PSA 8.5 for BPH, is it a concern?

Thank you all for participating in this forum and shared all the experiences related to the disease which I found very educative and helpful. Hi all, my name's Bill, 65 years old, got BPH 3 years ago and currently on Tamsulosin 0.4 mg. 2 months ago, I got a PSA blood test and the result was 8.5. Just to let you know that I have no other symptoms except waking up one or two times per night to go to he washroom. During the day, I pee every three, four hours and I drink about two liters of liquid. I am quite active like daily walking, some yoga...My family physician sent me to an urologist whom I will meet next week. What should I need to prepare when I see my urologist next week? I heard that besides the DRE check, what will he do next?

I really appreciate if any experienced the same situation shares your knowledge or give me an advice.

Regards and thank you all.

Post Edited (Bill Nguyen) : 10/17/2020 9:57:14 AM (GMT-6)

Hi Bill and Welcome to the Forum! Do you have past PSA readings to put the current 8.5 (which is high) into context? I had a 25 year history of BPH with a slowly rising PSA and had many biopsies over the years to ensure the rise was entirely caused by a growing volume of only healthy, and not malignant, prostate tissue. BPH poses a difficult problem because having it (with its accompanying PSA rise) does not rule out that there is also prostate cancer present contributing to the PSA rise.

Your uro will take a detailed history and may measure your prostate size using ultrasound. PSA density (PSA/cc of prostate tissue) is more important than absolute PSA numbers, and your uro may want to draw blood to measure your free to total PSA ratio. These both provide indications of the likelihood of cancer.

If prostatitis is ruled out, and even if your DRE is normal, I think your uro will likely recommend a biopsy. The less of a prostate history you have (PSA values and rate of rise, prostate size and consistency notes from DREs, urinary symptoms, family history, etc.), the more important it becomes to establish a baseline pathology, which requires microscopic examination of some prostate tissue. An MRI might be suggested; however, some insurers will not cover it unless there is a prior negative biopsy. You'll also have a urinalysis, and your uro may order some other blood tests that predict cancer.

You uro may start you on a 5-alpha-reductase medication such as finasteride (Proscar) to shrink your prostate. This often (but not always) relieves some inward pressure your growing prostate is putting on your urethra, causing your urinary symptoms. If you are not getting sufficient relief with the Tamsulosin, you can discuss with your uro trying the max dose (2 capsules, 0.8 mg, daily). This medication combo greatly improved my BPH symptoms for many years; however, I eventually needed a TURP procedure to reduce prostate size, because BPH growth outpaced the effects of the medications and urination was too difficult. (My prostate cancer was found 4 years later -- I had surgery and only wish I could have had my PCa earlier so that prostate removal would have solved both conditions!).

Note that 5-alpha-reductases usually cause a reduction in PSA of roughly 50% after a few months. After that your uro will take your medication into account when evaluating your future PSA values -- any increase needs to be adjusted: it will be twice as large/significant. For example if your PSA after 6 months is 4.3, it will be considered to be 8.6; a subsequent rise to, say, 4.6 will be equivalent to 9.2.

I should give you a heads-up that if you have a negative biopsy and your PSA continues to rise in the future, repeat biopsies are a distinct possibility. Welcome to the BPH club!

Good luck, and keep us posted!

Djin

Yes, infections do happen with TRUS biopsies, and you may want to inquire about a transperineal biopsy, which has close to a zero infection rate. With antibiotic coverage, I had no infections after my 9 biopsies. My uro does wash the biopsy needle in isopropyl alcohol between each core when he does a TRUS biopsy. He has never had an infection requiring hospitalization.

I had my prostate removed 5 weeks after my cancer diagnosis and am fine, thanks! My high-risk cancer was diagnosed early, with an excellent outcome, thanks to my uro wanting yet another biopsy.

Your uro will evaluate whether your PSA is reasonable for a healthy prostate of your size. He may want to just monitor you for some number of months, or may push for a biopsy now. Remember, we are not docs, but do have a great deal of collected experience. I always give conservative advice about biopsies: if a uro you trust uro wants a biopsy, get it. And if you don't trust your uro, find another.

Djin

Djin gave you excellent advice, so I can be brief.
It looks to me that a biopsy is in your future. Even if the newfangled (transperineal) biopsy technology isn't available to you, let me reassure you that conventional biopsies have a very low rate of complications. Typically, your urologist will prescribe an antibiotic to take in advance of the procedure. The prostate area will be numbed, so you will feel very little during the needle sampling. Afterwards, some blood may be in your urine; that's not at all unusual. As I mentioned, complications are rare, but do happen.

Your PSA tests seem 'jumpy' to me and it may well be that other factors play a role in this. In other words, your PSA results by themselves don't prove that your prostate has cancer cells in it. Only a positive biopsy can do that. And a negative biopsy doesn't mean that there are no cancer foci, as Djin explained.

Please ask further questions; there are a good number of knowledgeable survivors that participate on this forum to help you along.
PS: treatment questions (surgery vs radiation etc.) seem premature at this point.

A PSA of 8.5 is not unusual with BPH. I know two people who have PSA ranging from 8 to 12 for many years, and both have had multiple negative biopsies.

There are several new treatments for BPH. These include Prostate Artery Embolization (PAE), UroLift, and Rezum. Be sure to study what each offers.

Hi Bill, while I don't have much to add to the advice you've already received, I just wanted to welcome you to HealingWell. I'm glad that we're helping give you some context as you move through your next steps--this place was a Godsend to me as I began my journey. Wishing you all the best!

My situation was different in that I was never diagnosed with BPH--in that sense I think you're getting more relevant information from DjinTonic whose situation is closer to yours. (He's also a super knowledgable guy.)

But to answer your question: despite landing in the "high risk" group when I was diagnosed eight years ago, I'm doing fine and PCa isn't even an issue in my life anymore. In your case, you don't know if you have PCa (and there's a good chance you don't have it), but in the event that you ever do end up joining our club, the vast majority of us do very well.

Bill - The Yana article you reference is like many found on the internet. It identifies some issues and then goes on a never ending rant that typically ends up blaming everyone and everything except the author. It is more a commentary on the entire medical profession than specific to PCa.

PCa is an odd cancer in that it is rather benign in many men and typically appears late in life when other causes of death are equally probable. The problem is when someone says you have cancer, everyone flips out and something must be done. That logic was followed for many years and lots of men had brutal treatments until medical science learned that some PCa is not as bad as other PCa and monitoring and treatments have gotten better. It is a long way from being perfect but it is better than it used to be.

If and when the time comes that you have to deal with PCa, the folks here can help insure that you don’t make any big mistakes or forget to consider various options, get second opinions, etc. There are very few cancers that I am aware of that does not require a biopsy to confirm and determine the cancer type and severity so it is hard to skip that step if you or the doctors think you might have cancer or want to rule out the possibility. The location of the prostate makes it a little more cumbersome than say a skin cancer biopsy thus not the most pleasant process.

Hello again Bill,

Your PSA does seem to bounce around a lot. Your urologist may want to do some other PSA tests and/or an MRI prior to a biopsy but you will have wait for your appointment to find out. The type of biopsy proposed will probably be based on the equipment the urologist has as the transperineal procedure is not all that common.

There are also some insurance issues that come into play that may govern what you can do. You just need to politely discuss your concerns with the doctor and see what he can and can’t do for you. Good luck with your visit.

Thank you Mumbo and Halbert for your nice advices. The reason I ask for transperineal biopsy because I heard about the infections and many other problems associated with transrectal biopsy. I will keep you posted after I meet my uro next week.

Thanks again,

Bill

Bill, yes, you're getting very standard care in your situation. If (hopefully) the infection resolves, then your PSA will then be more useful.

One of the things we sometimes say in here is that your PSA reading is kind of like the check engine light on your car. It doesn't mean a lot without the scanner to decode what it's saying. PSA is that way. It's flashing and saying "something is happening".

Oh, something that many docs don't tell their patients: Make sure you do not engage in sexual activity (including self-care) for 48 hours before a PSA blood draw. Anything that stimulates or irritates the prostate can cause a PSA jump.

Seems odd that your prostate treatment is being handled by two doctors. Did your urologist agree with the Cipro approach or just want to wait for next PSA? Usually the GP backs off once the urologist is involved. The result seems to be a reasonable approach so just wondering if they are communicating.