Young man with high PSA

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reachout
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Date Joined May 2009
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   Posted 1/15/2011 3:50 PM (GMT -6)   
Hi, guys
My own PSA remains 0, 15 months after DaVinci surgery. However, my nephew, 40 years old, just had a PSA test and it came back at 11! He saw a urologist who felt nodules on the prostate and has put him on antibiotics for a couple of weeks before repeating the PSA. He doesn't have symptoms of prostatitis, so PC is a real concern, but at his age it would be very unusual. Has anyone else had a PSA this high, without many symptoms, and been found to not have PC?

142
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Date Joined Jan 2010
Total Posts : 5809
   Posted 1/15/2011 4:01 PM (GMT -6)   
In reading Walsh's book, I got the clear message that PSA is to be considered only a part of the puzzle. He cites patients with below-average PSA who have aggressive cancer, and very elevated PSA with no cancer.
 
I would wait for the antibiotics to kick in, and the next PSA.
DaVinci 10/2009
My IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3220
   Posted 1/15/2011 7:43 PM (GMT -6)   
I had no symptoms, negative DREs, no record of PCa in the family. But my first PSA (age 56) was 17. Of course prostatitis was assumed and antibiotics started but my PSA continued to climb faster than the national debt.
The biopsy confirmed what we already knew.

From what I have seen here there were very few lucky guys who had numbers that high and did not have PCa. Another PSA and a biopsy is in his future.

Jeff

Jerry L.
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Date Joined Feb 2010
Total Posts : 2303
   Posted 1/15/2011 8:00 PM (GMT -6)   
I have a friend who has a PSA of 16. Had a 24 sample biopsy, no PC.

But, I also know a guy whose PSA was 4 and had aggressive PC (that would be me.)

So, by itself, the PSA doesn't mean much. Sounds like a biopsy. My hope is that your nephew is like my friend.
Nov. 2009 Dx at Age 44
Dec. 2009 DaVinci Robotic Surgery
Jan. 2010 T3b, Gleason 9
Feb. 2010 Adjuvant Radiation

PSA History:
-----------------
Nov. 2009 4.30
Feb. 2010 <.05
May 2010 <.05
Aug. 2010 <.05
Nov. 2010 <.05

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 7584
   Posted 1/15/2011 8:07 PM (GMT -6)   
My first PSA test at the age of 44 was near 19.8...Unfortunately it was advanced disease. But in my observations over the last four years as a survivor I have learned that these younger guys can do well. I'm in that category and for that I am very thankful.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3620
   Posted 1/15/2011 8:59 PM (GMT -6)   
The nodules would be more of a concern than the high psa. These are two red flags. At the very least I would get another psa test after the antibiotics and definately another DRE to verify the nodules.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 3590
   Posted 1/15/2011 10:22 PM (GMT -6)   
I must agree. No symptoms here only PSA jump. Not unheard of to be young and have PCa. The PSA is only a red flag that something is not just right. The 2 nodules are much more concerning to me. Do keep us posted.

Cajun jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
2 year PSA <0.1
Only issue at this time is ED but getting better

MarkMyWords
Regular Member


Date Joined Dec 2010
Total Posts : 55
   Posted 1/15/2011 10:35 PM (GMT -6)   
I am 45 - my PSA was 10 on my first blood test - and had advanced PC. My Brother is 38 and his PSA was 6 and has PC. Neither of us had any symptoms and no detectable issues from the DRE.

Best of luck to your nephew. Being young really works on his side for things like incontinence should it come to surgery.
Age 45
Jul 2010 - PSA 10.1
Aug 2010 - Biopsy - 12 of 12 cores positive - Gleason 7 (3+4 on the right, 4+3 on the left)
Sept 2010 - CAT and Bone scans negative.
Nov 2010 - da vinci RP with negative margins. nerve bundles were not spared. negative lymph nodes. Pathology Stage pT3c.
Jan 2011 - PSA undetectable

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 3959
   Posted 1/16/2011 3:59 AM (GMT -6)   
Nodules felt during a DRE can be calcium build ups and are harmless. But antibiotics for a couple of weeks – another PSA then it’ll probably be biopsy time.

reachout
Veteran Member


Date Joined May 2009
Total Posts : 582
   Posted 1/16/2011 8:25 AM (GMT -6)   
Thanks for all the responses. I'll post when the results of the next PSA and/or biopsy are known.

It's been a few years since I went through the decision process and I'm trying to recall, in the case he has PC, what is the best course of action for a younger man. In my case I was in my mid-60s, so cancer control was most important, followed by continence, then potency. I'm sure that priority doesn't change with age, but potency and continence are of greater concern. Is there a shift towards or away from any particular treatment method for younger patients?
Age: 66
Pre-surgery PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Post-surgery PSA one year of zeros.
Continent right away.
Viagra and other pills only gave me headache
Trimix working great!

Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 596
   Posted 1/16/2011 4:08 PM (GMT -6)   
i was mid 40's. There was unanimous agreement among the five surgeons i saw, that surgery at my age was the best way to go. Even talked to a radiologist who talked me out of radiation at that young age. He said, they can kill this cancer dead. But, I had the genetic markers, had the lifestyle already for 45 years, and the chances are another entirely new batch of cancer would show up in the next 40 years - not a reccurance. And the treatment for that second cancer? It has not been invented yet.
The treatment for younger guys is usually different thinking than for the older guys. chances of his recovery of sex and continence are really pretty good. Have him email me.
Paul
Founder, Erectile Dysfunction Foundation and creator of www.franktalk.org The site for erectile dysfunction.

46 at Diagnosis.
Davinci at 47.
Doing fine.

reachout
Veteran Member


Date Joined May 2009
Total Posts : 582
   Posted 1/16/2011 8:43 PM (GMT -6)   
Thanks, Paul. For men still interested in children, can the sperm be frozen prior to surgery for future use?

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 3590
   Posted 1/16/2011 11:53 PM (GMT -6)   

Reachout,   Yes to answer you question.. If you have any thoughts of wanting children in the future.  By all means make a deposit for future use.  People do it all the time. 

That is a great questions and hope this answer helps.

Cajun Jeff


Dave1950
New Member


Date Joined Jan 2011
Total Posts : 7
   Posted 1/17/2011 12:50 AM (GMT -6)   
My advise for anyone with a PSA above the norm, watch it close, don't take chances it not worth and the pain and suffering.

NED +2.5 (no evidence of disease)

HIFU 2 1/2 years ago PSA .03 / Gleason (4+4)

Dave

leeanglo
Regular Member


Date Joined Dec 2010
Total Posts : 191
   Posted 1/17/2011 5:22 AM (GMT -6)   
HI reachout, i was found to have advanced pc last year no symptons and fit as can be at 44 yrs old.My psa was 144,from the research that i did i concluded that psa over 10 is a likely hood of pc BUT!!! not certain by along way which takes us to the only place that will give any true results and that is the BIOPSY ROOM.
If it were me id have the biopsy to find out for sure.

natural44
Regular Member


Date Joined Dec 2010
Total Posts : 172
   Posted 1/17/2011 9:45 AM (GMT -6)   
I had no problems just had my PSA checked at the age of 40 as a base line check and found it to be 2.6 repeated next two years till this past year when reached a 4.0 then biopsy and RRP! I know someone who found a high PSA and then Pca at the age of 34! I wish I had been more agressive and had the surgery back when I was 40 than to wait till 44....
age 44 when diagnosed 45 now
RRP 9-28-10
gleason 3+3=6
pathology report all clear
11-1-10 PSA 0.02
3 month PSA 0.00
bladder control 3 weeks post cath. removal!
Osbon pump works great!
some noctural erections stated 12-01-10
5mg Cialis daily 1-3-11 able to get short semi erections(60-75%) with effort daily

reachout
Veteran Member


Date Joined May 2009
Total Posts : 582
   Posted 1/24/2011 9:43 AM (GMT -6)   
Well, what about this? After two weeks on antibiotics his PSA dropped from 11 to 1.6! That certainly indicates an infection as being the cause of this high PSA, but the urologist also felt numerous small nodules on the prostate. Hopefully the nodules are also the result of infection. He had an ultrasound, and has a return visit to the uro in a couple of days. We'll see but I think the drop in PSA is very promising!
Age: 66
Pre-surgery PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Post-surgery PSA one year of zeros.
Continent right away.
Viagra and other pills only gave me headache
Trimix working great!

SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 326
   Posted 1/24/2011 10:58 AM (GMT -6)   
Thats good news with the PSA drop!!! just needs to keep an eye on it.
Age Dx 37, 7/2008, First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008, Biopsy: 6 out 12 Postive all on right side, Gleason 7 (3+4).
Bone Scan/CAT Scan: Clear 7/2008
Da Vinci Surgery 7/2008, PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
7 Post Op PSA’s from 9/2008 to 11/2010: <0.1

reachout
Veteran Member


Date Joined May 2009
Total Posts : 582
   Posted 1/27/2011 10:41 AM (GMT -6)   
After another visit with the urologist, he said the ultrasound looked fine and he couldn't find any nodules. So it's just another PSA in 6 months to double check. After all the bad news on this board, it's good to hear of a good news case. This is also a good example for those who think a high PSA is a direct route to PC and its treatment.
Age: 66
Pre-surgery PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Post-surgery PSA one year of zeros.
Continent right away.
Viagra and other pills only gave me headache
Trimix working great!

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3129
   Posted 1/27/2011 10:51 AM (GMT -6)   
Further tests you might do for the 40 yr. old mentioned:

fPsa ('free unbound antigen testing)- check the percentages levels
PCA3 urine detection test for PCa (considered fairly accurate)
Color doppler ultrasound imaging (Dr. Bahn, Lee et al....some are masters on using this)
Maybe monthly walkin psa testings somewhere for further comparison as to velocity
PaP and Prylinks testings (some oncologists use these, may find nothing in your case)
Hey if the glove don't fit you gotta acquit...maybe others can look at this list, in case it is not that useful in his case.
 

Word (LOL)

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 5809
   Posted 1/27/2011 4:09 PM (GMT -6)   
Good news! It is nice to find a new visitor who doesn't need us as badly as feared.
 
Report in on that next PSA.

K2
Regular Member


Date Joined Feb 2011
Total Posts : 51
   Posted 2/12/2011 11:08 PM (GMT -6)   

Hi everyone - here's my story, slowly unfolding

 

50 yrs old just received a 12.76 PSA with DRE results smooth and firm - I've been referred to a urologist Feb 23rd.

 

I did a LOT of reading and well...I'm pretty much completely terrified but with a first-time 12.76 PSA who wouldn't be. I'm having trouble emotionally dealing with this avalanche.

 

Younger patients (me) apparently tend (quite often?) to have more aggressive PC. My doctor ordered a second PSA and also a fPSA (1st PSA & 2nd PSA are about 2 weeks apart).

 

The whole ordeal unfolds kind of slow with a HMO - Clearly the urologist will do another DRE and order a biopsy.  I'll get a Gleason score, all the data will be run through the Partin table and then sometime after that my Prostate will be in a jar (if I'm lucky enough to be a candidate for surgery).

 

Like a most guys I'm willing to live with the likely (almost certain) unfortunate side effects - my concern is purely longevity.

 

Baring divine intervention (a possibility I never discount) this is my likely future.

 

So my questions are:

I'm still trying to sort out the efficacy of radiation/chemo options and whether they should/could be done before or after the prostate is removed?  I read one article saying efficacy of radiation/chemo after removal was suboptimal but isn't that what salvage treatment is?

 

I read another article stating that is was statistically beneficial to have the prostate removed even if the PC is locally (locally confined means outside but near the prostate?) but I don't know - it was one study.

 

The higher higher the PCA (assuming PC) the more aggressive the cancer?


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 845
   Posted 2/12/2011 11:35 PM (GMT -6)   
Hi K2, and welcome to the forum.

I think you are jumping the gun a little. While it's possible you have PCa, maybe even probable, it's by no means certain. It may be just an infection and not necessarily one that has obvious symptoms.

For your next PSA test, make sure you abstain from sex and bike riding for two days beforehand, and also make sure you have the blood draw before the DRE and not the other way round. Surprisingly some docs don't do this.

Generally higher PSAs mean more serious cancer, but not always so. Gleason 8-10s may not generate much PSA -- for example I was a Gleason 9 at biopsy but with a PSA of only 5.7.

As far as treatment options are concerned, from what we know so far, all options are open to you. The actual treatment you receive will be very much determined by your next PSA and biopsy. Good luck -- lets hope this is a false alarm and we never see you here again :-)
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4/12 cores
Non-nerve-sparing RRP 7 March 2008 age 63
Organ confined, neg margins. Gleason downgrade 4+4=8
Fully continent
Bimix worked well; now using just VED
PSA undetectable at first but now 0.4, doubling time 7 months
No radiation but ADT coming unless I can slow down the rise...

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1821
   Posted 2/13/2011 2:17 AM (GMT -6)   
Jerry L. said...
I have a friend who has a PSA of 16. Had a 24 sample biopsy, no PC.

But, I also know a guy whose PSA was 4 and had aggressive PC (that would be me.)

So, by itself, the PSA doesn't mean much. Sounds like a biopsy. My hope is that your nephew is like my friend.


And that's the problem Jerry. The higher grade cells a tumour contains the less PSA they produce per CC of tumour. For example a normal prostate of volume 40cc should produce a PSA reading of 40x0.066 ng/mL i.e. 2.64. As the Gleason grade increases (ie aggressiveness) the yield of PSA per CC decreases. Grade 3 tumour cells will produce about 4ng/cc while grade 4 will yield 2ng/cc and grade 5 yield 1ng/cc. So a prostate of 45cc with 40cc normal tissue and 5cc of Gleason 6 may show a PSA of (2.64+{5x4}=22.64). Jump up to Gleason 8 and it changes to (2.64+{5x2}=12.64 while going to Gleason 10, it becomes (2.64+{5x1}=7.64. Gleason 7 and 9 yields approximately 3 ng/cc and 1.5cc/cc respectively.
Bill
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