28 year old, high PSA

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young_guy
New Member


Date Joined Apr 2013
Total Posts : 4
   Posted 4/22/2013 5:25 AM (GMT -7)   
Hi, I've been reading some posts in this section recently and was hoping for some guidance from the excellent community that you have built up.

My situation:
-I'm a 28 years old male

- Nov 2012, started taking 1mg finasteride (propecia) per day for male pattern baldness, not for any prostate related problem

- Feb 2013, stopped taking finasteride due to erection problems (still not sure whether they were finasteride related, or perhaps something else)

- March 2013, Doctor sent me for blood tests related to erectile dysfunction (mainly hormones such as testosterone). Included in this test was total PSA.

- 27/03/2013, Total PSA 2.0. According to the pathologists report 20-29 year old men have a median total PSA of 0.7. Did not get free PSA measured in this instance. As this result was high I saw the doctor the next day.

- 28/03/2013 - Total PSA 1.7, Free PSA 0.3, % free 17.6%. Note that this was measured at a different pathology than the first test, as the first one was not available that day.

My questions for the forum
- Isn't finasteride supposed to reduce Total PSA? If so this is concerning as it means my Total PSA may be even higher. I used finasteride 1mg a day for 3 months, how long would you expect my PSA returns to pre-finasteride levels?
- The doctor recommends I do nothing and repeat the PSA Total/Free test in 3 months. Does the community here think that is appropriate?
- note, I haven't seen a specialist yet, only my local General Practitioner.
- any other comments welcome!

Thanks,

stixandstonz
Regular Member


Date Joined Nov 2012
Total Posts : 173
   Posted 4/22/2013 5:51 AM (GMT -7)   
Sounds like a follow up appointment with urologist is in order. Could just be an infection. Good Luck and I will keep my fingers crossed that it is nothing serious.

Cheers
Diagnosed at 51, 7/12 PSA 4.0, DRE negative.
Gleason 8, 3 of 12 cores positive. Left Apex GS 4+3=7 10% of specimen, Left Mid GS 4+4=8 10% of specimen, Left Lateral Apex GS 3+4=7 60% of specimen. 3 of 12 cores positive.
CT & bone scans neg.
Decided on ADT w/Proton Therapy at UFPTI 8/12
Trelstar 11.25 mg shot, ADT 8/12 and 11/12
Proton treatment finished 1/13, no incontinence or ED
PSA 0.1

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25343
   Posted 4/22/2013 6:25 AM (GMT -7)   
Your doctor's advice sounds perfect and reasonable for your situation, wouldn't worry too much.

david
Age: 60, 56 at PC dx, PSA 16.3
3rd Biopsy: 9/8 7 of 7 Positive, 40-90%, 4+3
open RP: 11/8, Catheter in 63 days
Path Rpt: 3+4, pT2c, 42g, 20% tumor, 1 pos margin
Incont & ED: None
Surgery Failed, recurrence within 9 months
Salvage Radiation 10/9-11/9, SRT failed within 9 months, PSA 4/12 = 37.x
Spent total of 1 ½ years on 21 catheters, Ileal Conduit Surgery 9/10,
7 other PC-related surgeries
Member of Prostate Cancer & Chronic Pain HW Communities since 10/2008
“I live in the weak and the wounded” – Session Nine (Movie)

InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 7966
   Posted 4/22/2013 7:12 AM (GMT -7)   
Welcome to HW.
I vote for the retest in 3 months and go see a Uro.

That PSA number may be normal for you. You need to see a trend in a number of tests. It could be a simple infection.

Andrew
I'll be in the shop.
Age 53
PSA 4.2 10/11, 1.9 6/12, 1.2 12/12
GS 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My PC blog

quincy17
Veteran Member


Date Joined Feb 2013
Total Posts : 1280
   Posted 4/22/2013 7:59 AM (GMT -7)   
DITTO!!!
Age 52 at time of Dx, PSA 511, Gleason 9, tumor inoperable, and HT advised for maintenance.
Current age 58, PSA 4.5 and still on HT . . . Lupron 30mg every 4 months with accompanying blood work including fresh PSA, 50 mg Casodex daily. CP drugs are #30 90 Mgs Cymbalta 1/d #240 Oxycodone IR 1-2 every 4 hours, #120 Fentora 600mcg 4/d
CP syndromes: OA, Fatigue, musco-skeletal pain, severe joint pain

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2454
   Posted 4/22/2013 8:10 AM (GMT -7)   
Another ditto. Retest in 3 months. Make sure that you abstain from sex 48 hours before the test.
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, SV, clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
PSA tests every 3 months undetectable
PSA at 32 months: .005
PSA on 4/3/12 <.01 (38 months)
PSA on 10/1/2012 <.01 (44 months)
PSA on 2/1/13 <.008 (4 years)

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 4/22/2013 9:08 AM (GMT -7)   
Still,
I would watch it. In three months it may or may not drop and no assumption should be made about what is normal. Obviously there's more story here and it is not normal for a 28yo to have a PSA at 2 nor is the free PSA at 17% a good number. Have you had a PCA3 test as yet. If not, and your GP probably does not have that test readily available, then you need a specialist.

You are very young and the prevalence of prostate cancer at 28 is extremely rare. But it's not zero. I have know a few cases like yours but don't assume anything. Three months is not unreasonable but it's also possible that you may have a urinary tract infection and that should not go untreated. From my own perspective, it would not be unreasonable to see a specialist now.

Tony
Forum Moderator and Patient Advocate
Dx Age 44, PSA 19.8 in 2006 ~ RALP Surgery 2007 , radiation and hormonal therapies.

Patient Profile:
/www.facebook.com/notes/tony-crispino/working-for-hope/10150776531122571

Blog: www.caringbridge.org/visit/tonycrispino

Memberships:
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Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3726
   Posted 4/22/2013 10:21 AM (GMT -7)   
Did you have a DRE or did you ejaculate before having your blood drawn for the PSA? There is plenty of evidence that an aggressive DRE or ejaculation will elevate the PSA reading.
Be consistent. I'd have blood drawn at the same tome of the day and would avoid sex for 48 hours before the draw.
Jeff
Age: 60, Mar 37 yrs, 56 dx, PSA: 4/09 17.8, 6/09 23.2
Biopsy: 6/09 7 of 12 Pos, 20-70%, Gleason 4+3 Bone, CT Neg
DaVinci RP: 7/09, U of Roch Med Ctr
Path Rpt: Glsn 3+4, pT3aNOMx, 56g, Tumor 2.5x1.8 cm both lobes and apex
EPE present, PNI extensive, Sem Ves, Vas def clear, Lymph 0/13
Incont: 200ml/day ED: Trimix
Post Surg PSA: 10/09 .04, 7/10 <0.01, 7/11 <0.01, 1/12 <0.02
AdV Sling 1/10/11 Dry

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8955
   Posted 4/22/2013 10:51 AM (GMT -7)   
young_guy said...
- Isn't finasteride supposed to reduce Total PSA? If so this is concerning as it means my Total PSA may be even higher. I used finasteride 1mg a day for 3 months, how long would you expect my PSA returns to pre-finasteride levels?


Finasteride is good at reducing PSA due to BPH, but it's not very good at reducing PSA due to prostatitis or prostate cancer. 1 mg is a low dose for BPH - 5 mg (Proscar) is prescribed. Also, 3 months isn't very long. It often takes 6 months on Proscar to really have a big effect on PSA.

My first suspicion in a man your age would be prostatitis (which is common) rather than PC (which is improbable). You didn't mention any symptoms (slow, hesitant stream, incomplete emptying, burning, pain in the perineum, penis or pelvis), but it is often symptomless.

young_guy said...
- The doctor recommends I do nothing and repeat the PSA Total/Free test in 3 months. Does the community here think that is appropriate?


I do. I don't think there's any urgency. If it's still elevated, he might want you to take a course of an antibiotic like Cipro to see if you have bacterial prostatitis. Your % free PSA is about at the median and doesn't really tell you anything.

young_guy said...
- March 2013, Doctor sent me for blood tests related to erectile dysfunction (mainly hormones such as testosterone). Included in this test was total PSA.


Was your testosterone normal? Low testosterone levels may contribute to PC years later.
Allen
•3rd biopsy (4/2010):
PSA=7.3, prostate volume=55cc, 8 of 17 cores G6 5-35% involvement
•SBRT (5x8Gy) at UCLA, 10/2010 at age 57
•PSA since treatment:
+3 mos:3.9 +4 mos:3.5 +7 mos:3.0 +10 mos:3.7 +13 mos:3.6 +19 mos:1.18 +23 mos:1.29 +29 mos:.37
• Side Effects of treatment:
+2 wks: Grade 1 urinary & rectal last 1 wk
+1 yr: Grade 1 urinary last 2 months
no ED

Susan R
Veteran Member


Date Joined Dec 2010
Total Posts : 511
   Posted 4/22/2013 4:00 PM (GMT -7)   
My first thought was infection. Why not take an antibiotic and retest in 6 weeks?
Husband 39 at diagnosis 12/2010.
No symptoms, PSA 18 in 10/2010
one month antibiotic then PSA 12.6 in 11/2010
biopsy end of 11/2010 Gleason 6
Da Vinci prostatectomy 2/2/2011
Taking 20 mg levitra daily June 2011.
Feb 2012 - 1 year post surgery PSA = undetectable
Low T - started Androgel Feb 2012
Started Trimix Feb 2012


staging: pT2aNo, Gleason6

Horace
New Member


Date Joined Dec 2012
Total Posts : 9
   Posted 4/23/2013 4:46 AM (GMT -7)   
Repeat in three is sound advice...

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2207
   Posted 4/23/2013 5:09 AM (GMT -7)   
Welcome to HW
Yes. I'm not medcially qualified to recommend anything but I feel that you need to have a few weeks/months to clear the meds out of the system and then retest PSA, and then, even if PSA still above "normal", the first thought I have is that there is some sort of infection so a course of antibiotics would be needed, and then you'd have to wait for them to have the full effect and then retest PSA once more.

Alf

young_guy
New Member


Date Joined Apr 2013
Total Posts : 4
   Posted 4/24/2013 12:52 AM (GMT -7)   
Thankyou everyone! I'm taking all advice on board.

Answers to specific questions:

Somebody said...

Have you had a PCA3 test as yet. If not, and your GP probably does not have that test readily available, then you need a specialist.


No I haven't had a PCA3, I'll ask my doc about it (and specialist if I have to).

Somebody said...

Did you have a DRE or did you ejaculate before having your blood drawn for the PSA? There is plenty of evidence that an aggressive DRE or ejaculation will elevate the PSA reading.


I've never had a DRE (although happy to have it done if doc suggests it). For the 2nd test I didn't ejaculate within 48 hours of the test. (I read about this so took it into account). For the first test I probably didn't ejaculate within 48 hours of test, but honestly can't remember. I also don't ride a bike or anything like that.

Somebody said...

You didn't mention any symptoms (slow, hesitant stream, incomplete emptying, burning, pain in the perineum, penis or pelvis), but it is often symptomless.


I actually have none of those symptoms, I originally came to the doc for Erectile Dysfunction (soft erections, but not non-existent) that may be finasteride related. I'm not even sure why he tested PSA.

In saying that since ~2009 (4 years ago) I very occasionally dribble a tiny bit of urine about 5 mins after urinating. This is infrequent, however, so i never worried about it. Other from that and the very recent ED issue, no other symptoms whatsoever.

Somebody said...

Was your testosterone normal? Low testosterone levels may contribute to PC years later.


My testosterone was in the upper end of the reference range, but apparently (according to my doc) this is very normal for a 28 year old (wouldn't expect to be at median at my age).

Thankyou again, I'll continue to monitor this thread.

young_guy
New Member


Date Joined Apr 2013
Total Posts : 4
   Posted 5/28/2013 11:58 PM (GMT -7)   
OK so I've had new blood & urine taken and have had a followup consultation with my Doctor:

PSA Blood Tests
27/03/2013 - Total PSA 2.0
28/03/2013 - Total PSA 1.7, Free PSA 0.3, % free 17.6%.
23/05/2013 - Total PSA 1.4, Free PSA 0.27, % free 26.1%

Urine Microbiology Test
23/05/2013 - pH: 6, Calcium oxalate crystals seen


My Doctor's advice. Do nothing, but wait 6 months to repeat next PSA & Urine test. Forum members, does this seem like good advice?

p.s. i did not ejaculate within 3 days of each test, nor ride a bike. I've never had a DRE. Also I've never had any treatment for this (not even antibiotics) and I've never seen a specialist or urologist, just a General Practitioner.

Post Edited (young_guy) : 5/29/2013 1:01:35 AM (GMT-6)


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2207
   Posted 5/29/2013 1:16 AM (GMT -7)   
First reaction as a non-doctor, is that this is great news, a slowly dropping PSA suggests all is well, especially when is is pretty low anyway.

I don't know enough to comment on the Calcium oxalate crystals.

I am however mildly surprised that your doc has never given you a DRE. They can usually feel how big the darmed thing is, and if it turns out that you have a very large prostate that might partly explain things,

I would thus expect that in 6 months time you PSA will be even lower.

Alf

HighlanderCFH
Veteran Member


Date Joined Dec 2012
Total Posts : 677
   Posted 5/29/2013 1:42 AM (GMT -7)   
Hi there,

It would be highly unusual to have PC at your young age, although anything is possible. Your total PSA is somewhat elevated and your free PSA of 17.6% is fair. Anything under 10-15 is considered suspicious and anything over 25% is considered very good.

A PSA reading, by itself, is usually not an indicator of PC. Some men have PC with an almost zero PSA reading, while others with large PSA readings have no PC.

Do you have any family members (blood related) who have had PC? If so, your chances of getting it are much higher than normal -- although it would still be unusual to develop it in your 20s. An infection, etc., is more likely than PC.

But still, with your tPSA and fPSA readings, it would be wise to begin regular PSA testing to develop a baseline and a history of readings, perhaps once a year. The thing the urologist will be looking for is a SPIKE in the PSA. If the number should rise -- but only gradually -- it may not be any problem.

But if the number should suddenly begin to rise and perhaps double over a year or two, it is a possible indicator of PC.

It is possible that a prostate biopsy might be in the future if the above should happen.

My advice would be to just keep checking your PSA once a year (or even every 6 months if it continues to be elevated) to keep an eye on it. Then, if any PC should be found in the future, it would likely be still at a highly curable stage.

Once again, though, remember that it is rare to have PC at your age, so do not lose any sleep over this. Just stay on top of things and you should be okay.

Take care,
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.

Post Edited (HighlanderCFH) : 5/29/2013 2:45:02 AM (GMT-6)


young_guy
New Member


Date Joined Apr 2013
Total Posts : 4
   Posted 8/29/2014 2:55 AM (GMT -7)   
hi guys, I decided to get another PSA test.

I'm now 29 years old. A summary of my tests is below:

date psa free:total
27/03/2013 2.0
28/03/2013 1.7 17.6
23/05/2013 1.4 26
15/08/2013 1.9
21/11/2013 2.3 29
22/08/2014 1.8 23

Note
- i didn't get free:total ratio everytime.
- the first two values (2.0 and 1.7) were taken on consecutive days, my doctor wanted to make sure it wasn't an error. For me this is a combination of my PSA naturally fluctuating and margin of error in the measurement equipment. It does tell me that i shouldn't be too focused on each change, but rather the trend.
- i don't have a family history of prostate cancer to my knowledge.

Question for the forum - I was considering annual PSA tests from now on to detect changes, seeing urologist if there is a spike. Any advice on this?

PeterDisAbelard.
Forum Moderator


Date Joined Jul 2012
Total Posts : 5640
   Posted 8/29/2014 4:49 AM (GMT -7)   
Your plans sound sensible. Your PSA is a bit high for a kid your age but there doesn't seem to be much by way of a trend there. You should, of course, talk this over with your doctor when you see him.

We'll be here if you need us.
61
Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012:
1)neg (some inflammation),
2)neg,
3)positive 1 of 14 GS6(3+3) 3-4%, 2nd opinion GS7(3+4)
4)neg.
Mild Pre-op ED
DaVinci RRP 6/14/12. left nerve spared
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
Start 24 mo ADT3 7/26/12
Adjuvant IMRT 66.6 Gy 10/17/12 - 12/13/12
Leaky but better, Trimix, VED
Forum Moderator - Not a Medical Professional

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7184
   Posted 8/29/2014 5:43 AM (GMT -7)   
I see absolutely nothing worrisome at this point. If you had PC, it is reasonable to expect a steady rise in your PSA. That is not happening.

ALSO, WHY DO THE FREE-PSA? That is only recommended when your regular PSA is > 4. I think the free PSA is annacurate otherwise. Maybe somebody could chime in here.

Mel

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8955
   Posted 8/29/2014 10:11 AM (GMT -7)   
young_guy,

A few questions...

Did your doctor do anything to diagnose prostatitis? Give you a course of Cipro?

Did you have a DRE to check for enlargement, hardness & lumps?

Did your ED disappear when you stopped finasteride? What was your testosterone level?

Have you had a Cystoscopy to check for blockage? The oxalate crystals may be related to stones somewhere in the urinary tract. That can certainly cause elevated PSA.

galian
New Member


Date Joined Mar 2016
Total Posts : 1
   Posted 3/23/2016 12:29 PM (GMT -7)   
Wondering what happened. As my case is kind of similar
Maybe quiting propecia messes up with prostate and psa?

Break60
Veteran Member


Date Joined Jun 2013
Total Posts : 1782
   Posted 3/23/2016 6:56 PM (GMT -7)   
Dear young guy
I took avodart then finasteride for ten years to reduce enlarged prostate. It does reduce PSA by about half which unfortunately lulled me and my pcp into thinking My PSA was in the appropriate range for my age and therefore" all was well" but as it turned out all was not well. I ended up being diagnosed with high risk PCa which I probably had starting in my late 50s.
Bob
DOB January 1944 (now age 72)
8/12 PSA 2.7
5/13 PSA 6.6
7/13 Bx 4+5=9, 2 of 6 cores, 10%, 40%
9/13 ORRP, Gl9, pt3b, SVI+,margin+, EPE, Nodes clear
11/13 to 5/14 PSA .1,.2,.3
6&7/14 IMRT 68.2 gy. to Prostate bed, ADT 6 mos. Lupron
9/14 to 8/15 PSA <.1,<.1,.1,.3,.7,1.2
9/15 to 10/16 ADT(lupron, casodex, avodart
9/15 to 12/15 IMRT/D.A.R.T. 75 gy to pelvic nodes
3/16 PSA .034

ASAdvocate
Veteran Member


Date Joined Feb 2015
Total Posts : 636
   Posted 3/23/2016 7:47 PM (GMT -7)   
I hope that those replying realize that this thread is from 2013 and 2014, and that the original poster has not responded in over 18 months. You may be dialing a disconnected number.
DOB: May 1944
In AS program at Johns Hopkins
Five biopsies from 2010 to 2014. The third and fourth biopsies were positive with one core and three cores <5% and G 3+3. Fifth biopsy was negative.
OncotypeDX: 86 percent chance of PCa remaining indolent
August 2015: tests are stable; no MRI or biopsy this year for my AS program
March 2016 PHI = 28; a good result for AS
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