New to This and Confused About PSA at Age 35

Hello… I’ve just stumbled into this forum and was hoping those of you with experience could help me find clarity in my situation, since Dr. Google is only adding to my confusion and stress.

I’m 35 y/o, slightly overweight, with high blood pressure and IBS but otherwise healthy. I had a routine physical done in June and my former primary care physician always included PSA testing as part of the screening. It came back at 4.2, and he urged me to see a urologist ASAP. I looked at my previous results from late 2012 it was 1.5 and early 2014 it was 1.6. I have since moved to start a new job, bought a new house, a new car, and have been wedding planning with my lovely fiancée. So this medical stuff is a shot to the jaw at an otherwise joyous time in my life.

There is a curve ball in this story… back at the end of January/start of February I had tremendous pain in my lower right back, and I was screaming in the bathroom. On the Friday before the Super Bowl I went to the ER with this pain and a fever of just over 100, and had a CT scan done. They said the CT scan looked great and dismissed me under the theory that I had at some point passed a kidney stone. Well the next few days I was worse, and saw the afore-mentioned primary care doc on the Tuesday after the Super Bowl. By then my fever reached 102+, still was having pain. He gave me a shot to help the pain, and gave me a round of Cefdinir, which took care of the issues. Next time I saw him was the June test previously mentioned.

So following the primary care doc's advice, I saw a urologist upon settling into my new home in mid-July and he gave me a month’s worth of Cephalexin, and then re-tested me about 3 weeks into the dosage (he wanted to prescribe Cipro but I took it once a few years ago for some pain I was having in my groin then, and I thought I was going to explode). PSA that time was 3.2 but he also mentioned something about Free PSA being 15%. The urologist I am seeing is an arrogant fast talker who doesn’t like questions, so I don’t remember everything he said, and frankly I’m not a fan of his. He also removed some skin tags from that area at that time he said were viral in nature. I had them for a few months, and wonder if that’s related.

Anyway, I had a follow up test done 2 weeks after finishing the meds, meaning last week, and the results were 3.4. He basically insisted I must get a biopsy done now. Again he would not answer my questions about it, other than to say get the biopsy, and do it immediately. He also mentioned that the PSA numbers from 2012/14 should’ve warranted further testing then given my age, which is the first I ever heard that.

I’m a professor, so I do research for a living. Naturally, I began to look on Google and see inconclusive evidence about the use of PSA levels, and how they can lead to unneeded biopsies. I also see differing opinions about the cutoff PSA level for different ages. But what keeps catching my eye is that someone who had an infection in that area, as I seem to have had though was never clearly diagnosed with back in February, can have higher PSA levels. I still occasionally have a twinge in my lower back on the right side at the waistline, just not a badly as it was back then. I feel like if this is a result of the infection, then a biopsy is just a wild goose chase that will cost me thousands of dollars. Would a cancerous prostate have PSA numbers that drop like mine did seemingly as a response to the Cephalexin?

My next steps are to find a new primary care doctor here, and I have an appointment with one in about 36 hours. I am going to ask him to test for PSA again, and run the full physical diagnostics since I have new insurance that will cover some of the costs (darn deductibles). I am also going to get a second opinion from a new urologist after seeing the primary care doc and getting a new referral, and hopefully finding someone more personable than I have so far. I have a biopsy scheduled with the urologist I don’t like on 9/17 but I may cancel it or move it to the new doc if they say it’s needed as well. But if I can avoid it I really would like to do so, as I’m not sure how I would handle the test and results.

So, long story short: I’m very anxious and confused about all this and wondered if others (around my age or not) could relate to the story? Especially regarding the decline in PSA levels? Every time I go to the bathroom or feel a twinge in my back I think of cancer and then all the plans my fiancée and I have, and it’s getting me pretty depressed. Though I do realize the whiny nature of saying that compared to you gentlemen who have been diagnosed.

Thanks in advance.

Dr Old School, welcome to hpthe forum, hope you are just passing through and don't become a permanent member.

It would be highly unusual at your age to be diagnosed with prostate cancer. But not impossible. First thing is the advice Jeff gave you above. Aside from the proper prep for PSA blood draw though, it seems like something is going on, could be a lot of things, not just cancer.

Seems like the antibiotic not doing much to lower your PSA would rule out infection.
I think it's good that you are seeking out a new URL, and I wouldn't let your current uro do the biopsy. If God forbid it comes back positive, the last young in the world you want is a desensitiEd Iro that won't let you ask questions. Howebpver this turns out, you want someone who will give you clarity.
If you could arrange for an MRI guided biopsy, it would probably be best. The MRI will highlight areas of interest from which they will take extra samples. Vs a traditional "blind" biopsy which just takes a small amount of tissue from random places in different areas of the prostate and can easily miss something.

But let's hope it doesn't come to that.

Btw, I doubt that episode of back pain you had was in any way related to prostate cancer. And it leads me to believe, that there is a decent chance this whole thing is something not related to cancer.

Others will chime in, and keep in mind I'm nit the most knowledgeable guy here, just a guy with some experience. And also keep in mind that nobody here is a doctor.

Good luck, please keep us posted.

Hello OldSchool

I'm no expert on all of this but find myself in a similar boat to you... In addition to the sound advice regarding seeking out an MRI (which can then inform the (Fusion) biopsy), you might also ask about the newer less 'noisy' blood tests. Johns Hopkins uses the Prostate Health Index (PHI) and I know there is another one too. Their 'elevated PSA' protocol is to do the PHI test BEFORE moving to MRI and/or biopsy. If you fall into the bottom quartile they relax a lot and place you into some form of surveillance program and move back to Defcon1. I'm not sure of the details of that though because I failed and scored a solid 47.5; qualifying me for more anal delights.

Worth a question at least if it can save you a biopsy (which is why it exists).

Paul65

Suggest you get a PHI test before scheduling biopsy.

Depending on your area and availability, that may be somewhat hard to do.

My understanding is that the test is only done by http://www.myinnovativelab.com/prostate-cancer/

I had them send me a list of physicians in my area, and am going to a urologist 30 miles away to get it scheduled. Have an appointment today, actually. PCA3 test also offers more info, but insurance will usually only pay with rising psa after negative biopsy.

Note: Bostwick Labs gave me a firm email quote for PCA3 of $175. Bostwick is one of the more respected labs used by urologists and one of two preferred place to have your slides from biopsy read.

The first urology practice I went to was owned by a hospital, and refused to allow me to use Bostwick to read a PCA3 (requires specific prostate massage prior to collection) and refused to do a PHI.

I found this forum and believe I am on a far better path.

Since the uro practices in my city (Greenville, SC) are owned by hospitals, they have specific guidelines they follow on lab procedures. I am going to Spartanburg to a Urology practice that is owned by the Urologists and they are fine with using the lab of my preference.

How it is working where I live anyhow.

Short version:

When you change urologists inquire as to if you can get a PHI test done, and if they will allow you to use the lab of your choice (bostwick or other)

Doc, welcome. You have received some excellent advice here, IMHO. It is very unlikely (though not unheard of) for you to have prostate cancer so I certainly agree with others about ruling out other issues before getting a biopsy. And, it sounds appropriate to move on with new doctors in whom you have confidence and trust.

Infections and prostatitis are notoriously hard to find and cure at times and it may be that another and different course of antibiotics are appropriate. And, perhaps you have BPH with an enlarged prostate that will naturally give off a lot more PSA.

Finally, re the biopsy, yes it is normally a routine procedure. However that is not always the case. It is invasive and can lead to urinary issues, infections and even temporary ED. I'm particularly sensitive to the issue of biopsies since I had an acquaintance who died after getting sepsis after a "routine" biopsy. Of course, that's just one anecdote and I'm not trying to scare you; rather, I'm just trying to reinforce the advice of the others here who are encouraging you to first rule out other issues in a 35 year old man.

Good luck and please let us know what happens.

Jim

Just adding my welcome and concern about having a biopsy. You don't mention if you have lots of PC in your family--but even then I would be reluctant to have a biopsy at this stage of the game.

Good luck to you and keep us posted!

Thanks for all the help and advice gentlemen. I am going to take the information about other tests with me to the primary care doctor tomorrow afternoon. I live near Indianapolis so I will have to research hospitals in this area as I've only been here about 6 weeks.

There is no history of PC in my family. My father had a prostate biopsy a few years ago which made him ill for a few days. He has been sensitive to anesthesia though. He is currently battling lymphoma. But that is the only cancer in the family I know of.

I sincerely thank you all again for the advice and information.

A slow and steady rise in PSA over time almost always indicates cancer (e.g. 0.5, 0.85, 1.1, 1.5, 2.2, etc), bouncing of PSA in all directions over time most likely indicates some other cause. You have your age going for you. Functonal MRI can be useful in discovering PC, but the only way to know for sure is biopsy. Even if nothing comes out of this (I am sure it won´t) you have a reference value and some knowledge of this topic. Get your PSA value measured regularly, and chart it out. These historical values are very important. My father never had his T or PSA measured before his diagnosis, and this was a big omission on our part. Good luck.

Saw the new primary care dr today. Decent guy. Was confused when I informed him that the urologist said the numbers I mentioned from 2012/14 warranted more treatment then let alone now. Suggested that I get blood drawn again late next week and if psa is still above 3 then he will refer to a different uro. But said it is worth following and not dismissing cancer chances completely, though it is rare. I asked him about the other tests mentioned here and he just shrugged. I will have to inquire about those with the next uro.

The jerky uro I had before was at urology of indiana. The primary care doc actually had heard of him, and nothing good. I will have to look for one associated with IU Health