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PSA 5.7 at 40 years old, Im very concerned.

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Posted 6/21/2013 5:55 AM (GMT 0)
Hello everyone,

As my subject line states, I recently went to the Dr due to illness and they did a complete CDC and blood lab workup on me as well as checked my PSA and everything came back great with the exception of my PSA which is at 5.7.

First some background on what brought me to the DR to begin with. I am a very active and in shape man that just turned 40 in March, however over the month or so prior to my DR visit I had became very lethargic and had some varied symptoms. By lethargic I went from sleeping 5-6 hours a night to sleeping 9+hrs and am still tired all the time to the point that I will go to bed at 10 or 11, wake up at 8 or 9 and by noon will have to nap for an hour just to make it through the day.

I had developed a chronic pain in the lower right quadrant of my abdomen that would become quite severe at times to the point of making me bedridden. I have also over the last 8 or 9 months completely lost any and all sex drive and would never wake in the morning with the usual morning wood. I had also developed pain in the back of both of my legs which I had originally written off as over doing it at work. I also experience some intermitten pain in my testicles and groin area.

Along with those symptoms I also have developed a very weak stream when urinating and found that sitting would sometimes help but I would still have interrupted flows and would still feel as if I needed to urinate after I was finished and have some "dripping" during the day. I also have some rectal pain and an intense case of anal itching. I thought that perhaps I had a parasite causing the itching and took some over the counter meds for parasites and had no relief.

What sent me to the DR however was that a lymph node on the right side of my groin had become tender (still is) and had swollen. The swelling has went down but it is still tender.

As I said my DR ordered a complete CDC and blood workup including PSA and everything came back great except the PSA. After the DR got my lab results back he ordered a contrast CT of my lower digestive tract to rule out anything such as Crohns or Colitis and everything on the CT came back fine. Of course he manually checked my prostate and it is about the size of a golf ball and was somewhat tender to the touch.

I live in a very small town here in ND about an hour from Bismarck so my DR visit was to our town DR and the CT scan was done in Bismarck. My DR told me that the 5.7 PSA was high as normal is 4.0 however after doing much research online I have found that this may not be quite true. I have read on many different places that at 40 2-2.5 is normal.

I am waiting now to go to a Urologist on the 26 and am now very worried about my PSA results being so high at my age since prostate cancer does seem to run in my family. My grandfather died of it and have 2 uncles that have it.

My leg pain and abdominal pain as well as the anal itching and rectal pain is still present and the leg pain has been getting worse than it was 2 months ago.

Any advice on what to expect with the urologist would be greatly appreciated. As I said I have been very healthy my entire life, never been hospitalized or had any surgeries and have rarely even went to a DR except for yearly physicals.

 

Post Edited (pat matt) : 6/21/2013 12:01:01 AM (GMT-6)

Posted 6/21/2013 6:34 AM (GMT 0)
Hi there,

It is good that you are seeing a urologist. You are on the young side for developing PC, but anything is possible. Having such an extensive family history of PC means that your chances of having it someday are several times greater than average. So, if everything turns out okay now, you're at the age where you should begin annual PSA tests so that you can establish a consistent pattern to compare to.

It could be that you have a prostate infection that is elevating your PSA, but the uro will be the one to tell you. Yes, your PSA probably should be around 2 or less at your age. My first PSA test was at the age of 51 and the normal range, at the high end, was about 4.0 for that age.

The urination problems could be caused by PC, which can be a symptom of the disease. More commonly, the problem can be caused by BPH, which is a harmless enlargement of the prostate. Larger prostates produce greater amounts of PSA, which gives the higher reading. Doing annual testing can track the progress of BPH, which should be gradual. If there should be an upward spike from one annual test to the next, PC could be the cause. That is why annual PSA tests are so valuable in finding the disease as early as possible.

Chances are that the uro might recommend a biopsy. Prostate biopsies, although awkward & uncomfortable, are not painful. So I'd suggest that you agree to one if it is suggested.

To help relieve your anxiety a bit, you can take some comfort in that a PSA of 5.7, while on the high side, is not horribly high. Prostate cancers with PSAs of 10 or higher can be suggestive of a possible penchant for it to spread to other parts of the body.

So, chances are that any PC they might find with you could still be confined to the prostate -- and hence curable.

So, just take a nice deep breath, wait until you see the uro and then deal with whatever s/he says. Odds are heavily in your favor that you will never die of prostate cancer. If you are NOT diagnosed with PC, let this be a wakeup call for you to begin those annual tests to stay on top of things.

Good luck -- and stay tuned because lots of others will be jumping in with their own thoughts & advice.

Take care,
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.
Posted 6/21/2013 9:27 AM (GMT 0)
The pelvic ct scan will answer lot of questions , tho i doubt any will be answered about Pca. You mentioned twice that you are a healthy and active guy , normally. I gots to say, from your description, you got very unhealthy very quickly. do not want to scare or upset you, but a swollen pelvic lymph node is a known symptom of Hiv infection, among other things, as well . So get that checked out as well, if you think that would help. Something is going on. a lot of your symptoms could be Pca, A lot do not appeart o have any thing to do with Pca. I'll tell you this, you are in the right hands now, it seems. Get it all checked out, make sure doc explains in language you understand, what is going on. You have hired him, if he doesn't d his job, fire him. Oh one more thing, Please make a note to self to come back and let us know Whats going on when you can.
Posted 6/21/2013 10:52 AM (GMT 0)
Hang in there. You've come to the right place for support. You'll know more after you see the urologist, and as was suggested, have the biopsy if he suggests it. let us know how you make out.
Posted 6/21/2013 1:57 PM (GMT 0)
Welcome to our corner of the world, sorry you need to be talking to us. That's a bit concerning for sure and glad you hear you're going to get it checked out. Something sudden like that seems more like an infection of some kind. PC doesn't normally move that fast or cause symptoms that fast.

What to expect from the Uro? Well a DRE to start, a few more tests and likely a scan of some kind. There are so many possible things that could be wrong the URO will need more information to narrow it down. You might get sent home with an antibiotic just to rule out an infection.

Even if they do find the worst, you're likely in a very curable zone and healthy enough to tolerant whatever treatment you select.

It's scary to have to deal with this kind of thing but hang in and keep us updated on your progress.

Andrew
Posted 6/21/2013 3:17 PM (GMT 0)
Pat Mat,

Welcome to the forum. We're sorry you find yourself here but we'll try to help.

I will echo what some of the others have said in that your symptoms don't sound like the sort of things one associates with prostate cancer in a 40 year old guy. The most common symptom of men who are diagnosed at your age is ... nothing. -- no symptoms at all. We have some guys on the forum who were diagnosed at more or less your age with rip-roaring metastatic advanced aggressive cancer who had nothing like the level of symptoms you describe. Which is what makes us all suspect that what is going on with you is something else.

It does sound a bit like a prostate infection. That is probably what your urologist will look for first. There are some other blood tests he can do that can help distinguish between PSA caused by a large prostate, or an infected prostate, or a large, infected prostate, and the PSA caused by prostate cancer. Another thing he may do is put you on antibiotics for several weeks and retest your PSA in a month to see if it goes down.

He will also get you to pee in a cup, will probably do a DRE, and may do an ultrasound to see if you are retaining urine (bit of cold goo on your belly, like an obstetrician checking on a pregnant woman's baby).

Let us know what he says. Good luck.
Posted 6/21/2013 3:31 PM (GMT 0)
Again, we are not doctors.

Is this your first PSA? If not, then is this a huge rise?

It really does sound VERY MUCH like a prostate infection, probably prostatitis.

As others have said, PC tends to be rather silent in terms of symptoms until the later stages (where the PSA would be high double or even triple digits).

Nevertheless, of course it COULD be PC, but again very unlikely. Let us know what the urologist says. I suspect a 4 week course of antibiotics and a PSA  retest is in your future.

Mel

Posted 6/21/2013 3:34 PM (GMT 0)
I know where you are. 3 years ago I wa salso a strong, fit 40 year old who went to the doctor for an unrelated issue and as a result of bloodwork found my PSA to be elevated at 2.4

I don't want to question your doc, but based on what other urologists have told me, the 4.0 as normal is old school. For our age 4.0 is potentially high.

Personally, short of the weak stream, I don't think any of your symptoms would be related to PCa. But that is for a medical professional to reconfirm to you.

The first thing I did was a course of antibiotics to rule out an infection. I then tested my PSA two more times over the course of 1-2 months before going for the biopsy.

Hang in there, ther eis a lot of uncertainty right now and I'd guess that even with your family history there are more chances of this not being PCa at your age then them finding PCa.
Posted 6/21/2013 10:52 PM (GMT 0)
Take it one step at a time, your greatest fears are likely unfounded. Keep us posted, and all the best to you.
Posted 6/21/2013 11:03 PM (GMT 0)
My appointment with the urologist has been changed to Monday the 24th. My GP had me go back in and give more blood on Wednesday to check my testosterone, free PSA, hemoglobins and another liver function as well as a fasting blood sugar test.

My testosterone levels came back and were low, at 205 and my free PSA was only 12%, again all other labwork came back normal. I received a call from the urologist this morning that he wanted to see me this afternoon but since I was on the other side of the state with work there was no way I could make it to see him today so I have an appointment with him at 9:00 on Monday.

I didn't realize that my PSA was checked 3 years ago and nothing was said to me about it being done, I suppose because it came back in range of good. My GP had requested my medical records from my previous DR in Florida and found where it had been checked along with my cholesterol, liver and kidney function, blood sugar and a slough of other blood tests I needed for a physical for work. I guess I should be thankful since now it gives a baseline for the UR to go by.

Apparently he is concerned with my PSA being higher than normal and my free PSA being so low. I also found out that my PSA was checked 3 years ago during a physical and blood work that I had done for my job at the time and that when it was checked it was 1.9.

So I guess Ill know more by Monday afternoon what is going on. I did ask my urologist what the plan was for Monday and he said that we would discuss it at the appointment but that he finds my numbers to be odd for my age given what my PSA was 3 years ago.

I always try to find the silver lining in everything and at least now my wife will understand that my lack of interest in sex has nothing to do with being unattracted to her but is instead due to my hormone levels. I guess as long as I don't start having the urge to have Tupperware parties and take up knitting I'll be okay. smilewinkgrin

Ill update with what the UR says on Monday, for now I'm gonna take my boys camping and fishing for the weekend and try to relax.

Thanks again for everyone's input.

Posted 6/21/2013 11:11 PM (GMT 0)
Thanks for the update.

Yes, you want the Free PSA to be high (above 25%) and the PSA to be low.

I still suspect he will do the antibiotic routine with you.

If not, and he wants to do a biopsy, ask about the PCA-3 test. It's an excellent test, very specific for PC. It's also easy -- you pee into a cup after a vigorous DRE. Hopefully, your urologist does it or maybe can send you somewhere to get it done. It would give you one more bit of data. I know for me, it triggered the biopsy.

Mel

Posted 6/21/2013 11:17 PM (GMT 0)
logoslidat,

That had actually crossed my mind, not so much HIV specifically but a number of diseases that I could have been exposed to. I worked for many years as a commercial diver, mostly offshore in the oil industry. However about 3 years ago I had to take a job working inshore due to lack of work in the GOM and one of the jobs we had was to inspect a water treatment plant in Sarasota Fl.

During that job we wore full no contact biohazard drysuits and were only diving grey water and semi-treated water, however on the 3rd to the last day of the job I snagged my suit and ended up with about a 9" tear in my suit and was exposed to the water from the neck down. Afterward I had to be tested for a plethora of diseases due to my exposure to the bacteria in the water. However all of my tests came back negative (thank god), but it was still a scary 12 months getting tested for certain diseases that could be latent over that span.

However other than that incident there was never any chance of me being exposed to anything, well I wont say never since you never know when you could pick up Hep and such from public places. Yet I am still going to go ahead and have my DR test for everything next week after I see the UR.
Posted 6/22/2013 12:14 AM (GMT 0)
..I am close to your age and have PAc. No symptoms at the time just blood work and bingo. I just had surgery, when I saw my Medical Oncologist cause of a positive lymph node after surgery in my pathology report, I felt some swollen lower pelvic lymph nodes left behind. The Doctor examined and assured me that is not a sign of cancer but after effects from surgery. It seems you have some issues to work out on your end, you need answers. Do not hesitate and travel if needs be to get to good equipment, good doctors. It is in your history, it is in mine too..

.....steady as she goes......Nick..............
Posted 6/22/2013 1:38 AM (GMT 0)
Sounds like you have a pretty good doctor. I also think that a round of antibiotics would be a good idea to see if your PSA drops after a few weeks because you have an infection. Some of the other symptoms do not sound like PCa. I had no symptoms at all when I was DX but had several of your symptoms when I had an enlarged prostate at 44 years old.
Let us know how it goes. Hopefully you will just be visiting with us for a short while.

Bill from Florida cool
Posted 6/25/2013 5:11 AM (GMT 0)
Well I went to my UR appointment today, and it was interesting to say the least. The DR performed a rectal sonogram and I am set to return tomorrow with a designated driver so he can do a biopsy of my prostate. I thought the sonogram was bad until he was explaining the needles involved in the biopsy, I'm sure not looking forward to tomorrow at all but I guess you guys have been down this road already and know what Im talking about.

My Dr said that a normal prostate is about 1"x1"x1.5", mine is about 1.5"x1.75"x2.25" and he said that is rather large and is contributing to my troubles urinating. I also have, and this worries me, a mass within my prostate that is approximately 8mm in diameter, hence the need to biopsy. He wanted to do the biopsy today but said I would be lightly sedated and would not perform the biopsy without someone to drive me and my wife was out of town with work.

I also have a mass on my right testicle which I have noticed some intermittent pain in my right testicle for several months but wrote it off as strain due to work. He will also be doing a fine needle aspiration of my right testicle and send those samples off as well. I know that you can usually tell the difference between a cyst and a mass on a sonogram so the fact that he has called both of these masses combined with the tender lymph node on the right side of my groin has me rather worried. But what can you do? worry doesn't make it go away.

I asked the UR about the leg and foot pain and he said that it could be associative pain since the groin and prostate share many of the same nerves as the legs and that it could be contributed to that.

I guess I'll know more in a couple of days when I get the biopsy results back and will update then.

Post Edited (pat matt) : 6/24/2013 11:19:51 PM (GMT-6)

Posted 6/25/2013 10:55 AM (GMT 0)
Hey pat the biopsys not that bad at all....I wasn't given anything for pain and was able to drive back on my own....a little uncomfortable when that things going up there but once its there the needles are not that painful......they startle you some because it wasn't expected but did not hurt. Good luck, chris
Posted 6/25/2013 2:05 PM (GMT 0)
Hey patt matt -

Just chiming in with the others wishing you all the best...you've come to the right place - a lot of good information and support here.

The biopsy itself is no big deal (especially with the light sedation) - afterwards, you can expect some blood in your urine for a few days (nothing to be alarmed about), and also in your ejaculate for maybe a month or so (for me, that took a little getting used to!). In terms of pain, I didn't have anything more than very mild discomfort afterwards - that seems to be most guys' experience as well.

Keep us posted...
Posted 6/25/2013 2:33 PM (GMT 0)
Pat Matt,

I had four biopsies and never really learned to like them. My usual advice for guys nervous about an upcoming biopsy is to ask the doctor for some 'light sedation' during the procedure. You seem to have that covered. Biopsies are not so much painful as annoying and I found that a bit of pharmaceutical detachment helps a lot. I had my first one without sedation (the doctor also uses various local anesthetics) and the Valium makes a huge difference.

After the biopsy you will feel Ok (maybe a little woozy until the Valium wears off). You should be ready for a bit of blood in odd places for a few days -- on the tissue when you wipe the goo off your butt after the procedure, in your urine, in you poo, and in your semen (this last may persist for a month, fading from vampire-movie red through shades of brown). Not a big deal but best to expect it.

If you get the person who is driving you home to stop someplace that serves manly food on the way you can grab a nice moment. A burger and fries with a friend and a beer, plus the tail end of the Valium, and knowing that you have the biopsy behind you, so to speak, can combine to give you a nice glow...

...that doesn't last because you will quickly move into "worrying about the results" mode which is also a major annoyance. Be sure to come back and vent.
Posted 6/25/2013 4:43 PM (GMT 0)
Needing to stress to you that your semen will be blood coming out. This isn't just a slight streak of red, michaels was pure dark red. We were shocked and our Uro had prepared us. It is shocking. Don't freak out about it, it is perfectly normal and the more you ejaculate the quicker it will clear up but expect it to last a while. Just wanted you to be aware of that! Te biopsy itself wasn't that bad, from what hubby said!!

Best of luck
Hugs
Susan
Posted 6/25/2013 6:51 PM (GMT 0)
Good luck with the biopsy, it is uncomfortable but it really doesn't HURT. Should feel back to normal in a couple of hours. As has been mentioned, the biggest surprise is the blood in the semen for a couple of weeks. The color is hard to describe. Put some towels down to protect the sheets or bedspread.
Then the waiting starts to see what they have found.
Hoping for the best for you.

Bill from Florida cool
Posted 6/27/2013 8:54 AM (GMT 0)
Welcome. Please keep us posted...fingers crossed that all vows well;) Alison
Posted 7/1/2013 3:55 PM (GMT 0)
Well I everything went normal with my biopsy other than the usual blood in my urine and semen though it isn't something I look forward to anytime soon.

My UR also ordered new lab work and I asked the lab to send me copies of the results as well as what they send the Dr so that I can keep my own records of everything. One thing that is odd is that on my testosterone results it seems it is done using a different scale. It says my testosterone is 2.56 and the normal range is 1.75-7.81. Is anyone familiar with this, is it just a different scale of reading the results? It does seem like it is borderline low still however.

I don't go back to my UR until Wednesday.

Posted 7/1/2013 4:16 PM (GMT 0)
Does you lab include units? I've seen ng/dl (nanograms per deciliter -- usual range 250 to 1100 or so) and nmol/l (nanomoles per liter -- usual range 8.8 to 37) your numbers don't fit either of those.

So, on Wednesday you will get the biopsy results? Let us know so we can modulate our worry appropriately.

Good Luck.
Posted 7/1/2013 4:30 PM (GMT 0)
Yes, its in units of ng/Ml? Since posting I  have done some web searches and have found some info on the 1.75 ng/Ml-7.81 ng/Ml readings but nothing to correlate it with my previous test of nd/ml. I am wondering if the Ml is milliliter and perhaps this test was done on a more precise scale for more accurate reading? Just guessing here...
Posted 7/1/2013 5:04 PM (GMT 0)
Usually the 'm' is not capitalized for ml = milliliters but that sounds right. That would mean that you can convert to ng/dl by moving the decimal point right two places. (If you want to) That would make your testosterone reading 256 and the quoted 'normal' range 175-781 ng/dl. That normal range sounds a bit low to me but whatever. That way you should be able to compare your T score with other guys who quote figures in the hundreds (while not on HT).
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