PSA Doubled in One Year

[lucky penny]

The elevated number may be a fluke, but I second the recommendations to find yourself a good urologist. "PSA velocity" (numbers that are rising) can be of concern even if the actual numbers are quite low, as a friend found out. For several years his primary care doctor tested PSA, did a digital exam & told him he had an enlarged prostate, not to worry. Finally went to a urologist who did a digital exam, ordered a biopsy & found advanced cancer. (PSA was still less than 4.)

 

[Car-Guy]

PSA's have ran high in all the men on my dads side of the family. All of them have been over 10 by the time they were 60 years of age and none have had cancer. The only problems any of them have had due to high PSA's are the negative effects of some of the follow-up test they had done to check for cancer. Certainly something to take serious but I'd be very careful on some of the more invasive test.

The doctor I had 5 years ago (he retired ) didn't put much into the PSA test. My current doctor does. Of course he likes all sorts of testing that my previous doctor never did or even mentioned. Of course I'm older now too. So who do you believe.


As an FYI, I "think" (and I may have misunderstood him) that my new doctor told me that Medicare won't pay for PSA testing "unless" you are having some sort of "related" problem or symptoms. As I say, that might not be true but I'm pretty sure that's what he told me once.

 

[Corporateburnout]

Had a prostate biopsy about 5 years ago that turned up negative but the resulting sepsis infection brought me closer to death than I had ever been.

My older brother had a radical surgery for prostate cancer but he too had sepsis from the biopsy that almost killed him.


Although I have an enlarged prostate my annual PSA tests have been normal.

 

[Teacher Terry]

My DH was having issues so went to a urologist at age 49. He had prostrate cancer and had it treated with the seeds. Ten years later he is fine.

 

[aja8888]

@ 74, my latest PSA test result was 1.4. Over the last ten years it has ranged from 0.7 to its current value. Due to "low flow", my Dr. put me on Tamulosin (Flowmax) which has helped.

 

[Teacher Terry]

My uncle died of prostrate cancer at 72.

 

[Just_Steve]

??
If you are implying that it's a bad thing to gather as much information as you can on a medical issue or test result before agreeing to treatment, I disagree. In fact, the OP asked for information on PSA testing/treatment that others cared to share, which is exactly what Human and I (and others)
tried to do. Doctors often disagree on the best course of action for certain issues or test results also - see the links that Human posted for evidence of that.

Not what I'm implying at all. I might get censored for this but........The first link advocates the elimination of PSA testing for the #2 cancer killer of men, less than lung cancer but more then colon cancer. So I have a rather harsh attitude for those advocates. I think those who are advocates of eliminating PSA these are nothing more than misandrist.

 

[Teacher Terry]

My husband would be dead by now with out the testing. It was not routine as he was having issues. Our family doctor had been treating him for a few years for impotence. When nothing worked she sent us to a urologist who identified the real problem which saved his life.

 

[Midpack]

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

 

[RAE]

Not what I'm implying at all. I might get censored for this but........The first link advocates the elimination of PSA testing for the #2 cancer killer of men, less than lung cancer but more then colon cancer. So I have a rather harsh attitude for those advocates. I think those who are advocates of eliminating PSA these are nothing more than misandrist.

The articles don't necessarily say that the PSA test should be eliminated, but they do say that it has been widely overused, and that the follow-up treatments from a positive test have done a lot of damage to men who would never have died from prostate cancer. Here is a quote from one of the articles posted:


"If 1,000 men ages 55 to 69 get tested regularly for 10 to 15 years, 240 men will receive a positive PSA result, which is usually followed by a biopsy. 100 will receive a positive biopsy result, 80 will receive surgery and/or radiation, and 60 will suffer side effects from this treatment, including incontinence and impotence. One to two deaths from prostate cancer will be prevented.
Just to be clear: you are 240-120 times more likely to misdiagnosed as a result of a positive PSA test and 80-40 times more likely to get unnecessary surgery or radiation than you are to have your life saved."


Here's one from a different article:


"The medical community is slowly turning against P.S.A. screening. Last year, The New England Journal of Medicine published results from the two largest studies of the screening procedure, one in Europe and one in the United States. The results from the American study show that over a period of 7 to 10 years, screening did not reduce the death rate in men 55 and over.
The European study showed a small decline in death rates, but also found that 48 men would need to be treated to save one life. That’s 47 men who, in all likelihood, can no longer function sexually or stay out of the bathroom for long.


Numerous early screening proponents, including Thomas Stamey, a well-known Stanford University urologist, have come out against routine testing; last month, the American Cancer Society urged more caution in using the test. The American College of Preventive Medicine also concluded that there was insufficient evidence to recommend routine screening.
So why is it still used? Because drug companies continue peddling the tests and advocacy groups push “prostate cancer awareness” by encouraging men to get screened. Shamefully, the American Urological Association still recommends screening, while the National Cancer Institute is vague on the issue, stating that the evidence is unclear."

 

[harley]

I find it interesting that the new baseline for testing, diet, whatever is whether it reduces the death rate. While I'm all for doing away with unnecessary testing or prescribing, I haven't heard of anything that actually reduces the death rate, which to my best knowledge remains at 100%.

 

[H2ODude]

I'd think long and hard before I let them operate based on PSA. My very good friend had PSA that spiked over 100 with prostatitis that lingered for a long time. The doctors wanted to do a biopsy. He got appointment with Mayo who said, no, wait this out and we'll monitor the PSA. It came down and there's no problem now. And, his father passed with prostate cancer.

 

[Just_Steve]

The articles don't necessarily say that the PSA test should be eliminated, but they do say that it has been widely overused, and that the follow-up treatments from a positive test have done a lot of damage to men who would never have died from prostate cancer. Here is a quote from one of the articles posted:

As someone who had early detection at a younger age I reject that article as tripe, you can not convince me otherwise so you might as well stop waisting you time. My mind is closed on this topic.

 

[Just_Steve]

I'd think long and hard before I let them operate based on PSA. My very good friend had PSA that spiked over 100 with prostatitis that lingered for a long time. The doctors wanted to do a biopsy. He got appointment with Mayo who said, no, wait this out and we'll monitor the PSA. It came down and there's no problem now. And, his father passed with prostate cancer.

I don't think any many doctors would treat based only on a PSA test, that would be unethical and probably malpractice too. Personally my doctor put me through two courses of antibiotics to insure against infection induced high PSA.
I had an MRI prior to the biopsy which was a targeted biopsy as opposed to random needle biopsy.
Oh and I was waiting and seeing for almost 10 years prior to all of the above.

 

[Midpack]

I don't think any many doctors would treat based only on a PSA test, that would be unethical and probably malpractice too. Personally my doctor put me through two courses of antibiotics to insure against infection induced high PSA.
I had an MRI prior to the biopsy which was a targeted biopsy as opposed to random needle biopsy.
Oh and I was waiting and seeing for almost 10 years prior to all of the above.

I hope you’re right, but FWIW my GP and the urologist he referred me to would have based on one (false) PSA result. What made we wonder is why during my annual physical my PSA tripled vs all earlier results. And when I went to the urologist and he immediately scheduled me for a needle biopsy, no other options, I started doing some research. My GP did a DRE on me before drawing blood for the PSA and DW and I had "relations" the night before, and I found online that either could lead to a false PSA result (BTW, he no longer does DRE's on his patients). But most of all, the urologist and GP's nurse both acted insulted that I was asking for another test (a simple blood draw and a $50-$100 lab charge) and objected, and that I just didn't go ahead with the needle biopsy - how dare I ask questions, etc. The nurse relented and my second PSA (and three annually since) was well below any threshold for concern, as earlier readings had been. And they never admitted they might have been wrong.

I’d go as far as to say no one should have a needle biopsy based on a single PSA result, without at least carefully rechecking PSA weeks later.

 

[Just_Steve]

I hope you’re right, but FWIW my GP and the urologist he referred me to would have based on one (false) PSA result. I’d go as far as to say no one should have a needle biopsy without at least carefully rechecking PSA weeks later.

I concur 100%. People need to understand a needle biopsy is an invasive surgical procedure and absolutely should not be done in a hurry. One thing men should understand is even if you do wind up with prostate cancer it is not going to kill you tomorrow, next week or next month. There is time to research a course of action.

 

[audreyh1]

But most of all, the urologist and GP's nurse both acted insulted that I was asking for another test (a simple blood draw and a $50-$100 lab charge) and objected, and that I just didn't go ahead with the needle biopsy - how dare I ask questions, etc. The nurse relented and my second PSA (and three annually since) was well below any threshold for concern, as earlier readings had been. And they never admitted they might have been wrong.

I’d go as far as to say no one should have a needle biopsy based on a single PSA result, without at least carefully rechecking PSA weeks later.

I remember your experience well, and learned a lot from it. Advising DH to refrain from his daily bicycle riding before a test among others things.

I have also read since that if you have a sudden high reading, you need to wait a couple of months before a retest? It might be an infection.

It is still shocking to me how aggressive your Dr. and urologist were. I'm so glad your "this doesn't make sense" buzzer went off and you researched the issue.

 

[MRG]

I remember your experience well, and learned a lot from it. Advising DH to refrain from his daily bicycle riding before a test among others things.

I have also read since that if you have a sudden high reading, you need to wait a couple of months before a retest? It might be an infection.

It is still shocking to me how aggressive your Dr. and urologist were. I'm so glad your "this doesn't make sense" buzzer went off and you researched the issue.

Here's the thing about prostatitis, takes 6-7 weeks of antibiotics to clear up. Most primary care providers don't know that! They treat it like a UTI and it is. Its different due to lack of blood flow to the area.

A urologist blessed me with that knowledge and when I had an issue last year; my shiny new PCP said no way. She wanted to show me how wrong that information was, opened up her clinical application and searched. Turns out it takes 6-7 weeks of antibiotics to treat prostatitis.[emoji23]

 

[Richard4444]

Thanks, I hadn't heard of this test but it sounds very interesting.
I'm another one with a very large prostate (my PSA is currently over 7) and I've had three negative biopsies, which are no fun at all.

I'll be talking to my doc about the 4K test, so you've passed on some useful info.

Wow, useful new info for me. Thanks!

The 4K test and the Prostate MRI have both been the standard of care for elevated PSA for a few years anyway. Make sure you are under the care of a urologist, not just a PCP, and if your urologist does not mention it, I would seek a second opinion from another urologist. Of course, by now you have likely googled 4K prostate test and MRI prostate biopsy

Rich

 

[audreyh1]

The 4K test and the Prostate MRI have both been the standard for a few years anyway. Make sure you are under the care of a urologist, not just a PCP, and if your urologist does not mention it, I would seek a second opinion from another urologist. Of course, by now you have likely googled 4K prostate test and MRI prostate biopsy

Rich

Good to know. Of course if test results looked bad we would see a urologist and make sure we had access to more complete non-invasive tests.

 

[braumeister]

Yes, I have been seeing one of the top urologists in my city for 20 years. He's a great guy and I'll be talking to him about this at my next visit.

 

[harley]

As someone who had early detection at a younger age I reject that article as tripe, you can not convince me otherwise so you might as well stop waisting you time. My mind is closed on this topic.

OK, so you were one of the 2 in 1000 that was saved by this process. That doesn't negate the potential problems others might face with false positives and invasive procedures. Nobody is asking you to be open minded, but courteous might not be beyond your capabilities.

 

[Just_Steve]

OK, so you were one of the 2 in 1000 that was saved by this process. That doesn't negate the potential problems others might face with false positives and invasive procedures. Nobody is asking you to be open minded, but courteous might not be beyond your capabilities.

Hence the reason I previously stated that infections and other causes should be ruled out first.

Also I don't believe I was being discourteous just firm in disagreement, but thats just my opinion and you have yours.

 

[audreyh1]

Yes, I have been seeing one of the top urologists in my city for 20 years. He's a great guy and I'll be talking to him about this at my next visit.

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.

 

[6miths]

'Routine' PSA screening was never recommended by many organizations and several of those that did recommend it are now reversing their positions based on evidence of more harm than benefit. It is important to educate oneself as to whether one is outside of the low risk general population and might benefit from some screening maneuver but for most men the test seems to be neither 'good' nor warranted.