PSA Doubled in One Year

[Richard4444]

I’d be very curious about his opinion of the 4K Test and the Prostate MRI and whether they are now considered the standard of care.

Note: This would apply in cases of high PSA when considering whether or not to biopsy; not for routine screening.

Rich

 

[audreyh1]

Note: This would apply in cases of high PSA when considering whether or not to biopsy; not for routine screening.

Rich

Of course

 

[Mr._Graybeard]

My PSA tripled, I was referred to a urologist who scheduled a $3K-$6K needle biopsy. When I asked for a PSA retest first, the the urologist and the GP’s nurse were adamant against it - even though it’s a $50-$100 test. I had to force the issue and demand a new test. Good thing I bucked them all.

My GP was routinely performing a DRE just before drawing the blood used for the PSA - that’s asking for false reading. I wonder how many patients were misled unnecessarily? He dramatically changed his view after my false PSA, and presumably other reading he did after. I’ve had low PSA results annually several times since my false PSA episode.

First thing, wait a few weeks and get a retest making sure none of what you learned in post #4 are true. And there are other things that can falsely elevate PSA.

http://www.early-retirement.org/forums/f38/psa-on-psa-applicable-for-men-70814.html

I also encountered a urologist who really, really wanted to perform a prostate biopsy on me even though my PSA was under 3. Gotta keep that expensive medical equipment humming.

 

[donheff]

OP, the PSA test and random needle biopsies based on them are controversial as you might guess from the comments in this thread. But, I agree with the bulk of the responses that you can go slow, especially with a marginal PSA result like yours - PSA goes up with increasing prostate size so plain old BPH can gradually lift the numbers into the questionable range. Others have given good advice about seeking additional information and pushing for a 3TmpMRI to target the biopsy if a biopsy is warranted, Although I suspect some insurance companies will not pay for an MRI unless a random biopsy has been done first. In the event that you do test positive it is also not the end of the world. In most cases there are a lot of options so take it slow and do your homework.

I got on this runaway train when I broke my hip. A glowing mass showed up on the Xrays right where my prostate would be. The osteopathic surgeon who did my followup on the hip surgery noticed what appeared to be cancerous lesions on the hip bone. That with the glowing mass led him to alarm the sh** out of me that I had prostate cancer already metastasized to the bone. The urologist calmed things down (it turns out that lesions that look like bone cancer can show up from trauma and I had a lot of previous trauma on my hips and ribs from various mishaps in my youth.) He found that I had a big bladder stone and a borderline high PSA like yours. I elected to get the stone blasted and removed through the urethra and decided to get a laser TURP (roto-rooter) while they were in there to relieve my long standing BPH and let me get a few more hours of uninterrupted sleep. The urologist insisted on a biopsy prior to surgery since, if I did have Pca, it would/could affect the way they proceeded. The biopsy came back negative but the debris from the surgery disclosed a small amount of Pca cells.

The diagnosis led me to do a lot of research. It turns out that a lot of us have cells rated Gleason 3 that many researchers believe are not truly cancerous and will never metastasize. Nevertheless, it is always possible that the biopsy (or debris field) missed a spot of tissue that has other truly dangerous cells at Gleason 4 or 5. Thus the proper protocol is active surveillance that calls for monitoring PSA, DREs, and possibly periodic MRIs going forward. My urologist is quite up to date and agrees with this approach. Some urologists are more old school and will push agressive treatment of low grade cancers as was routinely done in the past. If you end up with a Pca diagnosis I recommend a forum called Inspire for hooking up with a bunch of guys who are dealing with this and can give you multiple perspectives on treatment and research. Inspire has forums for newly diagnosed, advanced cancer and related topics.

 

[Crabby Mike]

I've been following this thread with interest, as I have extensive family history of prostate cancer (my father, maternal grandfather, and older brother, when he was younger than I am now), and thus see it as a near-certainty sometime in my future. As such, I see my urologist regularly, and have PSA tests done at least once a year. My last total PSA was 6.8, down from a high of 7.5 a year or so ago.



I'm surprised that no one has brought up the "free and total PSA" test, which my urologist is a big proponent of. (This is two parts of the 4k test.) It measures, out of the total PSA number, the % that is free vs. bound to other proteins. For those of us in the "gray area" between 4 and 10 ng/ml total PSA, the % free can help determine the likelihood that the cause of elevation is cancer, vs. benign conditions like BPH. In my case, my % free of 30 or so implies a statistical likelihood of cancer of around 8%.


My urologist prefers to limit prostate biopsies because of the possibility of infection, as others here have discussed, and thus has me do a free and total PSA test every time. If and when those numbers don't look good, we'll discuss next steps; I don't know if he would suggest an MRI before biopsy or not. And thanks to my proximity to Baltimore, if and when I need surgery, I hope to go to Dr. Patrick Walsh's excellent team at Johns Hopkins, as my brother and former boss have done, with good results.

 

[Shredder]

I had elevated psa tests over 3 years in my mid fifties. Every year it went up. I also had a family history of prostate cancer. That lead me to a urologist and a biopsy. 2 of 12 needles showed cancer, six months later 8 of 24 showed cancer. I eventually had my prostate removed at the U of M. A great dr and a great hospital btw. I'm still functional, something i feared almost as much as death, and cancer free thanks to their good works.

As much as the biopsies suck, they're a valid tool to find out exactly what's going on. Without those tests, I'm not sure how things would have turned out.

 

[Midpack]

I had elevated psa tests over 3 years in my mid fifties. Every year it went up. I also had a family history of prostate cancer. That lead me to a urologist and a biopsy. 2 of 12 needles showed cancer, six months later 8 of 24 showed cancer. I eventually had my prostate removed at the U of M. A great dr and a great hospital btw. I'm still functional, something i feared almost as much as death, and cancer free thanks to their good works.

As much as the biopsies suck, they're a valid tool to find out exactly what's going on. Without those tests, I'm not sure how things would have turned out.

You've missed the gist of what many of us are saying. We're simply saying that a needle biopsy should not be performed based on one slightly elevated PSA result - and I will stand by that, though I won't repeat my experience, documented earlier.

 

[Offgrid Organic Farmer]

Mine shot up to 25. They scanned it and did a biopsy, it turned out my prostate was 100% consumed by a gleason 9 cancer.

I had a DaVinci robotic surgery, it was quick and easy [for me]. I went to the hospital one day and I was released the next day. My insurance co-pay for the entire process from detection, biopsy and the surgery was $32.

 

[NC 57]

My father had prostate cancer in his early 50’s. He had it surgically removed, became impotent from the surgery and is still living at 88. At 58 my PSA spiked and my urologist wanted to do a needle biopsy. I asked for a non invasive alternative. He told me the hospital system his office is associated did not have equipment for alternatives and if I wanted a prostate MRI I was on my own. He would not even tell me where to look.

I did research and found one of the top urological oncologists in the country is doing prostate MRI research at a major university medical center a two hour drive from my house. I got the physician’s office phone number from the university directory online and called his office for a consultation appointment. Two weeks later I was talking to him in his office. Two weeks after that appointment I had my prostate MRI even though I wasn’t yet sure if insurance would cover the $7000 cost of what was considered an “experimental” test. A week later I sat with the doctor and saw the images of my hugely enlarged prostate as well as the bonus images the test provides of the bladder and surrounding lymph nodes. No evidence of cancer in any location. The doctor explained my prostate was so large a traditional blind needle biopsy would have less than a 20% chance of finding cancer in mine. I had the images and physician notes sent to my regular urologist and scheduled an appointment to review the data. He was angry and asked, “What do you want me to do with this? You need a biopsy.” I walked out of his office and called the oncologist at the research hospital asking for a referral to a new urologist who could work with the test results. Surprisingly, he offered to see me for an annual urology exam. Five years later, with drug therapy and dieting, my PSA is down and my prostate is much smaller. My urine flow is better and there is still no indication of cancer.

In today’s world we have to do our own research and not blindly trust doctors. Technology is developing rapidly and there are many doctors in the comfort zone who aren’t staying current.

 

[Bamaman]

I was tested this week and all was good. Now if I could just convince my wife all is so good.

 

[bmcgonig]

My father had prostate cancer in his early 50’s. He had it surgically removed, became impotent from the surgery and is still living at 88. At 58 my PSA spiked and my urologist wanted to do a needle biopsy. I asked for a non invasive alternative. He told me the hospital system his office is associated did not have equipment for alternatives and if I wanted a prostate MRI I was on my own. He would not even tell me where to look.

I did research and found one of the top urological oncologists in the country is doing prostate MRI research at a major university medical center a two hour drive from my house. I got the physician’s office phone number from the university directory online and called his office for a consultation appointment. Two weeks later I was talking to him in his office. Two weeks after that appointment I had my prostate MRI even though I wasn’t yet sure if insurance would cover the $7000 cost of what was considered an “experimental” test. A week later I sat with the doctor and saw the images of my hugely enlarged prostate as well as the bonus images the test provides of the bladder and surrounding lymph nodes. No evidence of cancer in any location. The doctor explained my prostate was so large a traditional blind needle biopsy would have less than a 20% chance of finding cancer in mine. I had the images and physician notes sent to my regular urologist and scheduled an appointment to review the data. He was angry and asked, “What do you want me to do with this? You need a biopsy.” I walked out of his office and called the oncologist at the research hospital asking for a referral to a new urologist who could work with the test results. Surprisingly, he offered to see me for an annual urology exam. Five years later, with drug therapy and dieting, my PSA is down and my prostate is much smaller. My urine flow is better and there is still no indication of cancer.

In today’s world we have to do our own research and not blindly trust doctors. Technology is developing rapidly and there are many doctors in the comfort zone who aren’t staying current.

Is the MRI controversial with respect to diagnosis?

 

[Richard4444]

Is the MRI controversial with respect to diagnosis?

When the PSA is high, a prostate MRI is taken (hopefully) which shows if dense areas (tumors of some type) are present. Then the urologist can biopsy these specific areas with MRI guidance rather than just taking random samples and guessing. This is not controversial but the present standard of care. I have a friend who had a high PSA and was going to get biopsied, so I told him about it; his urologist didn't do the 'MRI thing' so he went elsewhere. In his case he did the 'MRI thing' elsewhere and did have Ca and is presently being treated for it. Random biopsies may very well have not picked up his Ca.

Rich

 

[bmcgonig]

When the PSA is high, a prostate MRI is taken (hopefully) which shows if dense areas (tumors of some type) are present. Then the urologist can biopsy these specific areas with MRI guidance rather than just taking random samples and guessing. This is not controversial but the present standard of care. I have a friend who had a high PSA and was going to get biopsied, so I told him about it; his urologist didn't do the 'MRI thing' so he went elsewhere. In his case he did the 'MRI thing' elsewhere and did have Ca and is presently being treated for it. Random biopsies may very well have not picked up his Ca.

Rich

Interesting. It seems to be more useful than an actual biopsy as well.


"In the study, scanning correctly diagnosed almost all of the aggressive cancers (93 per cent), whereas biopsy correctly diagnosed only half 48 per cent, For men who had a negative MRI scan, nine out of 10 either had either no cancer or a harmless cancer, an accuracy rate far highter than surgery."

However

"An economic evaluation will now be needed to demonstrate if this method is cost-effective, and should be taken up as standard of care, since internationally MRI prior to prostate biopsy is not universally practised."

https://www.telegraph.co.uk/science...uled-simple-mri-scan-prevents-25000-biopsies/

 

[Offgrid Organic Farmer]

Ask around there is a mini-MRI that can be used to guide the needle when doing the biopsy.

My biopsy took 12 core samples along the length of my prostate.

I should add when my PCP first referred me to a urologist, the local hospital did not have enough urologists. I contacted my insurance and they recommended a different hospital that had 8 of them. I called that group and I got in for an appointment the next day.

 

[target2019]

Here are my historical results for PSA. Last two years just about track the end number.
DATE PSA
9-Nov-2001 3.3
26-Feb-2003 3.9
5-Oct-2004 3.3
1-Jul-2005 3.4
14-Aug-2006 4.7
5-Mar-2007 4.6
18-Jun-2007 4.66
24-Aug-2007 5.2
1-May-2008 4.5
1-Dec-2008 4.8
1-Aug-2009 5.3
1-Jan-2010 5.9
10-Oct-2010 7.2
18-Feb-2011 7.8
21-Apr-2011 7.6
9-Nov-2011 3.2
19-Dec-2012 3.2
29-Nov-2013 2.5
22-Jul-2015 3.6

Was diagnosed 11/2006, just after 1st biopsy. If had not had PSA yearly, I would not have known. However, having all results listed, and being under active surveillance, I am not sure life would be that different if I had no PSA tests at all.

 

[RunningBum]

Here are my historical results for PSA. Last two years just about track the end number.
DATE PSA
9-Nov-2001 3.3
26-Feb-2003 3.9
5-Oct-2004 3.3
1-Jul-2005 3.4
14-Aug-2006 4.7
5-Mar-2007 4.6
18-Jun-2007 4.66
24-Aug-2007 5.2
1-May-2008 4.5
1-Dec-2008 4.8
1-Aug-2009 5.3
1-Jan-2010 5.9
10-Oct-2010 7.2
18-Feb-2011 7.8
21-Apr-2011 7.6
9-Nov-2011 3.2
19-Dec-2012 3.2
29-Nov-2013 2.5
22-Jul-2015 3.6

Was diagnosed 11/2006, just after 1st biopsy. If had not had PSA yearly, I would not have known. However, having all results listed, and being under active surveillance, I am not sure life would be that different if I had no PSA tests at all.

I don't understand this post, or what message you are giving.

You were diagnosed with what in 11/2006?

What was the impetus to have a biopsy done? You say it was your first, when and why were others done?

Quite a jump in 2010/11. What happened here? Was there treatment done?

If there was treatment done, and your PSA settled back down, why do you say life might not be that different, unless there are things you aren't telling us about the situation.

 

[Alvin Tostig]

I'll jump in here also. My PSA was historically about 1.5 - 1.6. About 3 years ago, it jumped to 6.6. Scary. I'm 62 years old.

My urologist told me that it's likely an infection - he put me on meds - returned a month or so later and it went down to 3.0.

Since that time, I've had regular check-ups (2x a year) and the PSA has been in the 3.0 - 4.0 range - usually around 3.5.

Like Marko's experience - this seems to me my new norm! I wonder if others on here who had an infection, eventually had their PSA go all the way down to their previous low numbers or had "a new norm".

However, another impact is that I have developed BPH over the last 5 years, and my prostate is double the size of a normal prostate (I'm at 90cc). Supposedly, BPH (which I take meds for) and a large prostate would typically result in a high PSA. As a result, I'm producing twice as much PSA.

I have not had a biopsy, but other tests (sonogram, digital) seem okay. My urologist team do not recommend a biopsy at this point.

 

[Mr._Graybeard]

As an aside, I've consulted with a urologist in the Milwaukee area named, appropriately enough, Dr. Auger. Of course, he prefers the French pronounciation, o-ZHAY! It always reminds me of Gene Wilder in "Young Frankenstein."

For the record, I consider Auger a pretty sharp guy.

 

[Rambler]

Oh yeah. I know the experience well. I went from 1.5 to 2.9 in one year, then forgot the next year due to my focus on helping my DW recover from an illness. Next time I remembered, two years after the 2.9, it was 6.7. I had gone in for an unrelated spike in BP and asked the doc to run the usual tests as well. I’d forgotten to abstain from “extra-curricular activity” for 72 hours prior. So we retested...came back at 4.7. Cancer was suspected and later confirmed by biopsy with a Gleason score of 4+3=7. My dad had it 20 years prior so I did my research while waiting for the biopsy. 6 weeks or so post biopsy I had DaVinci robotic prostatectomy at the skilled hands of Dr Samadi in NYC. Post op results were a downgrade to 3+4=7, about 50% involvement, no extraprostatic extension (completely confined to the organ), no lymph or vesicle involvement. I chose both DaVinci surgery and Dr Samadi because of their outcomes beyond getting the cancer out. Incontinence and ED are major side effects to prostatectomy, but with DaVinci and Dr Samadi’s skills, I’m happy to report that I’m back to normal in both regards. I will also comment that if you do have PCa, your spouse or partner ‘s understanding and support are the most invaluable things you’ll have, and need. If it come to that, feel free to PM me. Happy to discuss my experience if it would be of any help.

 

[gnawbone]

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?

I followed a similar path as you. After the initial jump we did a 6 month follow-up and my PSA around 6.4.

I had a biopsy, multiple cancerous lesions (all contained within the prostate), the usual pre-procedure testing (tissue samples to a lab for type eval, MRI, etc.), followed a couple of months later with HDR Brachytherapy. This was in the summer of 2012.

My PSA last month was .1 and prostate cancer isn't even in my rearview mirror any more - out of site - gone.

People have a casual attitude toward Prostate cancer mainly because it is usually curable but my uncle died from it - never got physicals, never had a PSA. I'm happy knowing I'll die from something besides Prostate cancer.

 

[Offgrid Organic Farmer]

... People have a casual attitude toward Prostate cancer mainly because it is usually curable but my uncle died from it - never got physicals, never had a PSA. I'm happy knowing I'll die from something besides Prostate cancer.

And most prostate cancers are low gleason [slow growing and would not metastasize before you turn 120]. Few of us have high gleason cancers [fast growing and quick to spread].

 

[Offgrid Organic Farmer]

I don't understand this post, or what message you are giving.

Men with prostate cancer mark their journey by their PSA scores. Up / down / up / down, when the PSA goes down it is good, when it goes up it is bad.

If you go to a prostate cancer support group forum, you will see that kind of post. I have one.

After you have been through cancer surgery, you still need to get checked every quarter, and those PSA numbers end up representing your hopes and fears.

All prostate survivors have a PSA history that we may share, at least in a support group we do. For those who lose the gamble those numbers going high, means it has metastasized to bone cancer. ie, a speck of cancer on every bone, every where through out your entire body.

I am going through radiation now, in the hope to stop it.

 

[Teacher Terry]

Yes my uncle died of prostrate cancer at 72. My dh impotent at 49 after meeting him 10 years before. I miss our sex life but so happy he is still alive at 59. Every prostrate cancer is different.

 

[Cheesehead]

First, quit posting here and get active on:

https://www.healingwell.com/community/default.aspx?f=35

I AM A SURVIVOR. A doubling is troubling but you should compare rises over time. If it goes up fast over a year or two that's called "Velocity" and is a bad sign. All tests must be done at the SAME LAB to compare results with any meaning. That's very important.

Yes there is non-invasive imaging you can utilize but they can miss the tumor(s) and also most all insurance companies won't pay for them unless you had the biopsy first. They are trying to reduce the expense of an MRI by weeding out those who don't have to have it.

The biopsy is a series of probes, guided by an MRI, towards what looks to be the tumor(s) and hurts like hell so demand a painkiller. It is the best way to tell if there is cancer and what level of aggressiveness it is, although even their probes may miss it. There are different levels of aggressiveness of PC, called the Gleason Score, and the biopsy tells them what Gleason Level you are and if the tumors are close or far from the prostate's outer wall. Men with a low Gleason Score are assigned Watchful Waiting, sometimes for many years and the doctors hope you'll get so old you'll die of something else. The higher the Gleason Score and the closer it is to the outer wall of the prostate, the more aggressive the intervention. The Gleason Score is different than your PSA score, which is controversial because it does not tell aggressiveness.

The biopsy said mine was a Gleason 7 but after surgery it turned out to be an 8! The most aggressive, worst kind. Had I not had the needle biopsy they may have waited and it would have spread. Remember this: the initial tumor won't necessarily kill you but once it leaves the prostate, often through the lymphatic system, it can become a number of other cancers and then they play Whack-A-Mole. So don't fret yet, but this single doubling is how I started, and the digital exams said my prostate was large, and over a year it kept rising so fast, a "Velocity" that led to more digital exams, and then the biopsy, then the MRIs, then Davinci surgery. My tumor was so large I was not a candidate for radiation. You will find, once you do a deep dive, there are two camps among patients: Anti-Surgery and Anti-Radiation, but listen only to the cancer specialists in white coats.

Some people are candidates for radiation, others surgery, others through hormone treatment. However, I'd strongly suggest staying away from those free standing, individually owned by urologists and radiologists, Prostate Cancer Clinics because they have a very strong economic incentive, especially if they have an MRI machine or are partners in one, to steer you to radiation. They advertise aggressively, have slick videos, but they are selling you on their treatment because they make money. I knew that I was not a candidate for radiation but went to hear their approach anyway, and invariably they tried to sell me on radiation even though my tumor was too large, so beware of them. Doctors who are on staff at a hospital get the same paycheck not matter how they treat you.

Once I realized I had Gleason 7, the kind that can kill you fast if it becomes an 8, I ditched my local hospital and "went downtown" to a large teaching research hospital specializing in cancers.

So in sum, don't worry too much just yet but be very concerned if over several months the results keep rising at the same lab. Remember not to ejaculate or bicycle a day or so before the tests. If the results are rising then go to the largest teaching hospital in your area, get the biopsy done and see what that says. If it's indecisive or bad news, meaning a higher Gleason Score, then you'll get the MRI. You must know your Gleason Score, that tells you how much you have to worry, how fast it will grow and the biopsy tells you how close to the prostate's outer wall it is. You don't want the horse to leave the barn.

Lastly, PC is one of those conditions where everyone will tell you anecdotes that are meaningless. PC is a very individualized cancer, every man's PC is unique, but once you're diagnosed with a higher Gleason score, then it's deadly serious (no pun intended). I've heard a million times: "My grandfather had PC and he lived to 90 something." Visit the main informational website, I volunteer at the annual 5K:

Us Too - International Prostate Cancer Education & Support Network - Us TOO

Good luck! Don't fear the finger!

 

[gnawbone]

And most prostate cancers are low gleason [slow growing and would not metastasize before you turn 120]. Few of us have high gleason cancers [fast growing and quick to spread].

Given that my uncle died from Prostate cancer as soon as I found out that I had it I was going to treat it. I wasn't going to be one of the "1 in xxxx" (however many that number is) that wasn't very lucky. Both my PCP and Urologist both told me they didn't think there was anything going on but I insisted on the biopsy.

I'm retired after 40 years in clinical healthcare and I know the professionals are not always right - I wasn't going to be one of their "Ooooops, sorry 'bout that" statistics.