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46yo Scared to Death with PSA Level at 3.7

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Posted 4/24/2014 9:41 PM (GMT 0)
confused
Ok, here is the scoop. Family history of Prostate Cancer, Father & 2 uncles. Base line over the last few years has been about 1.8 - 2.1. Test in Sept 2013 was 2.5, retested in Feb 2014 and result was 3.7. 46 yrs old and driving myself crazy. The DRE following the 3.7 test was normal. Dr said no need to have antibiotic as I had no signs of infection, only choice was biopsy or 1 more PSA test. I elected for the 1 more blood test to be done this week. I'm driving myself crazy, have had stomach issues since Feb I'm sure due to my nerves. cry
Posted 4/24/2014 9:53 PM (GMT 0)
Hello BigWave, Welcome to the forum.

Sorry you've got worries but glad you found us.

I'm sure your doctor reminded you of the things you should avoid in the 72 hours prior to having your blood drawn -- sex, bicycle riding, motocross, bull riding, and whatever you call that guy on America's Got Talent who broke 2x4s with his scrotum -- those can all make your PSA go up.

We have a pretty boring club here and most guys your age decide not to join. They come in with worries and we keep them company until they figure out what's going on, and when their doctors decide they don't have prostate cancer we release them back into the wild. Most of 40-somethings who visit here don't turn out to have prostate cancer-- even the ones with family histories. So your odds are pretty good.

But it is scary. We've all been there. When I was where you are (only ten years older) I carried Xanex in my pocket in an Altoids Smalls tin. In theory I would take half a pill whenever I scared myself thinking about an upcoming PSA test or about a biopsy. In theory. In practice it was enough to have to tin in my pocket. There's something calming about knowing that you have a pocket full of pharmaceutical calmness you can use if you need it.

We have another thread going right now about some other tests that can be used in addition to the PSA test go get some more information. That thread is here" www.healingwell.com/community/default.aspx?f=35&m=3061611&g=3061676#m3061676. I don't know how applicable it will be in your case but it will be something else to talk to your doctor about.

Do keep us in the loop. Come back and tell us the result of that next PSA test. It's why we're here and, did I mention that our club is boring? We're glad for the distraction.
Posted 4/24/2014 9:59 PM (GMT 0)
Hey. There are other tests you can consider.
Free PSA blood test, higher is better.
PHI test is on another thread here.
PCA3 test.
There are others.
A biopsy is not that bad and would also provide the prostate size which can be a significant factor you want to know.
Prostate cancer is most often not fatal especially when caught early.
Good luck on your testing and health.
Posted 4/24/2014 10:10 PM (GMT 0)
Hello bigwave, No need to stress (although perfectly normal reaction).  This forum is a great place to start reading and learning - although everyone's situation is different. Ask your doctors all the questions that you have.  I hope this helps in some way.
Posted 4/24/2014 10:16 PM (GMT 0)
In addition to the options RobertC mentioned, a prostate MRI would be another option. If you are going to have a biopsy, the MRI also might allow the doctor to be more "targeted" in how he does the biopsy. There has been a lot written about prostate MRI recently -- it is a very hot topic.

If you are going to do the MRI, you want someone reading it who has significant experience in prostate MRI. It is somewhat of an emerging technology.
Posted 4/25/2014 2:33 PM (GMT 0)
In case you did not notice it on way in, there is a thread at the very top for guys newly diagnosed

www.healingwell.com/community/default.aspx?f=35&m=2652250

May be a little early since you have not yet officially been diagnosed but a good primer for the future if it becomes applicable.

Good luck and let us know how the second PSA test came out, after taking the necessary precautions the prior 72 hours.

LupronJim
Posted 4/25/2014 3:52 PM (GMT 0)
welcome to our corner of the world.

So how did it turn out for your uncles and father? I understand your fear but these days there are lots of treatments even if the worst is true. But all you really know now is that your PSA is a little high. Speculation is natural but not helpful in your case. Stick to the facts and take it a step at a time.

The question now should be, biopsy or not? Waiting for another PSA test us prudent and the wait isn't going to hurt. The biopsy isn't that bad - not fun but not bad as medical tests go.

In situations like this I try to just focus on the next step and not project too far into the future. I know, easier said than done.

Hang in there and keep us updated on your progress.
Andrew
Posted 4/25/2014 4:32 PM (GMT 0)
Biopsy is a walk in the park and then you'd likely know where you stand (after another PSA w/free PSA).
Posted 4/25/2014 4:34 PM (GMT 0)
Note to self: stay out of parks frequented by Buddy.
Posted 4/25/2014 4:42 PM (GMT 0)
 

I wish I could take away your fear, as I have been there!!

Well, I am not a doctor, but:

Infection/prostatitis can often occur with no symptoms.

It would still be prudent to try an antibiotic (usually cipro) for 4 weeks. My doctor tries not to prescribe antibiotics, but did in my case (similar to yours). Unfortunately, my PSA did not decline and eventually I got the dreaded phone call with my lousy biopsy results.

BUT, as I said, a sharp increase is often due to the aforementioned items.

Perhaps you can push your doctor a bit?

(But, remember, my medical advice is worth exactly what you paid for it).

Perhaps others can comment.

If the antibiotics do not work, then a FREE PSA and a PCA-3 would be a good intermediate test before deciding on a biopsy.

Mel

Posted 4/25/2014 5:59 PM (GMT 0)
Dear Bigwave:

Welcome to HW. You have already received some great advice on this thread and I hope you will follow it. The only thing I was going to add was just mentioned by Mel and I'll just reinforce it. Take a course of antibiotics before any next steps and see if the PSA comes down. While biopsies are usually uneventful, it makes sense to take the other (easier) steps first before submitting to any invasive procedure IMHO.

Good luck,

Jim
Posted 4/25/2014 6:04 PM (GMT 0)
I agree with what the others have said. Also, note what Compiler said. I would ask about taking the antibiotics just to make sure you don't have an infection.
Posted 4/25/2014 7:06 PM (GMT 0)

robertC said...
Hey. There are other tests you can consider.
Free PSA blood test, higher is better.
PHI test is on another thread here.
PCA3 test.
There are others.
A biopsy is not that bad and would also provide the prostate size which can be a significant factor you want to know.
Prostate cancer is most often not fatal especially when caught early.
Good luck on your testing and health.

If it keeps rising even a little, even if there is some excuse like prostatitis or BPH or bull riding, I might go for the Bx and be done with it.

I had many possibilities for my rising PSA other than PC, including 30 years of problems with BPH and prostatitis especially. And NO family history. Another thing I felt reassured by was that, when I got up(in increments) to a reading of 4 from 1.6 over about 10 years, my free PSA was 23%. I had read that was almost always not cancer, while readings less than 10% were usually PC. So I'm thinking: No family history, lots of prostatitis, +BPH and free PSA 23%, most likely OK. Plus I was well versed on all of the controversy about PSA and all of the overtreatment many felt they lead to.

Still, when I doubled from about 4 to 9.1 over 2 1/2 years, I got worried enough to allow the Bx. My Uros words to me when finishing the Bx were that my enlarged 87 gm(turned out actually 107 gm huge) prostate could account for every bit of my ^PSA, and to try not to sweat it and we would be hoping for good news, which was quite possible we might get.

I knew something was up when he would not give me the news over the phone, leaving a message that we needed to talk at the office. So I find out I have a Gleason 9 PC, close to the worst PC news. So, I wish I had acted much sooner, I hurt myself with all of my excuse making. If I had caught it 3 or 4 years earlier, I probably would have made different treatment decisions. If I had made the same treatment decision, I would probably now have a much better prognosis than I have now. My prognosis is not terrible, but it also is not great. 50/50 at best for recurrence. Several years earlier treatment would have made a big difference.

Bottom line: just my personal opinion, so take it FWIW ( and free advice is worth what you pay for it LOL! ):
Don't dick around. Any more questions about the rising PSA, suck it up and get the danged Bx. If it shows nothing, then you are off the hook for a while and can start pursuing natural approaches to minimizing your chances of getting PC and maybe lowering PSA. Maybe the same thing if you have PC but it's G6 or lower, possibly you can just watch it real close, active surveillance. And/or you will have more time to pick your treatment without feeling in a panic to do something. If you have it, at the lower PSAs probably way more likely, even if a bad Gleason score, of it being confined to the Prostate. Even though the odds are in your favor, most elevated PSAs are not PC, don't mess around, don't do what I did. Better to just get er done, IMHO!
Posted 4/26/2014 8:54 PM (GMT 0)
Dear wave
Bx is , as has been said before, a no brainer. Just get it done so you know what's going on and move on from there, one step at a time.
Good luck!
Bob
Posted 4/26/2014 10:40 PM (GMT 0)
In Canada they don't tend to request biopsies until the PSA goes over 4.0. If you absolutely can't stand the pressure, you should probably go ahead and have the biopsy.

I realize this advice might not be appropriate for you, but if it were me I wouldn't sweat too much until the PSA went over 4. I would take it as a warning to make some lifestyle changes - decrease meat consumption, increase vegetable and fruit consumption, exercise more and try to relieve stress (not easy under the circumstances, I know). Google Dean Ornish and some of the studies he's done on diet and prostate cancer.
Posted 4/27/2014 11:49 AM (GMT 0)
Good luck and with a family history you should learn what you can. If not now then later.

I had no history and no elevated psa. I felt like something was wrong and started asking questions.

If your dr will do a biopsy then do one. Getting such things authorized in the ACA era is a tough road so go for it. Give you a baseline
Posted 4/27/2014 12:11 PM (GMT 0)
I agree with the others that another PSA test AFTER a round of antibiotics is the next step before an unnecessary biopsy. Anyone could have an infection without symptoms. You should be explained to avoid the several things that Peter explained 72 hours before a PSA test. They could also cause a rise in PSA. A biopsy could show more but antibiotics should be tried first. A biopsy can cause scar tissue that will not heal later.

Bill from Florida cool
Posted 10/7/2015 6:06 PM (GMT 0)
Well I'm sitting here all morning non stop searching PSA info on the computer and what do I stumble across? This post that I posted last year... That's not good that I find myself in the same distress again. I'm totally freaking out again, I can't handle this stuff!!! I never did come back with a follow up to this post last year, things improved and I was much relieved but I find myself now in even a worse situation then before. As I stated last year the PSA then was 3.7 which was up from the previous years. Urologist did not give any antibiotics but suggested a Biopsy or a retest. Of course I elected for the retest & 2 months later it was 2.6. She then suggested we test again in 6 months which we did and it was down again to the normal 1.8. Well I just had blood drawn 2 days ago prior to my yearly appointment and what do we have, 5.9.... I don't see her until the 19th of the month but I'm totally freaking out again. My stomach has been in knots all day, feel like I could throw up at any moment. What gives? Why the fluctuation all the time? I do work on the water and feel sometimes that's just like riding a lawn mower. We just had a Northeaster here last week that lasted 5-7 days & did have to go out in 10'-12' seas for a butt kicking last Thursday night, but that was 4 days prior to the blood work. They 24-48 hrs for lawn mower or bike riding so I doubt that would have effected it???
10/7/15- 5.9
10/2/14- 1.8
4/24/14- 2.6
2/24/14- 3.7
10/2/13- 2.5
7/9/12- 1.9
12/13/11- 2.1
6/24/10- 1.9
5/27/10- 2.7
10/2/08-1.5
Posted 10/7/2015 6:58 PM (GMT 0)
Your see-saw PSA pattern and especially the big recent jump are characteristic of relapsing and remitting prostatitis. It may or may not respond to antibiotics, and it may continue to do this throughout your lifetime. When it is PC, it just goes up and does not come down. She will probably tell you to wait 3 months and test again. Or you can try a new blood test called PHI. It's not quite as affected by prostatitis, but it's not a great test either. You have to call the number in the link and go to a Uro who offers it.
Prostate Health Index (PHI)

- Allen
Posted 10/7/2015 7:11 PM (GMT 0)

bigwave said...
Well I'm sitting here all morning non stop searching PSA info on the computer and what do I stumble across? This post that I posted last year... That's not good that I find myself in the same distress again. I'm totally freaking out again, I can't handle this stuff!!! I never did come back with a follow up to this post last year, things improved and I was much relieved but I find myself now in even a worse situation then before. As I stated last year the PSA then was 3.7 which was up from the previous years. Urologist did not give any antibiotics but suggested a Biopsy or a retest. Of course I elected for the retest & 2 months later it was 2.6. She then suggested we test again in 6 months which we did and it was down again to the normal 1.8. Well I just had blood drawn 2 days ago prior to my yearly appointment and what do we have, 5.9.... I don't see her until the 19th of the month but I'm totally freaking out again. My stomach has been in knots all day, feel like I could throw up at any moment. What gives? Why the fluctuation all the time? I do work on the water and feel sometimes that's just like riding a lawn mower. We just had a Northeaster here last week that lasted 5-7 days & did have to go out in 10'-12' seas for a butt kicking last Thursday night, but that was 4 days prior to the blood work. They 24-48 hrs for lawn mower or bike riding so I doubt that would have effected it???
10/7/15- 5.9
10/2/14- 1.8
4/24/14- 2.6
2/24/14- 3.7
10/2/13- 2.5
7/9/12- 1.9
12/13/11- 2.1
6/24/10- 1.9
5/27/10- 2.7
10/2/08-1.5

Yes the mower, and especially bike riding can give the prostate a beating and probably raise PSA. Still, that is a 1 year jump that must be paid attention to. But still again, your PSA has been all over the place and PC usually does not cause anything like that. There is usually only one direction with untreated PC as far as I know.

Regardless, look back at my previous response, my advice, FWIW, remains the same. Stop panicking f possible, but you need a recheck pretty soon, and unless your PSA plummets downward yet again, and unless your DRE remains negative, you might want to get that BX. Just remember, if you do need the Bx and it does show cancer, it may STILL show the type of cancer that many folks choose to nothing more than keep a close eye on. And a lot of those people are still just watching it 10 or 15 years later, and the ones that have to do something 2 or 3 years later are no worse off for long term survival iMO. So there is very little risk in that approach.

All is not lost yet, so try to settle down(I know, easy for me to say!)
Posted 10/7/2015 7:27 PM (GMT 0)
So I wonder if riding a 65' boat in 10-12' seas can mess with your prostate? Even though I wasn't sitting down(too rough for that) I was still taking quite a pounding. I think if she suggests a Biopsy I'm going to ask for the Cipro & retest maybe??? Even though I have no symptoms of anything wrong...
Posted 10/7/2015 8:56 PM (GMT 0)
Hi Bigwave

I'm in a very similar boat to you, PSA was 1.0 for 10 years then at age 50, in the space of 3 months went 4,2,8,8. Oh sh!t...

My PCP sent me unto a Urologist; DRE was negative and I made ALL the excuses... farked my wife last night, rode a horse, got hit by a meteorite etc etc.

He said "yep thanks, and now we'll do a Prostate Health Index (PHI) blood test my friend".

I scored a solid 47.5 out of 100 (you want to be 25 or less) so he said "yep, and now we'll be doing a 3T MRI won't we my friend".

So we did the 3TMRI and low and behold there's a 9mm lesion; so he said "yep, and now we'll be doing a biopsy in November my friend".

Bottom line: you have SOMETHING going on, it may be benign, it may be prostatitis, it may be the rotation of the planets but you need to chase it to ground and not make excuses not to... just in case it's something real. I don't want mine to be, I expected at each point to get a "oh that was negative, you're fine" and I still pray for that, but the truth is I just have to keep biting that bullet.

Your job now is to get smart and get educated, get a PHI, ideally get a 3TMRI and a well performed biopsy with slides read by Epstein or Bostwick. You owe it to your prostate for all those years of dutiful splooging service...

Sorry if that's a tad brutal but this forum has a fair few members who will say "yep, wish I hadn't procrastinated and had bitten the bullet and gone through the process earlier; I'd be in a better place if I had".

Knowledge is power, having a plan is calming and being here is vital.

Paul
Posted 10/7/2015 11:16 PM (GMT 0)
Bigwave,

I echo Paul65. My psa had risen to the mid 3's over the course of 5 or 6 years when I had an alarming jump up to 4.4. The uro took another blood sample and told me to prepare for the biopsy the following week. I showed up all prepared for the poke when he reported that the last blood test showed the psa had retreated back to 3.4, so he said the biopsy wasn't necessary. Two years later, after hovering in the mid-3's, I got another alarming jump up to 4.7. I finally had the biopsy and it was actually 5.9 when I got the needle. I wish I had gotten the biopsy two years earlier. I might have been able to avoid 50% PC volume and + margins. Bottom line, the biopsy isn't nearly as bad as all the anxiety your currently experiencing. Just get it done. Hopefully it'll be negative and you will have some anxiety relief.
Posted 10/7/2015 11:51 PM (GMT 0)

Paul65 said...
yep thanks, and now we'll do a Prostate Health Index (PHI) blood test my friend"…I scored a solid 47.5 out of 100 (you want to be 25 or less) so he said "yep, and now we'll be doing a 3T MRI won't we my friend"…..So we did the 3TMRI and low and behold there's a 9mm lesion; so he said "yep, and now we'll be doing a biopsy in November my friend".....Your job now is to get smart and get educated, get a PHI, ideally get a 3TMRI and a well performed biopsy with slides read by Epstein or Bostwick....Knowledge is power, having a plan is calming and being here is vital…Paul

I've been here a couple of months, learned to get a PHI (only one lab in US does, may be hard to get) get a PCA 3 ( had to change Dr's to get that done) Get a 3T multiparametric enhanced MRI ( asked specifically if that is what I would be getting, was told yes - however got 3T multisequential, and no PIRADS report) now am jumping thru hoops to get a 3Tmultiparametric targeted biopsy that will likely not be done till the first of the year.

Changing Dr again to one at a tertiary care center in hopes of finding out just what is going on. Standard blind (not targeted biopsy) 12 core can miss a hell of a lot. Regular uro offices, even good ones normally go with the tools they have on hand which may or may not be resolving enough.

I have yet to see a poster regret stepping up to a higher level facility, Dr, or getting a second opinion from Epstein or Bostwick However, more than one wished they had sooner.

Me? I really want to know, and make sure I get the best answers possible on my diagnosis so what I do is spend a lot of spare time reading threads here on the forum. I have gained a tremendous amount of knowledge that empowers me throughout this process.
Posted 10/8/2015 1:19 AM (GMT 0)
Big, I get your fears, but I have learned through my journey keep having test done. If theres nothing there that's great but if not youll catch it early and youll be fine. Heard that phrase all my life and now I get it. Deal with biopsys if you need them catching it early is the key. GOOD LUCK
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