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PSA Up and Down... Seeking opinions

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Posted 8/6/2017 3:33 AM (GMT 0)
This discussion will probably be academic in a week or so after I get the results of my latest (fifth) biopsy, but there are so many knowledgeable and well-informed folks here, I thought I'd just solicit some opinions.

Here's some background:

Age: 52. Being treated at Sloan-Kettering, NYC
85-year-old father has no signs of prostate cancer, just BPH.

Last six PSA readings:

10/24/14 – 6.24, Free PSA = 20%
4/24/15 – 6.14, Free PSA = 21%
11/6/15 – 5.86, Free PSA = 21%
5/20/16 – 5.75, Free PSA = 26%
12/2/16 – 7.73, Free PSA = 24%
6/16/17 – 6.19, Free PSA = 24%

Four previous biopsies from 2009-2012 -- all negative.

Prostate MRIs
8/10 -- PROSTATE MEASUREMENTS: 5.8 x 3.0 x 4.0 cm, calculated prostate volume 34.8 cc, calculated PSA density 0.16. IMPRESSION:Bilateral patchy changes in the prostate from base to apex. In view of
several negative biopsies, extensive tumor is unlikely. No dominant focal
lesion.

6/17 -- PROSTATE MEASUREMENTS: 6.4 x 3.4 x 3.8 cm; volume 43 cc, stable. IMPRESSION: 1. Since August 6, 2010, unchanged signal abnormality throughout the peripheral zone, probably prostatitis in view of multiple prior negative biopsies, however underlying low-grade tumor cannot be excluded. 2. PI-RADS v2 score 3 -- Intermediate (the presence of clinically significant cancer is equivocal)

PCa3 score (6/17) = 29

I'm currently waiting for the results of a biopsy just performed this past week... Doctors have admitted that I am an "unconventional" case.

I'm always seeking more knowledge, so please feel free to post views/opinions.

Thanks!

Post Edited (Hope4Happiness) : 8/5/2017 9:44:23 PM (GMT-6)

Posted 8/6/2017 4:33 AM (GMT 0)
In my humble opinion (IMHO), you have bph and likely prostatitis. That doesn't rule out your later having prostate cancer, but you don't have it now, and may never.

I am very concerned about the number of biopsies that you have had. I have also had five, and they did noticeable damage and hemorrhaging, which shows up on MRI's. You should try to avoid future ones, using whatever "liquid biopsies" that are approved. At this point in my long active surveillance protocol, I have to have EITHER an MRI OR a biopsy every two years. I do not intend to ever have another biopsy.

Good luck to you.
Posted 8/7/2017 10:59 AM (GMT 0)
@ASAdvocate -- Thank you very much for your response.
Posted 8/7/2017 1:58 PM (GMT 0)
i read your thread when you first posted it. And didn't want to answer because I didn't want to be coming across as a doctor. But I was wondering what makes you think you've got it? And what's making these docs wanna keep poking you? Don't they see PSA's run high with BPH? Looks like after 4 biopsies....with no other signs of the disease....at some point....they'd understand you don't have it.


I also thought...."You keep poking at that....and sooner or later, you'll find what your looking for. And it could do you more harm than good to do so".
Posted 8/7/2017 2:27 PM (GMT 0)
@island time -- thank you very much for your response.

It's not so much that I think I have prostate cancer -- it's that I'm basically following the doctor's lead here. I haven't had any outward urination problems (other than on the occasional morning in which I have to jump out of bed and pee like racehorse), and all my DREs has shown nothing.

My PSA has been up and down (always above 4.0) for many years.

My most recent biopsy previous to the one last week was July 2012.

Here are my PSA readings going back to 2012:

3/23/12 – 5.09, Free PSA = 16%
6/29/12 – 5.88, Free PSA = 12%
7/10/12 – 6.83, Free PSA = 12%
1/18/13 – 5.94, Free PSA = 16%
8/2/13 – 5.33, Free PSA = 19%
2/28/14 – 5.98, Free PSA = 17%
10/24/14 – 6.24, Free PSA = 20%
4/24/15 – 6.14, Free PSA = 21%
11/6/15 – 5.86, Free PSA = 21%
5/20/16 – 5.75, Free PSA = 26%
12/2/16 – 7.73, Free PSA = 24%
6/16/17 – 6.19, Free PSA = 23%

That 6/29/12 PSA jump to 5.88 is what prompted that year's biopsy.

My doctor was concerned with that PSA jump to 7.73 on 12/2/16 and that's what's prompted an MRI and a PcA3 test. If my PcA3 score came in under 25 and my MRI came back with a PI-RADS v2 score of 1 or 2 (instead of 3), the doctor would have skipped this recent biopsy.
Posted 8/7/2017 3:13 PM (GMT 0)
Yes, a strange case indeed....But if you have untreated prostate cancer, the PSA number seldom if ever goes down...If you DO submit to another biopsy, it should be the "saturation type"...
Posted 8/7/2017 8:32 PM (GMT 0)
@Fairwind -- thanks for your input.
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