Advice ..... PSA anxiety

Sorry for the long post any advice would be most appreciated ..

Should I get a biopsy or do I have a really bad case of PSA anxiety..

I am a 41 year old fit caucasian male ( with health anxiety) and in December / January of this year I started to wake up few times in the night to pee... and felt that my urine stream was getting a little weaker..... After going to the docs my PSA was measured at 1.9 . I should at this stage mention that I also take propecia ( finisteride 1 mg ) for hair loss. Being a natural worrier I finally convinced to get my GP to refer me to a Uro because of all the info on the web that you should double your PSA if you take finisteride.

In March my PSA was measured at 1.7 and I had a TRUS which showed my Prostate had a couple of stones and the person performing the procedure said at the time that my prostate looked a little irritated.

At the same time I had a urine flow test and a DRE. the DRE was normal however the flow test indicated that my urine stream was quite slow and so I had a follow up Cystoscopy, which was normal even though the nurse performing it said my muscles were very tense down there.

I was then sent off for 3 months with flomax and an appt to return 3 months later. On returning my PSA was 1.8 but my flow test had improved ( even though it was not perfect) and I kinda got the impression that the Uro thought I was not relaxed enough whilst peeing.

However due to my PSA score I suggested that I stop the propecia and see what happened. As I thought it was still at the high end for my age.

After returning a month later my PSA had gone up to 2.2, which is the high end of normal for my age.

My Uro is at this stage not keen to give me a biopsy and would like to wait another 4 months until the propecia is out of my system and the look at things again, but has agreed to give me a biopsy now if I really want one ( after going through all the complications that the biopsy could give me).

My Uro basically said if it's cancer it either really small and a biopsy could miss it or the worse aggressive type, due to the low psa numbers, which helped with my worries NOT.... or wasn't cancer at all and my PSA was at the high end of normal due to my prostate being irritated.

I am now in a real quandary about how to go forward part of me screams to take aggressive action to find out what is going on ... And part of me ( through rather not knowing and the fear of complications from the biopsy) would rather wait and see ...

Any thoughts would be appreciated.

Welcome. Take a deep breath. Sounds like your doctor is giving you sound advice. Feel free to post any questions you have here.

Tommy,

Welcome to HealingWell. This is a great source of information and support, which I hope you won't be needing.

I agree with those who say it sounds like you're getting good advice from your doc. It makes sense to hold off for a couple reasons:

* Your PSA isn't that high, and an increase from 1.8 to 2.2 could just be a blip. Lots of things besides cancer could account for that difference.

* A biopsy, while pretty safe, isn't without it's own risks. Waiting a year for another PSA test might show that the biopsy wasn't necessary.

* If you wait a year and your PSA goes up to 3, you still might not have cancer. If you find at that time that you do have cancer, it will still be very treatable at that point.

* Even if you do have the biopsy now, it could be negative and you'd be left wondering whether it's a false negative. With your score, chances are there's either no cancer there or there's a very tiny cancer. If I had to bet, I'd bet on no cancer. If there is cancer, a biopsy could easily miss it. You might as well spare yourself the discomfort and see where your PSA score goes in a year.


Prostate cancer is normally very slow growing and is very treatable. I don't see a downside to waiting, as long as you MAKE SURE YOU FOLLOW UP NEXT YEAR.

Unless your temperament just can't abide the uncertainty, I'd hold off for now and see what happens. If this is really going to keep you up nights for the next year, that may be a different matter. However, I think your doc is right that it's safe to wait.

Whatever you decide, good luck and good health.

Jonathan

I'd avoid the biopsy until you have several PSA tests with clearly increasing pattern. Lots of reasons for a bump like you saw - most not PC related. Could just be a bad day at the lab. Could be anything. The thing about PC is that in most cases it grows slowly so you've got time to be very sure of things before you proceed.