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High Risk of PC According To Doc

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Posted 5/7/2024 7:34 AM (GMT 0)
I'm 47 now and I had a biopsy two years ago due to high PSA levels that did not fall to normal levels. Biopsy found nothing so I thought I was in the clear. Especially after my PSA dropped to normal once at 2.48 Recent tests 9 months later show it is high again at 3.44 and the doctor sounds very ominous now as she does not like the sudden rise. She said "I'm very concerned you may have Prostate Cancer" But my biopsy found nothing I replied. Doc insisted that because my levels are abnormal for my age and the fact it keeps rising and falling rapidly over the years with numbers all over the place that I need to now go in for an MRI and possibly a 2nd biopsy with an MRI. I thought PC causes PSA to rise over time but evidently that's not always the case. Has anyone ever seen crazy fluctuating numbers like this.

Current Age 47
PSA Levels
05-03-2024 3.44
10-19-2023 2.48
04-03-2023 3.00
08-09-2022 3.19
03-21-2022 3.18
09-12-2022 4.04
09-18-2021 1.75
12-09-2020 4.28
04-10-2019 4.5 Strange that I was this high at age 43
Posted 5/7/2024 1:10 PM (GMT 0)
Looks more like a chronic prostate infection, by your fluctuating PSA. Were you ever given antibiotic treatment outside of when you had the biopsy?
Posted 5/7/2024 4:18 PM (GMT 0)
Ive never had antibiotic treatments as Ive never had a UTI or prostate infection. 4.0 use to be normal for my age group but they dropped it to 2.5. Is all that testing really necessary? Has it led to needless cancer scares or is the threat real? The doctor is very concerned and doesnt suspect BPH or infection and the words “Im concerned you may have prostate cancer” are very concerning. If its there I just wish they would find it. Why do they even suspect PC if its just an infection.
Posted 5/7/2024 6:11 PM (GMT 0)
Have you had a MRI scan and an estimate of your prostate size yet? Any talk about a PSMA PET scan? There are stories of men that have had a number of biopsies before they found a small high risk nodule causing trouble. There are also men who have been on active surveillance for years and never find anything of consequence.
Posted 5/7/2024 6:27 PM (GMT 0)
The MRI is next and possibly with a 2nd biopsy. Ive never had a prostate MRI and they say the DRE exams are normal. Maybe all this is young age BPH if that can happen. Will an MRI show if the prostate is too large and diagnose something like BPH? Why are they so worried about cancer and in a hurry to get me in for further testing. Isn't it much more likely that this is something harmless like an infection or BPH. Why do they express concerns that I may have PC wouldn't that be the last thing to suspect?
Posted 5/7/2024 7:29 PM (GMT 0)
It is easier to explain PSA with a larger prostate and there is a parameter called PSA density that is calculated from PSA/volume that is a check on significance. Are you taking any prostate meds for urinary issues?

An MRI does the best job of visualizing the prostate where cancer is difficult to locate due to its similar nature to regular cells. The normal process is to have the MRI and that would indicate if a biopsy was warranted and where to target sampling. A negative MRI does not mean a whole lot in the scheme of things given the difficulty of locating small amounts of cancer but better than a positive result I suppose.

I can not explain their hurry other than you do not have an answer to the obvious question and that is driving your doctor crazy. You want an answer and the doctor can not provide it. The PSMA PET scan would do a better job of finding PCa but is rarely approved without more compelling information and justification due to expense.

You can always get a second opinion from a well known cancer institution to see if it is just your doctor or a legitimate concern.
Posted 5/8/2024 10:51 AM (GMT 0)
The MRI may reveal something.
However, fluctuations in PSA, especially the kind you're seeing, are usually related to prostate infections--which are notoriously difficult to treat.

Also, again, this is something to remember: PSA, alone, is not a test for prostate cancer. It is a test of general prostate activity. Lots of things can cause PSA to fluctuate. Here's one for you: If you have a sexual release less than 24 hours before the blood draw, it can raise your PSA. Riding bicycles, motorcycles, or horses can stimulate the prostate. Oh, if your doctor gave you a DRE (digital exam) before the blood draw, that can raise your PSA.

So, the issue for you, is that you have a fluctuating PSA. Finding out why is important. Cancer is generally indicated by a slow steady rise of PSA over time. For example, my history began at age 45, with a string of zeros. Then over a 3 year period it went from 1 to 2 to 4 to 6. (This was over 10 years ago, I don't have the actual numbers)
Posted 5/8/2024 7:09 PM (GMT 0)
unknown, welcome to the forum, I hope you are just passing through...

generally speaking in the presence of prostate cancer, PSA doesn't drop from 4.28nto 1.75 in 9 months, or from 4.04 to 2.48 in a year. thats more what a chronic infection does. and you could have a chronic prostate infection and not know it.

I would insist on a course of antibiotics, and if that doesn't drop PSA, then id want an MRI Guided biopsy, for peace of mind.

but thats me, I'm as little overcautious about these things. and I'm not a doctor
Posted 5/8/2024 7:28 PM (GMT 0)
I've found that women doctors tend to over test more then men. They do not have a prostate so all they know is what they have read from a book.
Posted 5/11/2024 8:02 PM (GMT 0)
Unfortunately PSA is such a controversial marker for prostate cancer. I will tell you my PSA had been higher than it should’ve been for my age for the last 10 plus years … nothing alarming but higher than it should’ve been. For my case the better marker was the actual percent of free PSA. The lower the percentage the greater the chance of being cancer. At the time of my diagnosis my PSA was 3.5 which was a drop from 4.25 a few months prior but the percent of free PSA dropped as well which was more concerning. Before my biopsy I had an MRI which showed a lesion on my prostate which was classified as a PI-RADS 4 which is pretty much indicative of cancer but a biopsy had to be done for confirmation which it did. I am 49 and had surgery about 2 months ago. Ultimately my point is that diagnosis occurs differently for everyone but an MRI should definitely show if there is anything to be concerned about that may require further investigation. It will also show if the prostate is enlarged which mine was as well.
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