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Big PSA Jump In 20mos.

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Posted 1/19/2013 1:29 PM (GMT -6)

I am re-posting my last post hoping others will be able to add advice. I'm wordy here but new at all this. This is a great forum with so much knowledge and brave, loving people.  

I recently got my 1/4/13 PSA results back after convincing my local FP doc who no longer recommends PSA to add it to my blood panel. The result was suprisingly 6.6. Percent free was 10.2 and FTPSA .67. The PSA is way up from my last one in May 2011 at 2.3. I have a new UR appt. here in Boone, NC this Wednesday. He will probably want to run another PSA and if still up do a biopsy. First I will ask for a PCa3??

My jump from 2.3 to 6.6 in 20 months when I had a previous doubling shown below of 4 to 5 years, is very surprising to me...but, for the last several months, I had cut back on my 1mg/day finasteride (not the 5mg) to one piece every other day or only two/three times a week. Had been taking 1mg Propecia a number of years (hindsight wish I had not). Prior to this PSA, no exercise, or the other things to cause this.  

One more thing - just recently, I have had slight discomfort in perineum area like sitting on a small ball feeling...I have no urinary issues other than frequency when drinking a lot of coffee etc.

Anyway, I am very anxious, as you can tell, and a little miffed at myself and the local FP doc who Jan. 2012, kind of persuaded me against PSA testing. Not only this, but my wife is in the middle of radiation here for breast cancer, as I mentioned before, and my mom passed away last November of metastazied colon cancer, so life has been hard.

Robert 

8/1/06 age 60, PSA 1.1

2/26/08 age 62 PSA 2.1 (UR agreed workout and exercise bike that morning

affected test. I didn’t know not to exercise before test).

7/30/08 age 62 PSA 1.3

9/19/09 age 63 PSA 1.5

10/28/10 age 64 PSA 2.2

5/4/11 age 65 PSA 2.3

1/10/13 age 67 PSA 6.6

 

 

Posted 1/19/2013 1:54 PM (GMT -6)
Robert,

Welcome to HealingWell. This is all scary stuff, but we'll help you sort it out.

That's quite a jump in PSA, so a re-test will probably be in order before doing a biopsy. Mistakes happen. Your free PSA is a little worrisome, but it doesn't prove anything. Only the biopsy really can prove anything.

Prostatitis could account for your PSA spike. If there's any indication of that, your urologist might want you on a course of antibiotics before re-testing your PSA.

Assuming for the moment that you have prostate cancer, it's highly unlikely that a cancer with that PSA score would be advanced enough to cause you any discomfort. Stress can make you feel all kinds of things, though, and that may be what's at work there. If it's prostate cancer, you've probably caught it in a very early, treatable and asymptomatic stage.

So take a deep breath and try to relax. You may have another couple steps to take before you really know anything. One way or another, chances are excellent that you'll be fine.

Good luck to you and your wife. Let us know if you have any questions as you go through this, and please let us know how you make out. This is a great community of caring and well-informed people. You've landed in a good place.

Best,

Jonathan
Posted 1/19/2013 2:49 PM (GMT -6)
Going to a urologist is the right thing to do. Any number of things could cause that spike best get it checked out. Yes, you need a confirming PSA test along with the PCA3. That with a good DRE should give a better indication about what's up and if you need more tests like a biopsy or imaging.

This is all scary but you'll make it through.

Let us know what your Uro says and ask any other questions.

Andrew
Posted 1/20/2013 10:43 AM (GMT -6)
I'm 68 years old and have had benign prostate hypertrophy (BPH) for 20 years and elevated PSA levels as a result. My normal PSA hovers around 16, and I've had spikes as high as 50. I've had multiple prostate biopsies, with 6-8 cores (all negative). Recently, my PSA spiked to 23 and then, went down to 18. My urologist suggested a through transperitoneal template guided biopsy that sampled the entire gland with 13 cores, all of which were negative. I've also had periodic bouts of orchitis and epididymitis, which were cleared by antibiotics. I don't have symptoms of a urinary tract infection. (By the way, strenuous exercises that put pressure on the lower abdomen [bike riding, Nordic Track] as well as an orgasm can result in elevated PSA and should be avoided 4-5 days prior to doing a PSA). My urologist, who works at a major east coast academic medical center, remains watchful, but he also told me that he could fill a room with men with PSA's exceeding 50 who don't have prostate cancer. I hope my experience can help others.
Posted 1/20/2013 3:59 PM (GMT -6)
Hello.
I wonder if cutting back on finasteride might be responsible for part of the rise. finasteride consumption can lower PSA .
Your free PSA is kind of low and that is not a good sign, I'm thinking.
Good luck.
Posted 1/20/2013 9:37 PM (GMT -6)
Robert, I thought I'd pop in and say "hello." My husband and I also live in Boone. So sorry for all your troubles of late. We insisted on a PSA Free test when my husband's PSA rose quite a bit over the last year to 5.3. He is 68. While we have had some testing done in Boone and in Winston, we ended up at Duke for treatment once my husband was diagnosed with G7 PC. I just thought I'd invite you to contact me via this forum if you want to hash over anything or talk over local options. My best to you.
Posted 1/20/2013 10:08 PM (GMT -6)
Hello Irmaly!!

We actually live just done in Valle Crucis. Thanks for writing. I have appointment with a Dr. Miller at Boone Urology this Wednesday. I actually may also be going to Duke if I have PC to see Dr. Cary Robertson.

My free PSA percent is 10.2 which is low but Dr. Scholz says 10 to 28 percent is that gray area that means nothing. I'm not sure. I will ask for the PCa3 test. I question my 6.6 PSA and will have it re-run as suggested on this forum. The people here are really great and have more knowledge than a lot of Urologists.

If I may ask, what treatment did your husband have done at Duke? Hope it went well for him. Did he have a biopsy in Boone?

Since we all live here, you are welcome to email me. Btw, my wife goes to Seby Jones for treatment.

Thanks again!

Regards,
Robert
Posted 1/21/2013 7:29 AM (GMT -6)
Irmaly,

Btw, is there a local PCa group in the Boone area?

Robert

Posted 1/21/2013 11:09 AM (GMT -6)
Robert, I don't know of a local PC group in Boone, but we haven't really sought one out either. We went to Winston for the biopsy with Dr. Hamel. He is a good surgeon, but we went to Duke to talk with both a highly-recommended surgeon (Dr. Moul) and a highly-recommended radiation oncologist (Dr. Lee). We sent all biopsy reports and other information there to them. Frankly, we were most impressed with the Duke folks, so we went that route. My husband opted for IMRT and a year (hopefully not more) of HT. He has his first checkup next week. All went very well during treatment, but I guess next week will tell us where we really are at this point. We are exceptionally pleased with our choice of both treatment and doctor.
Posted 1/21/2013 12:01 PM (GMT -6)
Irmaly, thanks. So, he did not see a UR in Boone at all, or were you referred to Dr. Hamel?
And, your husband had to go every day for the IMRT at Duke from Boone or did you stayed down there?

Robert
Posted 1/21/2013 9:02 PM (GMT -6)
Hi Robert.  Sorry you are having problems. I am a Duke patient of Dr. Moul and had open surgery in May of 2007 and have been in the zero club ever since.  I live in Asheville and I am semi-retired with time on my hands for a prostate brother.  Just let me know if you want to get together and talk.  I live in Asheville but we can meet somewhere half way.  Just let me know if I can do anything for you.

Mika

Posted 1/21/2013 9:39 PM (GMT -6)
mika - still looking for a chance to hook up with you.. just have had too many issues to make it back to even Asheville. would you consider hooking up in Hendersonville or flat rock some time in the future?

david
Posted 1/22/2013 6:01 AM (GMT -6)
Hello Mika,

Yes, would really like to meet half way and talk ASAP. I have not had a biopsy yet. Am to see a urologist in Boone, NC on Wednesday. Also, to see the young FP who no longer recommends PSAs, to go over my blood panel.

I actually have a call into Dr. Moul's office yesterday. Haven't heard back. Does he also do biopsies? It will probably take time to get in to see him. Guess I could have the biopsy done here in Boone first??

Btw, my email is on my profile by clicking Time101. Then I can give you my cell so we can plan a meeting. I am retired to and am open.

Regards,
Robert
Posted 1/22/2013 3:37 PM (GMT -6)
We were referred to Dr. Hamal, and my husband did have an initial test here in Boone. We were leaning more and more toward radiation and believed Duke was the place to go for it. My husband stayed in Durham from Monday through Thursday and returned home on Fridays and left again on Monday mornings. It all worked out fine. We preferred Dr. Moul over Dr. Hamal, and if my husband had had surgery, we would have gone with Dr. Moul.
Posted 1/23/2013 7:23 PM (GMT -6)
Irmaly, did your husband have a biopsy done in Boone or at Wake Baptist? I met with a UR at Boone Urology today. He wanted to go ahead with biopsy, however, agreed to let's wait a month and re-do PSA. He was not high on doing PCa3. I will post details so rest of guys can read and hopefully offer their knowledge.

Robert

8/1/06 age 60, PSA 1.1
2/26/08 age 62 PSA 2.1 (UR agreed workout and exercise bike that morning
affected test. I didn’t know not to exercise before test).
7/30/08 age 62 PSA 1.3
9/19/09 age 63 PSA 1.5
10/28/10 age 64 PSA 2.2
5/4/11 age 65 PSA 2.3
1/10/13 age 67 PSA 6.6
Posted 1/23/2013 7:31 PM (GMT -6)
Robert, my husband had his biopsy done in Winston by Dr. Hamel, but you said you were using Miller in Boone, right? I'm sure he's fine for the biopsy. As for PCa3, you just had one, right? If not, I would demand it, but then that's just me.
Posted 1/23/2013 10:14 PM (GMT -6)
Irmaly, did you guys ask Winston or Duke about the MRI-ultra fusion guided biopsy? I don't yet know if either does it. Miller seems okay. Don't know why he wasn't in favor of PCa3 but I will demand it:) before a biopsy. He also said he would do seeds at my age if have PC...but that's what they do here. This PC stuff is so complicated my wife says with too many IF's and options.

Robert
Posted 1/23/2013 10:45 PM (GMT -6)
I hear Miller is a good doctor, and a friend of ours swears by him, but I don't see how he can say what he would do until after a biopsy and bone scan and Gleason Score, etc. Seeds can certainly be an excellent choice of course. But there's simply no way to decide treatment until you know what you're dealing with. We did not ask about MRI fusion guided biopsy. Just went for the regular up-your-bum kind :) Husband had the biopsy in Winston, but once we decided on Duke for treatment, we had all the slides and everything else sent over to them for both a second reading and consult.
Posted 1/24/2013 8:53 AM (GMT -6)
Thanks, Irmaly. Correction - Dr. Miller didn't volunteer the seeds comment. I asked him if it was PC, what would he do. Then, he said we do the seeds process here in the office center and that is usually a good choice for a guy your age at 67, but said we need to do the biopsy. He agreed to wait 5 weeks and re-run the PSA. But today, I'm antsy about going ahead with the biopsy....my fear is if I have PC, it could leave the capsule. He said no because he did not feel any lumps or hardness so it's confined to the prostate in his opinion. He guessed prostate size at 40g, when I asked him. Last thing - he siad if I wanted the PCa3, he has to push on the prostate a lot to try to get any potential cancer cells in the urine when they take the sample. Did not know that? Anyway, wonder if I should just not wait the five weeks for another PSA and bite the probe for the biopsy:)....he didn't think it would change but was okay to wait. 

Hey guys, if you see these postings, what do you think? Irmaly is my location neighbor and knows the doctors here. Her husband and I are about the same age. She has been very helpful.

Robert 

Boone, NC

8/1/06 age 60, PSA 1.1

2/26/08 age 62 PSA 2.1 (UR agreed workout and exercise bike that morning

affected test. I didn’t know not to exercise before test).

7/30/08 age 62 PSA 1.3

9/19/09 age 63 PSA 1.5

10/28/10 age 64 PSA 2.2

5/4/11 age 65 PSA 2.3

1/10/13 age 67 PSA 6.6

Posted 1/24/2013 9:52 AM (GMT -6)

Time101

If you check this link it will show you all of the UsTOO PC support groups in NC.  It is a great organization that can supply you with much needed support and information and you can get together with others who share this common bond.  Good luck to you and your family.

http://www.strivewell.com/wiki/Prostate_Cancer_NorthCarolina_USTOO

Posted 1/24/2013 10:09 AM (GMT -6)
Robert,

Yes, the PCa3 test involves peeing in a cup after the DRE from hell. Not much fun but not a big deal either. It's a quick and inexpensive test that urologists use, mostly with patients who are on the fence about getting a biopsy, to help them decide one way or the other. Obviously you don't want to get blood drawn for a PSA for a couple of days afterward.
Posted 1/24/2013 3:25 PM (GMT -6)
Sorry to hear it's been so rough on you and your family the past few years.

I have to say on "the local FP doc who Jan. 2012, kind of persuaded me against PSA testing" mine did the same. Comes down to money I think. A sort of rationing is what the upset urologist said when I told him.

Hopefully you will get the answers to move forward soon. I could be wrong but feel that the biopsy will be the only way to get an answer.
Posted 1/24/2013 5:35 PM (GMT -6)
Hello guys.Thanks again for the thoughts!! I have decided to go ahead with the biopsy. UR said he would give me an iv of a valuim type drug plus the lidocaine.

He said the DRE was normal, no lumps, or hardness. Only some BPH...guessed gland at about 40g. He said in answer to my question, that with the DRE result, if I have PCa, it is contained in the capsule. Lastly, he said with my numbers that he would give it a 50/50 chance he will find some PC on biopsy.

Think I mentioned he is in favor of Brachytherapy at my age although he said I was in as good shape as Jack Lalanne was...(just kidding), but all my other blood panel numbers were good.

Have a peaceful weekend - God bless and be with you all!!

Robert

8/1/06 age 60, PSA 1.1
2/26/08 age 62 PSA 2.1 (UR agreed workout and exercise bike that morning
affected test. I didn’t know not to exercise before test).
7/30/08 age 62 PSA 1.3
9/19/09 age 63 PSA 1.5
10/28/10 age 64 PSA 2.2
5/4/11 age 65 PSA 2.3
1/10/13 age 67 PSA 6.6
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