PSA elevated- doctor not worried

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meerkat
New Member


Date Joined Nov 2010
Total Posts : 4
   Posted 12/1/2010 12:33 AM (GMT -6)   
Hi guys,



History:

Father had PC.
I'm in relatively good health at 60 years old
Recent DRE [a month ago] Doctor said prostate was healthy. No hardness, no stoniness. Soft to the touch.
PSA came back at 5.2

Symptoms:

The main symptom that had me worried was a weak flow first thing in the morning. During the rest of the day and evening things were as normal as could be. On occasion there has been a burning sensation when I pee. I've also felt an aching between the testicles and anus. This has not been constant. I get up perhaps once a night to pee but not every night. It depends on how late I've had fluid to drink.

I do not exhibit the more common symptoms like interrupted flow, starting and stopping, difficulty getting started, not quite completely emptying, or weak flow during the day and evening.

I've requested a second PSA since my wife and I were intimate the morning I went for my PSA. I did not know that ejaculation could elevate the PSA. My doctor concurs.

My doctor is certain that I'm not looking at PC. He is convinced that it is BPH- an enlarged prostate that is elevating the PSA. He reiterated this several times. Can he tell based on the DRE and recent PSA?

I've researched Prostate Cancer and BPH until I'm blue in the face. I was trying to figure out if I was facing BPH, prostatitis, or PC. Though my doc assures me what he believes it to be I'm still uneasy.

Please share other symptoms anyone with PC began experiencing. I realize that sometimes there are no symptoms when it comes to PC. While I would like to have the utmost confidence in my doctor's judgement I would have been much more at ease knowing that my PSA level was below 4.

proscapt
Veteran Member


Date Joined Aug 2010
Total Posts : 644
   Posted 12/1/2010 2:08 AM (GMT -6)   
Hi, Meerkat

Just my personal opinion, but I think it's a warning sign of a bad doc if he says he's "absolutely certain" you don't have PC. He could say it's not all that likely, but by no means is it a certainty.

Lots of PC cases don't have symptoms and don't show anything on DRE. It would help if you had a history of your PSA and know how fast it's rising. Meanwhile, you are right to get the PSA re-done, and if it's not nice and low, I would ask for a referral to a urologist for either a biopsy or additional PSA-related testing. Don't take a gamble.

I can understand that your doc might want to understate things to alleviate anxiety but he has no business expressing such certainty, particularly with a family history.

good luck... hopefully it's nothing, but check it out.

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 12/1/2010 12:24 PM (GMT -6)   
Hi Meerkat,
The symptoms you are having can be caused by prostasitis, enlarged prostate or PCa. A negative DRE doesn't rule out PCa and high PSA doesn't mean cancer. You should see a Urologist who can do the proper diagnosis.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18 months) undetectable
Latest PSA test (21 months) .005

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 12/1/2010 12:43 PM (GMT -6)   
Meerkat,
Read "Invasion of the Prostate Snatchers" by Dr ark Scholz. It has a whole chapter on what to do before getting a biopsy.
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.

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 12/1/2010 12:47 PM (GMT -6)   
Second opinion might be worth your time and i hate the phrase 'my doc isn't worried'.... your doc only worries about lawsuits or profits, they cannot afford to worry about all their patients...that would paralyze their duties and work and making money. 
 
 Tests: fPsa, PCa-3 urine test, psa (verification re-test), and other things are possible choices to see what is what without biopsies.  Hope you don't have PCa, bph drugs will mask your real PSA value if you start them.

Post Edited (zufus) : 12/1/2010 10:54:54 AM (GMT-7)


Arnie
Regular Member


Date Joined Aug 2009
Total Posts : 372
   Posted 12/1/2010 1:02 PM (GMT -6)   
Hi Meerkat and welcome..........all good advice above. I had no palpable symptoms upon DRE, and was not having problems urinating to any major degree. But my PSA was steadily rising, and at biopsy, my PSA was still "only" 3.9.............it actually went down to 2.4 on a subsequent test between PCa diagnosis via that biopsy and my eventual surgery. I agree that you should probably get the biopsy done, or some of the other tests that Zufus has suggested to rule out or rule in PCa. Yes, it could be several things, but the sooner you find out, the better you can go about addressing whatever it might be.

meerkat
New Member


Date Joined Nov 2010
Total Posts : 4
   Posted 12/1/2010 1:44 PM (GMT -6)   
Arnie,
 
"at biopsy, my PSA was still "only" 3.9.............it actually went down to 2.4 on a subsequent test between PCa diagnosis via that biopsy and my eventual surgery."
 
 
Incredible. Your psa count was actually as low as 2.4 with no palpable indications and you were still diagnosed with pc??   Good grief.  May I ask...when you mentioned having surgery, did you have the prostate completely removed? 
 
With all the info about false positives and false negatives I'm finding this psa stuff so very confusing and frustrating.   There seems to be so much controversy about the reliability of the psa especially when it can be elevated due to numerous other reasons.  And then I read your comments Arnie where your psa was in the so called normal range with no DRE suspicions and you still end up being diagnosed with pc.  I don't know what to think anymore.  I've even read that pc can be missed even after having a biopsy.  What's a guy to think these days?

meerkat
New Member


Date Joined Nov 2010
Total Posts : 4
   Posted 12/1/2010 1:59 PM (GMT -6)   
Thanks John T for recommending Prostate Snatchers. I've been researching it and will definitely read the book.

Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2313
   Posted 12/1/2010 2:03 PM (GMT -6)   
Meerkat,
 
I agree with the opinions you've gotten so far. I had a PSA less than 3 ng/mL and a negative digital rectal exam, but still had prostate cancer.  Primary care physicians are great (my daughter graduates from medical school in June and will be in family practice), but get a 2nd opinion from a urologist, who specializes in sorting out whether your increased PSA is caused by BPH, prostatitis, prostate cancer or something else.   All the best!

PSA quadrupled in 1 yr (0.6 to 2.5)
DRE negative 1 of 12 biopsies positive (< 5%)
open surgery June 2006 at age 57
Organ-confined to small area, Gleason 3+2
Prostate weight 34 grams
PSA's undetectable < 0.1

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7213
   Posted 12/1/2010 2:30 PM (GMT -6)   
Meerkat:
 
With all due respect to your doctor, I don't think he is providing proper medical care. First of all, can you relay your PSA history? If this is a sudden rise, then a course of antibiotics and a repeat PSA might be helpful, as prostatitis could explain your high PSA and your symptoms.
 
Your PSA number is worrisome.
 
I think Zufus gave you EXCELLENT advice. There is a "free-PSAT" test. That is another blood test and a good score on that (here GOOD is a high score, above 25%) would indicate BPH or Prostatitis as opposed to PC. Even better is the PCA-3 test. This is very specific for PC, although all of the tests are far from fullproof. The latter test is easy to do. You udergo a vigorous DRE and then just pee into the glass.
 
I don't mean to get you all worried, but you really should follow up. You should request a referral to a urologist (or just make an appointment to see one, if possible. Remember, most likely this is nothing to worry about. But, it shouldn't be ignored either!
 
Mel
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. First post-op PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4183
   Posted 12/1/2010 2:32 PM (GMT -6)   

Dear Meercat, here are some thoughts:

1.  Many (most?) of us who had or have PCa did not experience any symptoms so that is not a good indicator.

2.  4.0 PSA is a very artificial cut off and very patient and age dependent...again, that alone is not a good indicator.

3.  Yes, as others have said, you should probably see a urologist for a more experienced opinion.  Many PCP's have little or no experience with PCa except looking for a hard spot in a DRE and sending someone to a urologist if there are urinary symptoms or PSA over 4.  I also would run from any doctor who says he is "certain" you are not dealing with cancer.

4.  Read "Prostate Snatchers" as JT recommended....at least the chapter about what to do before getting a biopsy.

Please keep in touch and let us know how you progress.

Tudpock (Jim)

 


Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 9/10/10. 6 month PSA 1.4, 1 year PSA at 1.0. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643

Arnie
Regular Member


Date Joined Aug 2009
Total Posts : 372
   Posted 12/1/2010 2:40 PM (GMT -6)   

Meerkat--------welcome to the shady world of PCa (and here's hoping you don't have to join us). My personal MD was very vigilant, and believed that "2.5 is the new 4'"-------he watched mine slide up over a period of 18 months w/o coming back down. It wasn't so much that I was "in range", rather it was the movement of the PSA over a short time period. He actually referred me to a uro when it went to 3.1, and the uro and I agreed to watch it for 6 more months. When it rose 0.8 over 6 months, he suggested the biopsy. I was positive in 4 of 12 core samples on the biopsy. The relatively early diagnosis gave me ample to time to research, consult, mull and then finally decide on a mode of treatment w/o feeling pressured.-------and yes, I had my entire prostate removed via robotic, or Davinci, laparoscopic surgery. That's the norm with surgery..........those that choose radiation, in whatever form, or another form of treatment, keep their prostate intact.

Arnie in DE

 

 

 


meerkat
New Member


Date Joined Nov 2010
Total Posts : 4
   Posted 12/1/2010 3:22 PM (GMT -6)   
Guys,

I'm really appreciating the input, suggestions and opinions you have presented. It may be that the symptoms and absence of other symptoms I've presented to my physician and his many years of experience may have lead him to "conclude" I'm not looking at pc. I did have a psa done perhaps 3-5 years ago. I can't remember which year it was. I will be in touch with that doctor and find out what the psa score was at that time. I will also look into making an appointment with a urologist to get a second or even third opinion if necessary. I will keep everyone here updated as things move along.

First things first. I will get a psa test done again next week and then book an appointment with another physician that I've known for quite some time.

tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 489
   Posted 12/1/2010 4:14 PM (GMT -6)   
Meerkat:
I think some of the amateur advice given here is a bit too aggressive. Some advice also dismisses the professional practice of your physician.
The best that I can offer is that I am certain that a urologist can give a much more effective digital exam and determine if there is any palpable mass. He (she) can also review your history, your psa results and give you an informed opinion about what your current situation is. GP's are not the most well trained in prostate exams, and uros do this every day, much of the day. If a color ultrasound is helpful that would be the professional to order it. I have no idea what your status is. A urologist is the specialist to establish that, and for another opinion there is no place else you should look.

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 12/1/2010 4:43 PM (GMT -6)   
Meerkat, At your age (60), there is a better than even even chance that you have PCa -- most of us do at this age. It's just undiagnosed in many cases.

You are wise to seek another opinion. Once you find the extent of the PCa (if any) then you will be well placed regarding future treatment, one of which may be "Active Surveillance" -- regular PSA tests and DREs with an occasional biopsy.

A diagnosis of PCa is not the end of the world; even if not "cured", we can stave off the beast for many years, and in that time, there may be some wonder cure.

Good luck with your future testing, and let's hope you are one of the lucky minority.
Pre-op:
Age 63 at diagnosis, now 65.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Operation:
Non-nerve-sparing open surgery on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Post-op:
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
PSAs:
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
19-month: 0.09 (maybe)
25-month: 0.2 (yes, bummer)
27-month: 0.2 (not up; glad about that)
ED:
After a learning curve, Bimix injections (0.2ml) worked well. From 14 months, occasional nocturnal erections. At 18 months, "graduated" to just the pump.

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7213
   Posted 12/2/2010 10:31 AM (GMT -6)   
Tarhoos:
 
What advice was too aggressive?
 
It seems you say that and then suggest that he see a urologist, which pretty much sums up our advice (we did mention other possible tests).
 
Mel

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3786
   Posted 12/2/2010 12:04 PM (GMT -6)   
With a PSA of 5.2, SOMETHING is going on..Find out what it is and treat it. Don't just ignore it..Be it infection, BPH, or PC...I would ask to be put on antibiotics for a month, then get a fresh PSA test avoiding sex and bike riding for three days prior..It's a process of elimination..
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT, Dec

JoeFL
Regular Member


Date Joined Oct 2009
Total Posts : 420
   Posted 12/2/2010 12:04 PM (GMT -6)   
Meercat,
 
You are on the right track in seeing a uro. I have only one thing to add to all the good advice and info you have received above. If you do continue to have elevated PSA, do have a biopsy and are dx as having some stage of PC (none of which is certain yet), be sure that the uro(s) you see discuss with you the whole range of treatment options open to you given your "numbers". Too early to go into all that yet, but do spend some time on this site in the event you have to join this club and choose a treatment.
 
Joe
Age 67 PSA 4.5 Biopsy 9/4/09 Bostwick Labs 5 of 8 sections (5 of 11 cores) positive-Gleason 3+3=6 Stage T1
BT on 12/11/09 (84 seeds of Palladium 103) Home same day/no catheter. Some burning, frequency, urgency for 6 weeks. No incontinence, mild ED. Normal activity within 3 days. 25 IGRT sessions ending 3/22/10 - some fatigue until 30 days after last treatment. PSA on 5/26 - 0.1 PSA on 9/1 - 0.1
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