crucial for proper diagnostics in my husbands case.

I wish you and your husband the very best. I will update when I have my results back.

I also think it is good news. PIRADS 2 is not bad. Your prostate is enlarged, this may justify your slightly elevated psa. As the final part of the report underlines, the enlarged nodes may mean something. I do not understand exactly what it tries to say, in special if whether "probably reactive" is good or not, but with this level of psa and no signals of extraprostatic breaks, PCa node involvement is not probable, in my non-expert opinion. But maybe it needs to be investigated. Enlarged nodes can be explained by many causes, some worrisome, some trivial. Your doctor will tell you about what it means, if something.

Post Edited (jmadrid) : 2/12/2019 3:28:43 AM (GMT-7)

K9 - I read your posts with interest, as we have some similarities. My dad died from prostate cancer (Dx at age 63, after his first psa test, and died at 70). I began testing at age 40. My first test result was 1.4. I had no idea, at the time, that was high, for age 40. I just saw the reference range said (< 4.0), so I figured all was good. A couple of years later, it got to 1.7. I think that is unusually high for someone who was around 43 years old. Around that time, I saw the same doc at JH who you saw, and asked him whether I should take finasteride or dutasteride for chemoprevention. The FDA had declined to approve this, but the studies seemed to support it. He wrote me the scrip. I then consulted with another doc at JH who recommended against it. I was on the fence about this for some time, and consulted with some other experts as well, including at NIH, but ultimately decided not to do it. (Very close call). So instead, I have just been testing psa regularly. Since that time, my psa has ranged from a low of 1.3 to a high of 1.74 -- mostly 1.5. I am about to turn 55. I have sometimes thought about getting an MRI. That is probably not "standard of care" for a 55 year old guy with a 1.5 PSA, but I might do it anyway. And if at some point my psa hits 2.0 (an admittedly arbitrary cutoff), I will go back to JH and see what they recommend.

Hello Medved, I’m glad to hear you are doing well. I was very impressed with everyone at JH, including Dr. Pavlovich. From all of the extensive research I did prior to meeting with them, I’m glad that he ordered the MRI before anything else. They said that this is the new wave of diagnosing elevated psa instead of jumping right into an evasive biopsy. My MRI clearly showed no suspicious lesions and in fact showed my prostate was slightly enlarged, which could certainly explain my elevated psa. Dr. Pavlovich said that if my psa ever gets to a 4 or higher he would order another MRI and compare that to my original one. Based on that information he would decide then if a mri guided biopsy was necessary. Getting the MRI helped me get over the anxiety of having an elevated psa. I’m being told a clear MRI showing no evidence of any issues is much better then the traditional blind biopsy.

Hello, well it’s been two years since I added to my original thread, so I thought I would update everyone. Last year my psa was a 2.5, today my test came back at a 4.1.

Dr. Pavlovich said to make an appointment with him if it ever got to 4. I can’t get my virtual appointment with him until May 6.

I’m hoping that based on my MRI that my psa is simply rising because my prostate is enlarged. Not sure what the doctor will want to do now, maybe order another MRI and go from there?

I’m disappointed that I can’t see him until May but based on my history I think that it will be ok. I do t want to see anybody else, I was very impressed with him and everyone at Johns Hopkins when I saw them 2 years ago.

Thought and or advice would be appreciated. Again thank you to everyone for their prior comments and advice.

I think I would take a shot at calling next week to see if you can get a more sympathetic scheduler. Four months is a ways out there but you have been doing this for a while so you can hang in there. It seems that a virtual visit would prelude a DRE so that might be a reason to question the scheduled visit. Will there be another PSA test between now and the appointment to double check current status? Any single PSA test can be off for a variety of reasons so it is nice to grab another point before visit. Just some things to think about.

My guess would be that a biopsy might be recommended at your visit. PSA and MRI's are not the best for eliminating PCa as a concern and at some point, the cells have to be looked at. Your PSA being over 4 is usually the time that the checking gets more involved so maybe expect more this time.

Hey k9guy,
Check out my profile.
I'm happy to answer any ?s or just talk if you need.
We can set up a phone convo too, if that would help.
I don't come here as much as i used to so please chime in soon and/or be patient.
Most importantly, try to chill and breathe.

Best to you,
BD