Update

I thought i would provide an update....and as always new questions.

So, by way of history i have now, at age 45 had four (4) PSA readings in my life.  My first was at 42 and at the time was 2.7.  My second was at 43.5 and was 2.6 and the reason that i found this nice (but i would rather be elsewhere) forum was a 3.9 psa three months ago just before my 45th birthday.  After research and giving some thought as to options including input here...i decided to wait three months and retake PSA.  Just got my results last night (after the three month wait) and they came back at 2.5.  No additional guidance from the MD other than a results letter.  By the way a free psa was done and was .2....i can do that math and that number is not the greatest....however the lab i am certain when i get the official results will not even calculate the free psa % given that they say it is not of clinical significance if the psa is not >4...thus while i am happy on one hand....no upward trend and my psa was actually the lowest it has ever been (and relatively stable over the last three plus years)....i am obviously high normal (and i appreciate many of you would not consider 2.5 for a 45 year old to be normal).

It is a little bit of a quandry....my gut says wait three more months (i have a regular visit scheduled with the MD at that time) and get a PSA at that point....make sure that there is no trend.

Any thoughts?  Is waiting another three months a reasonable approach.

PS the 2.5 was without Antibiotics, and refrained from all activity that can bump up numbers.

Thanks as always....a real good group of people and community which i have found helpful during the last three months of waiting....you guys are all in my prayers....

 

Thanks Medved....boy does PSA screening create lots of difficult decisions....i will contemplate some of your thoughts....i was quite surprised when my numbers went down by 1.4 in 3 months from 3.9 to 2.5.....at minimum i am going to have a restest in 3 months.....

it will be interesting to see in 5 years where the threshold is for biopsy recommendations given the changes over the last year or two....one thing that the last few months have made me acutely aware of is that there remains a lot of interest in prostate cancer...which hopefully means that the drug companies, medical device companies and others continue to devote research and monies to better detection avenues and treatment options for those effected....here's wishing for a blood test in the next 5 - 10 years that identies cancer and is not simply a screening test....will make lots of us less anxious....best to you...thanks for your comments.

Bob: First ask you urologist for antibiotics to rule out infection as a cause. At your age, your numbers are too high.  I will also say that you may want to find another urologist, since this doctor is much too complacent.  Today, the new "trigger" number is 2.5 (not 4.0) for us younger guys.

 I was similar to you and bumped around the 2.2, 2.3 2.5, 2.7 range for many years in my mid 50's'  My first PSA at age 50 was 1.5 and I knew that even though it was less than 4; it was too high for a 50 year old. My urologist also stressed that free PSA did not apply to those under total PSA of 4.  My online reading of medical articles showed that free PSA was indeed a useful number at PSAs BELOW 4 and I showed these articles to my urologist who still dismissed them. I did the antibiotic routine and refrained from sex but could not get lower than 2.5. Finally when my PSA reached 3.3 at age 58 and my free PSA went to 21%, my urologist finally agreed to a biopsy.  I was sedated and it was like a nice nap.  It did come back positive with 1 of 12 cores positive at Gleason 3+4.  I had robotic surgery and it was downgraded to Gleason 3+3.  I have no issues and am glad that I had surgery.

The good news is that you even if they find prostate cancer, it should be at a very curable stage based upon your numbers.  Good luck.

Bill K. from NJ

Age 58, PSA 3.3, free PSA 21%, neg. DRE

Biopsy 5/2011: 1/12 cores positive at 30%, Gleason 3+4=7 prostate estimated to be 50 grams.

DaVinci surgery 7/2011; Downgraded to Gleason 3+3=6, 10% involvement, contained, neg. margins.

Immediate urinary control, but ED took over a year to resolve.... Now good to go. All subsequent PSA < 0.015.

 

Yes Medved: My general practitioner and my uroligist were both of the same mind-set of under 4.0 is OK. Between 1 year tests (at age 53) my PSA jumped from 1.7 to 2.5 and both saw nothing wrong with that "velocity". Well, if I could find out as a layperson about PSA velocity in 3 minutes on-line, as being an indicator of possible PCa, why was I treat by both doctors as a nuisance!. As an engineer, I carried a graph with me of PSA results over 8 years whenever I saw my urologist. My doctor would "kiddingly" show the other urologists in the office my so called "obsession" with PSA numbers. He was quite dismissive and even played a joke on me one visit by saying: "Your PSA jumped up...only kidding" when he knew it actually went down! My wife said that she wouldn't have blamed me for slugging him after that one! I should have gotten another urolgist after that, but once I jumped from 2.6 to 3.3 in 6 months and my free PSA dropped to 21%, I think that he realized that things were indeed serious and maybe "Mr. Engineer" was right. Finally, my last presurgery PSA test of 3.3 was telephoned to me somewhat late (they didn't realize that I already had the number AND a POSITIVE Gleason 7 biopsy) and ther nurse said "You are fine..it is under 4". I went nuts after hearing that!

I cannot stress enough for men to learn as much as they can and for them to be their own advocate. No one will care as much about your own health as YOU.

Bill K. from NJ

I have a question. I'm the father of 3 boys ages 48, 46 and 44. I have been constantly bugging them to get their PSA tested which they have done. I don't know what their results were. What should their PSA be. Thanks

Bob: HERE IT IS......Here is an article that I found by the inventor of the PSA test (the famous Dr. Catalona) (In the SECOND PARAGRAPH he states that the normal range for men in thier 40's and 50's is under 0.9):

"The generally accepted cutoff for recommending a biopsy was initially a PSA of 4.0 or higher. While there has been some debate in the urological community about that guideline and whether the PSA test is an appropriate predictor of prostate cancer, Dr. Catalona has urged an even lower PSA indicator. He and his colleagues found in a previous study that more than 20% of men with PSA scores between 2.5 and 4.0 have cancer. He recommends biopsies -- taking tissue samples to check for cancerous cells -- be conducted when the PSA level reaches 2.5."

"The normal PSA range for men in their 40s and 50s is 0.6-0.9, so when the PSA reaches 2.5 or higher, or when you witness a significant increase in a short period of time, a biopsy is needed," Dr. Catalona said. "This new study shows that a steep slope in those PSA levels is a major red flag".

Bill K. from NJ

Bob: Here is the address of that article:

 http://www.sciencedaily.com/releases/2004/07/040708015111.htm

Bill K. from NJ