Trying to Understand it all

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New Member

Date Joined May 2009
Total Posts : 4
   Posted 5/11/2009 2:41 PM (GMT -6)   
   Im sure this has been discussed many times before...but I'm new to this chat so I apologize for the redundancy.  Just got word my PSA Total went from 5.19 in November 2008 to 6.5 this past week.  I am scheduled for Urology consult.
   I'm 49 years old in good shape. I'm absolutely freaking out......  I think they want to do a biopsy.  Is the PSA test so sensitive that something can cause this increase or is this increase really something I should worry about???
Any advice would be so appreciated.

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4269
   Posted 5/11/2009 2:49 PM (GMT -6)   
Did you get a free psa test? At your age with the rise in psa I would certainly get a biopsy.

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.

As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive

Awaiting schedule for seed impants


Veteran Member

Date Joined Nov 2007
Total Posts : 598
   Posted 5/11/2009 2:55 PM (GMT -6)   
Don't freak out, even though you feel you want to. Those PSA numbers are high. I was 46 (49 now) and our PSA's should be .8-1.3. So, yes, those number say something is going on, but don't panic. could be many things, could be nothing.

If it is something, it is not the end of your life as you know it. You will have some rough paddling ahead, but nothing you can't handle or get through. You are young and in good health otherwise. If so, your recovery should be good.

Now is the time to reach out - just as you have on posting right now - and let other guys help you through this. email me if you want to chat.

And don't apologize for asking any questions. that's what this place is all about!
46 at Diagnosis.
Father died of Pca 4/07 at 86.
1/06 PSA 3.15
1/07 PSA 4.6 (Biopsy 3/07 just suspicious)
10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC
Saved both nerve bundles.
Path Report: Stage T2cNxMx
-Gleason (3+3)6
-totally contained to prostate,
-10% involvement in L & R Mid lobes
PSA 0 at nine months.
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - Took 100mg viagra every night. for several months
Totally usable erections at 10 weeks, which disappeared over the course of a month or two.
ED bounce is what they call it. Now, at one year, ED is fine with viagra.
One year PSA - undectable!

New Member

Date Joined May 2009
Total Posts : 4
   Posted 5/11/2009 3:06 PM (GMT -6)   
Yes I did get a free PSA test. Here were those results:

PSA Free: 0.84
PSA Total: 6.5
PSA Free Calc: 13%

All I'm told is that the PSA total (which has increased in the past few months) is the concern - particularly at my age (49).

Thats why I'm just trying to understand it all.

Ed C. (Old67)
Veteran Member

Date Joined Jan 2009
Total Posts : 2461
   Posted 5/11/2009 3:07 PM (GMT -6)   
There is something going on with such high PSA and your age. Even though high PSA can be caused bu something other than cancer It is prudent to have a biopsy done. Also you may want to find out what your free PSA is.
Age: 67
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
Dx 12/30/08
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09
Surgeon: Dr. Randy Fagin, Austin TX.
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Bilateral 10-20% involved
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx
Negative margins
seminal vesicles clean
Lymph nodes: not dissected
1st PSA test 4/7/09 result <0.1

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 5/11/2009 4:07 PM (GMT -6)   
I agree, the safest bet at this point in my opinion would be to have a prostate biopsy, had 3 of them, not so terrible, at least for me. If it were PC, and I pray its not, then you would definitely want to have the earliest lead time possible to have the widest array of treatment options. Keep us posted.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 5/9 .10 doubled in 3 months, new test in six weeks, then possibly off for salvage radiation

Veteran Member

Date Joined Feb 2008
Total Posts : 655
   Posted 5/11/2009 4:54 PM (GMT -6)   
Greetings, S. Your PSA is a little high and getting higher which means something is up. I'd be inclined to have the biopsy although as some have already said a biopsy doesn't always pick up cancer. Your better off with it than just ignoring it. They are not too bad - more uncomfortable than anything. Please keep us posted on how things are going. David
Age 55
Diagnosed Dec 2007 during annual routine physical
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 positive with 2 marginal
Gleason 3 + 3 = 6
RRP 4 Feb 08
Both nerves spared
Good pathology - no margins - all encapsulated - Gleason 4 + 3 = 7
Catheter out Feb 13 - wore pad for couple of days - pad free Feb 16
Great wife and family who take very good care of me

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 5/11/2009 5:18 PM (GMT -6)   
Your free PSA is very suspicious...Let your Urologist review the blood workup and perform a rectal exam for any changes if that hasn't been done already. I would expect him to recommend a biopsy, however he may also recommend a round of antibotic to rule out any inflamation which could also account for the elevated PSA. (although the free test seems to indicate otherwise)

Good luck and let us know what the doc recommends after your visit.
You are beating back cancer, so hold your head up with dignity
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month April 2009 .06

New Member

Date Joined May 2009
Total Posts : 4
   Posted 5/11/2009 5:21 PM (GMT -6)   
Thank you for all the great advice and info. I guess their concerns are the rapid raise in the PSA in the past few months however I have not a single symptom of I too am hoping for something else.

Keep the advice coming and again, thank you!!!

Regular Member

Date Joined Jan 2009
Total Posts : 62
   Posted 5/11/2009 5:30 PM (GMT -6)   
PSA is subject to ANY stimulation of the prostate (orgasm, digital manipulation, hard stool) within 48 hours of the test. Make sure on the next test you refrain from anything that will stimulate the prostate within that time period.

PC diagnosis @ 53 YO
PSA: 3.4 - 3.7 for preceeding 10 years, new GP advised Urologist visit

09/18/08 12 plug biopsy
09/29/08 PC diagnosis, 1 of 12 plugs, 5% cancer, Gleason 3+3 (6), left side plug w/cancer
12/17/08 da Vinci robotic radical prostatectomy, lab confirmed biopsy, 5%, PIN rest of prostrate, negative margins
12/29/08 catheter removed
03/24/09 1st PSA blood draw, < 0.1% "undetectable"

current status: 1 pad/day, dry overnight; however, total ED

Forum Moderator

Date Joined Sep 2008
Total Posts : 4274
   Posted 5/11/2009 6:59 PM (GMT -6)   

Dear S:

1.  Most patients with early stage PCa do not have any symptoms, so, unfortunately, being symptom-free can't comfort you.

2.  Your free PSA number is inconclusive and won't give the urologist much indication.

3.  Your PSA is definitely high for a man your age and there is some concern about velocity Dan said, some of the rise may be due to pre-test sex, etc. 

4.  At least ask the urologist if he/she thinks a round of antibiotics to treat potential prostatitis is in order prior to a biopsy.

5.  If you do go for a biopsy, I recommend you ask for the form of IV anesthesia or even a mild sedative or relaxant.  Many men have no problems or pain with a biopsy and describe them only as uncomfortable.  However, we have had threads on this forum where the biopsy pain has been described as "excruciating".  Who knows how it will go with you and why take a chance on being the one who experiences pain?

Those are my thoughts.  Please come back and let us know how you progress and I hope for the best...i.e. NO PCa.


Age 62
Gleason 4 +3 = 7
PSA 4.2
2 of 16 cores cancerous
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 5/1/09.

Regular Member

Date Joined Dec 2008
Total Posts : 377
   Posted 5/11/2009 7:38 PM (GMT -6)   
As the last guy said, early prostate cancer has no symptoms. When I had my annual PSA and DRE the DRE was negative, the uro said, "See ya next year" and then his nurse called 3 days later, "(Houston) We have a problem here." I was 52 and my PSA had jumped from 1.9 to 2.85 in a year. And as the last guy said do try and take at least a sedating pill (maybe ativan) before your biopsy. My first biopsy was excruciating, I had no idea what the guy was going to do and when I figured out what he was doing my whole body tensed up and I put my back out for 3 days after the procedure. He used lidocaine shots on each side of the rectum before the biopsy but that isn't enough IMHO. For the second biopsy 3 months later I took an ativan an hour before the procedure and things were much better, except of course that biopsy came back positive for cancer.   Good luck with your test.
my age=52 when all this happened,
PSA went from 1.9 to 2.85 in one year, urologist ordered biopsy,
First biopsy on 03/08, "suspicious for cancer but not diagnostic"
Second biopsy on 08/14/08, 2/12 cores positive for Prostate Cancer on R side, 1 core=5% Ca, other core = 25% Ca, Gleason Score= 3+3=6 both cores,
Clinical Stage T1C
Bilateral nerve sparing Robotic Surgery on 09/11/08, pathological stage T2A at surgery,
No signs of spread, organ contained,
3 0's in a row now, 7 months out
Incontinence gone in early December '08,
ED remains, uro said try oral meds and then trimix for sex only now

Hopeful in MD
Regular Member

Date Joined Apr 2009
Total Posts : 66
   Posted 5/13/2009 10:05 PM (GMT -6)   

Please let me second the recommendations for sedation for the biopsy.  My Uro was going to do it without sedation but I told him that I wanted to be out.  He was considerate enough to honor my request.  Later, once the biopsies showed cancer, my radiology oncologist needed to use a probe to "map" my prostate before implanting seeds (brachytherapy). Unfortunately, I was not sedated that time. 

If you need treatment and choose brachytherapy, and need to have your prostate "mapped", try to get sedation.  I found it VERY uncomfortable and will insist on sedation if it is needed again.  Finally, it is the waiting and not knowing that makes things tough.  BUT, continue doing the things that you usually do; keep active; keep fit.  Live your life.  That will ease some of the stress.  You are young and, IF there is cancer, you will have many options for treatment.   IF you reach that point, there are many experienced members here to answer your questions.  Good Luck and be positive, no matter what.

Hopeful in MD
Age 69.
Dx Dec 07. PSA 8.4. DRE confirmed tumor. Three of six biopsies positive. Gleason: 6 (3+3). Seed implants Iodine 125 Jan 08. PSA's 3.9, 1.7 after implants. Then rising PSA's: 2.3, 3.4, 3.9, indicating that seed therapy not working. Dr's decided to begin hormone injection therapy with Lupron 30 MG ea. 4 mos. First injection Apr. 21, 2009. So far so good. Slight fever and aches 2nd day after shot. Buttock soreness 2-3 days. Walking helped. Waiting for hot flashes etc. Hope they will be mild.

Regular Member

Date Joined Apr 2009
Total Posts : 133
   Posted 5/13/2009 10:59 PM (GMT -6)   


We were all freaked out when we heard that our PSA went up and our heads were spinning too. We really understand. I say this often to new members (or possible members) of this club: you must do some research to get a context for all of the info that gets thrown at you. Just trying to understand the numbers can be mind numbing. There are many good websites hosted by institutions like John Hopkins, Sloan-Kettering, etc. There is also alot of junk on the internet so you have to sort through a lot. My wife bought Dr. Patrick Walsh's book "Guide to Surviving prostrate cancer" which gives alot of info and is well written so that one can understand and then feel informed enough to make decisions. In general our wives were the backbone to our experience and it is very important to have someone close to you to share and compare notes.

The guys on this forum have experienced almost every aspect of this disease and every treatment, including some not approved in the U.S. We can be helpful, but you must develop your own basis of information so you can filter what you hear from where ever you hear it.

This process, it seems to me, happens in Chapters:

1) PSA results indicating an issue (and hearing the "C" word.) Freaking out. You are here;

2)Biopsy/Results: If good, you may be invited to do it again in a few months if PSA still high; if positive-freaking out some more;

3) Figuring out what to do with information: what type of treatment, who should do it, where, when. This is where the real heavy psychological lifting was for me. Once I knew enough to trust my judgement, I made the decision and then calmed down.

4) The treatment itself;

5) Post-treatment recovery;

6) Getting plumbing systems under control;

7) The rest of your life

Having said all that, based on the numbers (PSA and fPSA) there is little doubt that you will hear a strong suggestion for a biopsy. If so, park your modesty at the door and do it.

We all wish you the best and feel free to call on us for support. We understand "freaking out."


Age 55, two teens, very fit cyclist (avg 2000+ miles per year) and weight, diet, etc. consistent with good habits. Stressful job as attorney; very supporting wife who is helping me through every stage of this war.
2006 PSA - 1.5
2007 PSA - 2.3
2008 PSA - 5.3 (18 mos.)
2009 Jan. 20 - Biopsy 12 samples
        Feb 3 Dx 2/12 samples positive, low volume  (5% and 7-10%)
Gleason 3+4, later downgraded by second opinion at Johns-Hopkins to 3+3, but "it's still PCa" as my Doc said.
Laproscopic surgery April 9,  University of KY Medical Center, Lexington, 3 days in hospital, catheter removal April 21.
Pathology: clear margins, no cancer in prostate: told that this is very rare and Doc has only seen it in 3 out of over 1400 cases; I rearched the concept of "vanishing cancer" and found a tumor classification of tP0 and asked Doc if it applied to me. He said that it was unlikely because if a pathologist had done a much more detailed analysis of the tissue, he would likely find more foci somewhere, and biopsy found "needle in the haystack as opposed to the tip of the iceberg"; Nevertheless, it is a blessing;
Regardless of the science, my family says "miracle."
Now working w/ post-surgery issues....

Regular Member

Date Joined Jun 2008
Total Posts : 407
   Posted 5/14/2009 4:23 PM (GMT -6)   
Following a rise in my PSA, and Free PSA levels, about 13 months ago I was sent to a Urology specialist who after examining me and saying he felt nothing out of order and the elevated PSA results may be been due to something other than Cancer he suggested a biopsy which I had in June, and the results of that indicated cancer - which was confirmed when my prostate was removed.  I suffered from no symptoms I or my physician or Urologist could identify beforehand.  My Urologist always uses some pain killer for the biopsy and even with that I did feel some pin priks - but other than that there was no pain or discomfort.  A biopsy seems a likely natural progression of your examination process, unless the physician/Urologist wants to first run a course of antibiotics.  But I think you should prepare yourself mentally for the biopsy, the wait for the results (a couple or just several days for me) can make you anxious - but, it's better to identify the problem, if there is one, instead of putting it off thinking it'll go away.  Best wishes for a negative biopsy!

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (1/2 light pads per day)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0; 4/09: 0.0


Cajun Jeff
Veteran Member

Date Joined Mar 2009
Total Posts : 4119
   Posted 5/15/2009 6:09 PM (GMT -6)   
Good luck. Most of us have been where you are at this time. My Uro in my initial visit suggested a biopsy. My reaction was "With the history in my family if he was not going to do a biopsy I would have found an new Uro." The procedure was not bad at all for me. He deadened the area and then proceded.

Anxiety is natural waiting for results is the most difficult part.

Let us know your meeting goes.
Jeff T Age 57
9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable
 ED- 5 mg Cialis daily, pump daily,

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 5/15/2009 6:44 PM (GMT -6)   
You could even consider the PCA3 urine testing sent to Bostwick Labs and see if they say it is PCa. Could do this prior to considering biopsy. (or Google it).

Read about it see if it is worth your thoughts.

New Member

Date Joined May 2009
Total Posts : 4
   Posted 5/18/2009 5:16 PM (GMT -6)   

Thank you everyone for the great replies.  I'm scheduled Wednesday morning for my biopsy.  I'll keep you posted.



Regular Member

Date Joined Mar 2008
Total Posts : 30
   Posted 5/18/2009 11:21 PM (GMT -6)   
"Get er done" Have the tests done. The sooner the better.
Found out Jan. 07
psa 116
The doc said chemo or radiation was not an option.
Started Lupron to shrink it before surgery, did not work.
Radical prostentechomy Sept. 5.
Couldn't get it all, it was outside the sack and into lower lymph nodes.
Cathader removed about 3 months.
Incontinont for about 3 months
Peranial rectal absesses w/ drains for about 4 months <MRSA>
Continued Lupron until Oct. 08 <psa.04 to .06>.
Started losing weight. <194 to 170>
Now trying Zoladex, next shot in Dec. 18, then we will see what the PSA is, before deciding on future treatments.
Now in the T4 stage
Side effects:
Lupron=memory, tired all the time, joints and muscle aches, hot flashes.
Zoladex=memory, tired after doing something, left back rib cage is tender when inhaling, all joints and muscles below the waist ache, the worst is the left hip.
Went to the doc's today 12-18-08, stopped Zoladex today waitin on blood work to come back.
Blood work came back .07. now back on Zoladex for three months then we will see what happens.
PSA came back .08, back on the Zoladex, see what happens in three more months.

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