PSA Doubled in One Year

[donheff]

I used to take Flomax and don’t remember any effect on my PSA. It did wreak havoc with my blood pressure leading to some fainting episodes on bike trips. I ditched the Flomax but always suspected it may have precipitated my ongoing periodic tachycardia episodes which are distracting but not a big deal.

[cbo111]

My urologist said the finesteride will increase PSA. I mentioned the possibility of increased incidence of prostate cancer. He said that was a small VA study that has since been debunked. From everything I read about those of who suffer with enlarged prostates, there are no really good solutions. All seem to have inherent risks

[razztazz]

Quote:

Originally Posted by cbo111 From everything I read about those of who suffer with enlarged prostates, there are no really good solutions. All seem to have inherent risks

I have had prostate problems since the early 90's. I have been following trends and developments in prostates since then. Even my urologist says I know more about prostates than he does. He's probably exaggerating. I state this as prologue.

There's good news for prostates large enough to cause trouble but not large enough to motivate one to surgery.

In the past 4-5 years two simple, effective, well-tolerated, minimally invasive treatments have been available. Look up Rezum and Uro-lift or ask your Uro

No, not risk free. Only being perfectly healthy has no risks. But their safety profile seem almost too good to be true.

[target2019]

Quote:

Originally Posted by cbo111 My urologist said the finesteride will increase PSA. I mentioned the possibility of increased incidence of prostate cancer. He said that was a small VA study that has since been debunked. From everything I read about those of who suffer with enlarged prostates, there are no really good solutions. All seem to have inherent risks

There are two distinct groups of patients in this thread: one with PC, and one with BPH. As you pointed out, one comment about finasteride/dutasteride may/may not be true. Even if there are multiple studies, another can be performed and show very different results.
I recommend that anyone concerned go to a teaching hospital to find a urologist.

[freedomatlast]

Quote:

Originally Posted by freedomatlast Just completed my annual physical earlier in the week. Doctor's office called yesterday and said everything looked great except PSA doubled since last year. In 2016 it was 2.88, in 2017 it was 2.38 and this year it is 4.59. I'm 58 1/2 years old at this time. They want me to come back in a month to check PSA again.

Ok, it's been 4 weeks since my last PSA test and the results are in:

3.89 this time.

PCP performed a test for infection that was negative. He put me on Bactrim, anyway, but I could only take it for a little over a week due to an allergic reaction.

PCP recommends a visit to a urologist. I asked him for a referral to one that will utilize a 3T MRI instead of an invasive biopsy.

Any recommendations anyone may have for a specific urologist in the south eastern or south central PA or northern MD areas that utilizes 3T MRI instead of biopsy would be greatly appreciated.

Thanks to all for sharing the information and experiences in this thread.

[freedomatlast]

I thought I would provide an update for those who have been following this thread. Again, thanks to all those who contributed to this thread and offered to me lots of things to consider.

Today I met with a highly regarded urologist at a major teaching hospital. A DRE was performed and the result is that I have BPH. This is consistent with the symptoms I have been having that many of us post 50 males know all too well. A prescription for generic Flomax (Tamsulosin HCL) was given and I am supposed to take this for a month to see if symptoms improve. If symptoms improve, I am to continue taking it.

The idea is that a larger prostate will produce a higher PSA number. So in six months, I am to have my PSA tested again. One week after that, I have an 3T MRI scheduled and then an immediate follow up appointment with the Urologist. At that time, I should have a much better idea of what is going on.

The Urologist mentioned that a 58 year old would "normally" be expected to have a PSA of about 3.5, and mine at the latest test of 3.89 is not that far off. He mentioned PSA is far from an exact science.

But given the velocity, he wants to move forward with the 3T MRI in six months, which he is certain, insurance will pay for. He mentioned his staff has become very good with the proper coding and comments needed to get it paid by insurance. I would have chosen the MRI over biopsy at this point even if insurance didn't pay a dime, remembering Marko's experience.

This plan of action is very consistent with the recommendations of those that have "been there, done that" on this board and again I thank all contributors for sharing their experiences.

Any additional comments or suggestions are welcome.

[aja8888]

Quote:

Originally Posted by freedomatlast I thought I would provide an update for those who have been following this thread. Again, thanks to all those who contributed to this thread and offered to me lots of things to consider. Today I met with a highly regarded urologist at a major teaching hospital. A DRE was performed and the result is that I have BPH. This is consistent with the symptoms I have been having that many of us post 50 males know all too well. A prescription for generic Flomax (Tamsulosin HCL) was given and I am supposed to take this for a month to see if symptoms improve. If symptoms improve, I am to continue taking it. The idea is that a larger prostate will produce a higher PSA number. So in six months, I am to have my PSA tested again. One week after that, I have an 3T MRI scheduled and then an immediate follow up appointment with the Urologist. At that time, I should have a much better idea of what is going on. The Urologist mentioned that a 58 year old would "normally" be expected to have a PSA of about 3.5, and mine at the latest test of 3.89 is not that far off. He mentioned PSA is far from an exact science. But given the velocity, he wants to move forward with the 3T MRI in six months, which he is certain, insurance will pay for. He mentioned his staff has become very good with the proper coding and comments needed to get it paid by insurance. I would have chosen the MRI over biopsy at this point even if insurance didn't pay a dime, remembering Marko's experience. This plan of action is very consistent with the recommendations of those that have "been there, done that" on this board and again I thank all contributors for sharing their experiences. Any additional comments or suggestions are welcome.

Please keep us updated. I take Tamsulosin HCL but my PSA is consistently between 0.7 - 1.4 for 9 years now. I still worry at 74 years old.

[Blueskies123]

Quote:

Originally Posted by freedomatlast I thought I would provide an update for those who have been following this thread. Again, thanks to all those who contributed to this thread and offered to me lots of things to consider. Today I met with a highly regarded urologist at a major teaching hospital. A DRE was performed and the result is that I have BPH. This is consistent with the symptoms I have been having that many of us post 50 males know all too well. A prescription for generic Flomax (Tamsulosin HCL) was given and I am supposed to take this for a month to see if symptoms improve. If symptoms improve, I am to continue taking it. The idea is that a larger prostate will produce a higher PSA number. So in six months, I am to have my PSA tested again. One week after that, I have an 3T MRI scheduled and then an immediate follow up appointment with the Urologist. At that time, I should have a much better idea of what is going on. The Urologist mentioned that a 58 year old would "normally" be expected to have a PSA of about 3.5, and mine at the latest test of 3.89 is not that far off. He mentioned PSA is far from an exact science. But given the velocity, he wants to move forward with the 3T MRI in six months, which he is certain, insurance will pay for. He mentioned his staff has become very good with the proper coding and comments needed to get it paid by insurance. I would have chosen the MRI over biopsy at this point even if insurance didn't pay a dime, remembering Marko's experience. This plan of action is very consistent with the recommendations of those that have "been there, done that" on this board and again I thank all contributors for sharing their experiences. Any additional comments or suggestions are welcome.

No doctor here but I have never heard that an enlarged prostate leads to elevated PSA. I have been on Flomax and now Tamsulosin for 10 years and my PSA is about 1.5. My PSA did not budge before and after taking meds.

[braumeister]

Quote:

Originally Posted by Blueskies123 No doctor here but I have never heard that an enlarged prostate leads to elevated PSA.

It's quite common. There are other causes as well.

Seven causes of a high PSA that are not cancer

[NC 57]

Quote:

Originally Posted by freedomatlast I thought I would provide an update for those who have been following this thread. Again, thanks to all those who contributed to this thread and offered to me lots of things to consider. Today I met with a highly regarded urologist at a major teaching hospital. A DRE was performed and the result is that I have BPH. This is consistent with the symptoms I have been having that many of us post 50 males know all too well. A prescription for generic Flomax (Tamsulosin HCL) was given and I am supposed to take this for a month to see if symptoms improve. If symptoms improve, I am to continue taking it. The idea is that a larger prostate will produce a higher PSA number. So in six months, I am to have my PSA tested again. One week after that, I have an 3T MRI scheduled and then an immediate follow up appointment with the Urologist. At that time, I should have a much better idea of what is going on. The Urologist mentioned that a 58 year old would "normally" be expected to have a PSA of about 3.5, and mine at the latest test of 3.89 is not that far off. He mentioned PSA is far from an exact science. But given the velocity, he wants to move forward with the 3T MRI in six months, which he is certain, insurance will pay for. He mentioned his staff has become very good with the proper coding and comments needed to get it paid by insurance. I would have chosen the MRI over biopsy at this point even if insurance didn't pay a dime, remembering Marko's experience. This plan of action is very consistent with the recommendations of those that have "been there, done that" on this board and again I thank all contributors for sharing their experiences. Any additional comments or suggestions are welcome.

I'm thankful you found a specialist you have confidence in and are able to utilize the modern diagnostic tools. Best wishes to you.

[ssarwar]

Quote:

Originally Posted by freedomatlast Just completed my annual physical earlier in the week. Doctor's office called yesterday and said everything looked great except PSA doubled since last year. In 2016 it was 2.88, in 2017 it was 2.38 and this year it is 4.59. I'm 58 1/2 years old at this time. They want me to come back in a month to check PSA again. Anyone have similar experiences or information on this they would be willing to share?

Make sure you aren’t doing few ‘no’s’ 48 hours before PSA testing.
Like Participate in vigorous exercise and activities that stimulate or “jostle” the prostate, such as bike riding, motorcycling, and riding a horse, ATV, or tractor, or getting a prostatic massage for 48 hours before your test.
Participate in sexual activity that involves ejaculation for 48 hours before your test. Ejaculation within this time frame may affect PSA results, especially in younger men.

[TwoByFour]

I no longer get PSA tests. As this thread illustrates, there are a lot of false positives (75% of positive outcomes are false) which leads to unnecessary treatments and surgeries. Basically, when faced with a positive PSA, there is a tendency to be aggressive "just in case" which can lead to complications like ED. There is a lot of debate about PSA so you should look into it yourself. It is a money maker for the medical business so they want to keep doing it.

[Offgrid Organic Farmer]

Quote:

Originally Posted by TwoByFour I no longer get PSA tests. As this thread illustrates, there are a lot of false positives (75% of positive outcomes are false) which leads to unnecessary treatments and surgeries.

There are many causes of a high PSA. None of those causes are a 'false' indication of anything.

If you have a high PSA, that indicates that something caused it to be high.

When combined with digital probing and possibly imaging a urologist may determine it is smart to do a biopsy.

PSA tests do NOT cause any surgeries to be performed.

Only after the pathology report comes back from a biopsy, showing cancer is surgery even considered. Even then it depends on the Gleason score.

PSA tests by themselves do NOT lead to surgery.

[Blueskies123]

Quote:

Originally Posted by TwoByFour I no longer get PSA tests. As this thread illustrates, there are a lot of false positives (75% of positive outcomes are false) which leads to unnecessary treatments and surgeries. Basically, when faced with a positive PSA, there is a tendency to be aggressive "just in case" which can lead to complications like ED. There is a lot of debate about PSA so you should look into it yourself. It is a money maker for the medical business so they want to keep doing it.

This is really bad idea and the false positive rate is not 75%. You might kill someone spreading that misinformation.

[6miths]

The false positive rate for the standard 4 ng/mL cutoff most commonly used is indeed 75%. Most screening tests have high false positive rates. https://www.cancer.gov/types/prostate/psa-fact-sheet On the government fact sheet read under 'Limitations and Potential Harms of PSA test'. It is worse than that though as many cancers detected are relatively benign and would not be fatal or even ever found without screening. There are many potential downsides to screening and more and more professional organizations are not recommending routine screening.

Offgrid Farmer is incorrect. The 4 ng/mL cutoff that has been chosen is arbitrary and many absolutely normal men will have levels above this without having one of the 'causes'. This is part of normal biological variation. We are talking about many bell curves the largest of which is for the truly normal population (with respect to the prostate) and others for those with prostate cancer, BPH, prostatitis, and many other situations.

The test is no panacea and certainly does have the potential to and has caused harm. It has also saved lives. The difficulty is finding the balance and recognizing that there might be other ways to save these lives with less negative impact and cost.

[TwoByFour]

Quote:

Originally Posted by Blueskies123 This is really bad idea and the false positive rate is not 75%. You might kill someone spreading that misinformation.

According to the NIH (National Institute of Health), the false positive rate is 75%. Here is the link to the NIH report:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183963/

[jabbahop]

I have had “elevated” PSA readings for probably 15 years (am 58) and have been diagnosed with BPH. Now I am about 5.5 I believe and they slowly been increasing over time. A year ago I had another biopsy (father had prostate cancer so I am considered high risk). This time (and confirmed with follow up biopsy a month ago) they detected a slow growing form of cancer in 1 of the 12 samples.

I have a low grade Gleason score so have decided to do watch and wait strategy.

[Blueskies123]

Quote:

Originally Posted by TwoByFour According to the NIH (National Institute of Health), the false positive rate is 75%. Here is the link to the NIH report: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183963/

This will be my last post on the subject. I think this number comes from this study where, for a small select group of people with a positive test:
"Most men with an elevated PSA level turn out not to have prostate cancer; only about 25% of men who have a prostate biopsy due to an elevated PSA level actually are found to have prostate cancer when a biopsy is done (2)."
https://www.cancer.gov/types/prostate/psa-fact-sheet


So for the group of people with a positive test many of them do not really have cancer.


The false positive rate for the entire population can be found here:
Conclusions:

"The false negative rates for men with PSA <3.0 ng/mL and negative sextant Bx are extremely low but not negligible. Proper risk stratification before deciding to biopsy is expected to hardly miss any clinical significant PCa diagnosis. This is especially relevant with the increased use of the relatively expensive multi-parametric magnetic resonance imaging (mpMRI) guided targeted Bx procedures."


https://www.ncbi.nlm.nih.gov/pubmed/29594020

[Offgrid Organic Farmer]

A high PSA score is NOT a 'false' positive of anything.

A high PSA score accurately tells you that your PSA score at that moment is high. If you want to try and predict cancer or some other such thing, from a high PSA test, that is on you.

Stop trying to blame PSA tests for some other thing.

Saying that a high PSA score is a 'false' positive, is making the false assumption that someone is reading your PSA score and trying to predict cancer.

If you have a high PSA, that indicates that something caused it to be high. That is all it does.

When combined with digital probing and possibly imaging a urologist may determine it is smart to do a biopsy.

PSA tests do NOT cause any surgeries to be performed.

Only after the pathology report comes back from a biopsy, showing cancer is surgery even considered. Even then it depends on the Gleason score.

PSA tests by themselves should NEVER lead to surgery.

I have been through this myself. I had a PSA of 25 and a Gleason of 9 in 10 out of 12 core samples.

[target2019]

And then we have most clinical situations, where there are multiple PSA tests.
As more results are taken in combination with examination, and so on, you get a truer picture.