New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

MR123
New Member


Date Joined Nov 2017
Total Posts : 8
   Posted 11/10/2017 5:55 AM (GMT -7)   
Hi,

My PSA has been jumping around for the past couple of months. Don't know at what point it started to rise from what was a steady 1.6 (9/2016 and prior) to 2.3 9/2017. I have been experiencing frequent urge to urinate, some burning pre/during/post urination. My Urinalysis and Urine Culture are both negative. My PSA density is .07 (have been told I have BPH for at least 10 years now...I am 61 years old). My % free PSA is 17%...here is my most recent PSA results released yesterday:

PSA, FREE (ARUP) 0.9 ng/mL ng/mL (Is there any significance to this particular value or is it just used to compute the % Free?)
PSA (ARUP) 5.4 ng/mL 0.0 - 4.0 ng/mL
% FREE PSA (ARUP) 17 %


I am scheduled to have blood drawn today for 4K test. My Urologist says:

"The rapid rise and fall is more consistent with inflammation and not cancer. Nonetheless, I would obviously rather have the PSA remain low and stable. Knowing that you had a relatively normal prostate MRI and low PSA density is also reassuring."

Am I missing any steps here or am I on the right track working this up? Also...what will the 4K test reveal and what are the values (and significance of the numbers low/high) that will produced? Any insight from this most learned membership would be greatly appreciate...you are a great bunch of supportive individuals...thank you.


History:

Sept 11, 2016 1.6
Sept 11, 2017 2.3…and then 1month later…
Oct 12, 2017 … 5.6…and then 12 day later…
Oct 24, 2017 …2.5…and then 7days later…
Oct 31, 2017 …4.68…and then 10 days later (yesterday)
Nov 9, 2017 5.4...last value...current...

3T MRI...

October 18, 2017 MRI of prostate
CLINICAL STATEMENT: Elevated PSA.
TECHNIQUE: Axial T1-weighted; axial, coronal, and sagittal T2-weighted;
and axial diffusion-weighted images were obtained.
1 mg of Glucagon was given subcutaneously.
COMPARISON: None.
CORRELATION: None.
FINDINGS:
PROSTATE MEASUREMENTS: 5.4 x 5.2 x 5.4 cm; volume 75.8 cc
TUMOR location(S): Ill-defined areas in the bilateral
Peripheral zone are nonspecific.
EXTRACAPSULAR EXTENSION: None.
SEMINAL VESICLE INVASION: None.
MEMBRANOUS URETHRAL
LENGTH: 1.2 cm.
PELVIC NODES: No adenopathy.
BONES: Unremarkable.
OTHER: None.
IMPRESSION:
1. No focal suspicious lesion. PI-RADS v2 score 2.

MR123
New Member


Date Joined Nov 2017
Total Posts : 8
   Posted 11/10/2017 6:30 AM (GMT -7)   
Hi...I would like to add that the PSA values I posted have been from three different labs:

Sept 11, 2016 (Internist...lab 1) 1.6
Sept 11, 2017 (Internist...lab 1)) 2.3…and then 1month later…
Oct 12, 2017 (First Urologist seen...sent blood out...lab 2)… 5.6…and then 12 day later…
Oct 24, 2017 (Internist...lab 1)…2.5…and then 7days later…
Oct 31, 2017 (First Urologist...lab 2)…4.68…then 10 days later...
Nov 9, 2017 (Second Opinion Urologist...lab 3)...5.4...most recent value

I understand from reading the forum that values can differ lab to lab...but would we expect to see such wide swings just attributed to using different labs (3 labs defined above)? I have seen 2 different Urologists since this event started in September 2017. I would also like to add that I have some starts and stops and dribbling post urination. I went to the second Urologist for another opinion...it is his comment that I posted in my original email. The first Urologist told me he didn't need to see me for 6 months. I was not completely satisfied with this POA and sought the second opinion. Thank you again.

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3726
   Posted 11/10/2017 6:51 AM (GMT -7)   
Are you aware that sex/ejaculation or a DRE will make the PSA rise?
To be consistent, you should abstain from sex for 24 hours (some say 48 hours) before having your blood drawn.
Good luck.

Howard3569
Regular Member


Date Joined Nov 2014
Total Posts : 257
   Posted 11/10/2017 8:20 AM (GMT -7)   
I have been told that I should try to use the same lab.
Surgery Nov, 14 2014 Negative margins, negative lymph nodes, negative vessels
Gleason 3+7 PSA .08 Dec 14, 2004; <0.05 on March and July 2015; 0.05 on Oct 2015 and 0.07 on January 2016, .06 on July 2016 and .10 on Oct 2016

MR123
New Member


Date Joined Nov 2017
Total Posts : 8
   Posted 11/10/2017 10:29 AM (GMT -7)   
Hi Worried Guy and Howard...thank you...

Abstained on most of the dates (not all but had blood drawn AFTER DRE on a few of these...I abstained and now DRE for 96 hours for the 4K today. I will be using the same lab from this point forward...really weird if that is part of the problem...swings in the range of 3 points...could see a point but 3...labs 2 &3 seem to be more in sync with each other then lab 1 is with labs 2&3...these are reputable labs my doctors are using...oh well...waiting for the 4K to be process...being told most likely a week or a bit more...thank you.

MR123
New Member


Date Joined Nov 2017
Total Posts : 8
   Posted 11/10/2017 10:31 AM (GMT -7)   
sorry...meant to say...

*NO DRE or relations for 96 hours prior to blood being drawn today for 4K...

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8785
   Posted 11/10/2017 11:33 AM (GMT -7)   
Your urologist is right that your sudden rise in PSA and your urinary symptoms are consistent with prostatitis rather than prostate cancer. Your low PIRADS score also tells you that if there is any cancer in there, it is most likely low grade. In contrast to prostatitis, prostate cancer is usually asymptomatic until very late stages, and PSA rises more slowly and steadily at first.

4Kscore is a test for a few kinds of PSA . PSA and free PSA are two of a family of proteins called kallikreins- that's the "K" --and there are 4 different ones they test for. The 4Kscore is better than just PSA and % free PSA at discriminating for prostate cancer. It's less affected by prostatitis, but it's not completely unaffected by it. It is somewhat expensive (around $400) and it is not FDA-approved so insurance/Medicare may not cover it - always get preauthorization. There is a very similar test called Prostate Health Index (PHI) that is cheaper and is FDA approved, so if your insurance won't cover 4Kscore, ask for PHI.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

MR123
New Member


Date Joined Nov 2017
Total Posts : 8
   Posted 11/10/2017 2:31 PM (GMT -7)   
Hi Tall Allen,

First I would like to thank you for taking the time to post a reply to me. You and others on this board are helping countless numbers of people (especially us newbies) navigate their way through this daunting situation we find ourselves in. Many thanks from me to you and the other contributing members...

I have a question regarding my % Free PSA which has been calculated at 17%...if my PSA is elevated secondary to prostatitis or UT infection and it goes into remission...is it a safe assumption to say that my % Free PSA will go "UP"? I understand that my value puts me in the "gray" zone and from reading the forum, a safe percentage is around 25. I guess I am asking "if" this an infectious process and "if" we can bring it somewhat under control, would I assume that my % Free PSA will change for the better?my values should come into a more normal line...correct?

Also...when you say:

" In contrast to prostatitis, prostate cancer is usually asymptomatic until very late stages, and PSA rises more slowly and steadily at first."

My PSA was 1.6 (Internists office) in September 2016. Then in September 2017, it was 2.3(Internists office)...I am wondering if it was going up slowly September 2016 to September 2017 to 2.3 ...but I will never know since there was no other values documented between those two time periods. Or, I guess the increase could have just begun in September of 2017 and, has been spiking up and down since only then. I am a bit concerned that my internist's numbers are the low ones and the two major (different) hospitals that my Urologists work out of have reported the high values.

So...I gave the blood for the 4K test before I read your comments...I did not ask for a pre-authorization so I guess I will have to wait and see what the damage is...when you say that this test is more discriminating then a PSA and % free PSA do you mean that the results will actually show if I have a cancer and what the grade of that cancer is (meaning slow growing as opposed to aggressive). Can the test tell you one way or the other if you have cancer?

Regards

ejc61
Regular Member


Date Joined Dec 2016
Total Posts : 25
   Posted 11/10/2017 2:45 PM (GMT -7)   
Hello MR123,

My PSA had been 0.9 to 1.9 over a period of 15 years. My signature line shows the rest. Prostatitis and BPH have been ruled out. Just absorb as much information as possible.
PSA:2/16-5.2; 5/16-2.8,FPSA-13.2%;10/16-4.6,FPSA-11.5%; 1/17-4.4
dx:3/17;age 55
bx:3/12 positive; all 3+3=6;5%,5%,20%
PSA density 0.16; volume 28; T1c; non-palp DRE
bx confirmed by Johns Hopkins
OncotypeDX-GPS-19 (GPS+NCCN classification)-Very Low Risk
mpMRI: 7/17 Emory/Atlanta;(2) lesions(Pi-Rad 3, Pi-Rad 2),otherwise none or normal results.
PSA:7/17-1.9; 10/17-2.08
AS Program-Emory/Atlanta

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8785
   Posted 11/10/2017 3:29 PM (GMT -7)   
All the tests that are PSA dependent -- PSA, Free PSA, PHI and 4Kscore -- are affected by prostatitis. None of them replace a biopsy. Their point is to show if it is safe to forgo a biopsy. None of them are very good, but PSA is the worst biomarker and % free PSA is a bit better. Neither of them have cutpoint where one can say with any confidence that a biopsy is highly likely to be positive or negative. PHI and 4Kscore, unlike those, have a cutpoint that simultaneously predicts the necessity of a biopsy reasonably well, or at least better than the other two. For example, if your PHI is over 35, your odds are 2/3 of a positive biopsy, and 1/3 negative due to a false positive. If your PHI is under 35, your odds are 2/3 that you can safely forgo a biopsy, but 1/3 that it will be unsafe to forgo a biopsy due to a false negative. See what I mean? Not great, but better than the others.

If your prostatitis goes into remission and your spike disappears, % free PSA will go up, PHI and 4Kscore will go down. There is a correlation between Gleason score and PHI or 4Kscore, but not % free PSA. The correlation is not strong enough to give it any grade-predictive value.

You are right to put "if" you are able to control the prostatitis in quotes. It is extremely hard to control. Antibiotics usually don't work and pathogens can rarely be identified. It is often relapsing and remitting for a lifetime. You just have to wait it out, treating the symptoms.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4148
   Posted 11/10/2017 9:33 PM (GMT -7)   
You also have a 78cc prostate. At .066 to .1 of psa per cc an expected psa of 4.8 to 8 would be considered normal for you.
70 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, 4 weeks of urinary frequency and urgency; no side affects since then. 6 years of psa's all at <0.1.

MR123
New Member


Date Joined Nov 2017
Total Posts : 8
   Posted 11/11/2017 9:18 AM (GMT -7)   
Tall Allen...thank you again...

Hello ejc61...thank you....

John T...thank you...so I see from your calculations that...although unnerving...my current PSA of 5.4 "could be" an expected finding with a prostate of my volume.

My urologist told me there is a medication that he could put me on that would shrink my prostate...anyone have any information on this...success rates...side effects...etc? Thanks...

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8785
   Posted 11/11/2017 11:50 AM (GMT -7)   
He's talking about either of two medications - Proscar (finasteride) or Avodart (dutasteride). They are excellent for BPH, and actually make PSA a better indicator for prostate cancer. Side effects include hair regrowth and sexual side effects in about 20% of men. They sometimes combine it with an alpha-blocker like Flomax that increases the relaxation in the urethral sphincter to allow more flow-thru.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

MR123
New Member


Date Joined Nov 2017
Total Posts : 8
   Posted 11/12/2017 2:29 PM (GMT -7)   
Hi Tall Allen,

When you say:

"Your low PIRADS score also tells you that if there is any cancer in there, it is most likely low grade. In contrast to prostatitis, prostate cancer is usually asymptomatic until very late stages, and PSA rises more slowly and steadily at first."

Can you help me understand better :

"...if there is any cancer in there, it is most likely low grade"?

Awaiting results of the 4K test...probably not till end of this week or next week.

Thank you,

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8785
   Posted 11/12/2017 4:46 PM (GMT -7)   
mpMRI evaluated using PIRADS scoring shows suspicion for significant and high grade PC. "Significant" means larger than about 4 mm. High Grade means Gleason scores of 7-10. A PIRADS score of 2 means there was nothing found that was suspicious for significant or high grade PC.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

MR123
New Member


Date Joined Nov 2017
Total Posts : 8
   Posted 11/12/2017 5:39 PM (GMT -7)   
Thank you Tall Allen...
New Topic Post Reply Printable Version
Forum Information
Currently it is Friday, November 17, 2017 12:46 PM (GMT -7)
There are a total of 2,894,804 posts in 317,734 threads.
View Active Threads


Who's Online
This forum has 157339 registered members. Please welcome our newest member, musiclife19.
384 Guest(s), 17 Registered Member(s) are currently online.  Details
momto2boys, TheIsomotion31, 81GyGuy, sar85, Billj, bellabee123, R-0.009, getting by, tonyaraven, Lynnwood, Mergirl, JasonSinis, TheYeti, Mustard Seed, MariaMaria, Jack & Diane, limey


About Us | Advertise | Donate
Newsletter | Privacy Policy & Disclaimer
Follow HealingWell.com on Facebook Follow HealingWell.com on Twitter Follow HealingWell.com on Pinterest
©1996-2017 HealingWell.com LLC  All Rights Reserved.