High PSA

Hello Everyone,
I am a regular on the Ulcerative Colitis thread.
I have UC but am currently in remission via excellent meds.
Just got some blood work done and my PSA came in very high at 8. In think my last one a couple years ago was 3? I am a cyclist and was riding considerably but took around 36hours before my blood work. Will go in Monday for a rectal exam. How concerned should I be and what else should I do?
Thanks everyone!

A PSA of 8 is a huge red flag. you need to find out what's going on

I would suggest staying away from the bike until your next test. Keep us posted.
Michael

Studies I have read show 10-15% increase in PSA related to very recent sex or physical irritation like bicycle riding. The DRE can tell a lot, particularly enlargement as you may have BPH and/or an infection. What is your age?

Key here is to find out the cause of the increase which can be caused by several different factors, cancer being only one of them. So relax and let the investigation begin.

F8 said...
A PSA of 8 is a huge red flag. you need to find out what's going on

Exactly.
You might want to read up on prostate biopsies and MRIs.

In the meantime, best wishes!

Like most guys, my red flag was an elevated PSA number. But mine inched up little by little over a matter of years. It did not increase by a significant margin in any given year. When it hit about 6 my primary doc sent me over to a uro. And that's when the ball started rolling. From my layman understanding, in many cases when a PSA number shoots much higher in a short period of time it could indicate something other than Pca. But the problem is ...... one never knows. That's why it's so important to get it checked out by a healthcare professional. At the end of the day, modern day science only offers the biopsy to confirm one way or the other. All the best.

The DRE sees if there is a palpable lump. If there is, that's a big Red Flag. If there's not, though, that's not a Green Flag. The high PSA trumps that. My DRE was normal. I have PCa.

You would definitely want an MRI next. You want a multi-parametric MRI (MP-MRI) which will look for lesions in the prostate. You can still have PCa if no lesions found, and they can find lesions that aren't PCa, but lesions correlate with PCa.

Following that, you can have a biopsy. If you have the MRI first, it can help steer the biopsy, otherwise the biopsy is a 'needle in the haystack' random search. If you have a biopsy first, it leaves a bunch of artifacts in your prostate (you just shanked it with a needle a bunch of times) that can screw up the MRI view, and you miss out on having the MRI guide the biopsy. So...MRI before biopsy.

You can also take many different actions to reduce the PSA and then watch the trend. If after a reduction it starts rising that could be more indicative of PCa. It it drops and stays stable, less likely for PCa. Drugs to control infection are routine as is Avodart, which will shrink the prostate, lower the PSA and then better expose any rise in PSA that could indicate PCa.

I wouldn’t rush to a biopsy unless the DRE finds a nodule or a MRI finds a high PIRADS score. On average 50% of biopsies are negative indicating other methods should be used to rule out non-cancerous causes. At age 56 you should expect to have some enlargement causing an increase in PSA, but 8 is well outside the normal range and needs serious investigation by an excellent urologist with a lot of prostate specialization. Don’t bother with a DRE by anyone other than a skilled urologist.

Hugo, a PSA of 8 is a red flag, thats true, but it could be other things besides cancer, such as a prostate infection or BPH (Enlarged Prostate). A series of PSA tests along with a DRE will offer more clues and inform as to whether a biopsy is called for.

Dont panic but dont sit on it either. Good that you are seeing Dr on Monday, good luck let us know how it goes

"Don’t bother with a DRE by anyone other than a skilled urologist."

I'd like to echo this point. When I had an elevated PSA, a nurse practitioner performed a DRE and found nothing. When I visited the urologist, he found lumps, and on that basis ordered a biopsy. It takes a trained finger to do a DRE.

Hugo18 said...
Thanks everyone. If someone came to me and said they had blood in stool combined with urgency I would say you have a 65% chance of crohns/colitis versus other causes. What would you realistically say my chances are having cancer versus other causes with a 8 PSA? I am not saying this in a panic mode.
Thanks

i too asked that question. everything i read said i had around a 60% of not having cancer. my doctor said i had a 70% chance of having cancer and that really pissed me off.

after the biopsy he said he was surprised the cores didn't look bad and he downgraded to 30-40% chance of having cancer. all 12 cores were positive

Not sure how pred impacts the prostate but it is a nasty drug. The new biologics are way less damaging to your entire body than pred. Actually prednisone wasn’t even effective for me personally.

Hugo,
PSA is just an indicator. A DRE is Jess and indicator. They are both diagnostic tools, but really the only way to know if you have prostate cancer is to biopsy the tumor or the prostate. Chances are, even if you have prostate cancer you are, still sitting really good when it comes to curative treatment options but once again, this is all purely speculation. My point is that you should try and relax and take things as they come. Stay off the Internet unless it's at a site like this because the only thing you're going to find on the Internet is things that will cause a rise in blood pressure lol. Keep us posted, and hopefully you will be able to let your membership at this forum expire