First Time Post about PSA

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Jamie1970
New Member


Date Joined Nov 2017
Total Posts : 13
   Posted 11/29/2017 10:14 AM (GMT -6)   
Hello,

I'm 47 male and I had some blood in my semen back in October, I did have the Vasectomy back in April so in the back of my head I think this could be related.

I went to see my Urologist who didn't bat an eye; DRE was negative, Urine tests were negative but the PSA test came back at 3.8, this was my first ever PSA test. He put me on Bactrim for two weeks and in my next visit he said it came down to 2.7 which was a significant drop. All along he has felt that I don't have PC and it's been treated as inflammation. I should be 2.5 or below for my age so I'm just right there. He said if my PSA had come down to a 2.4 then he'd see me in a year. I know the stats say that we all have a risk for PC but the only issue I had was the blood, which has not returned and the PSA dropped with a round of antibiotics.

What are your thoughts?

InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 9413
   Posted 11/29/2017 10:35 AM (GMT -6)   
Welcome to HW.

My thought: Prostatitis

Prostatitis often leads to large swings of PSA, it can be difficult to treat and often reoccurs. Don't know about the effect of a vasectomy, but if there was any infection or inflammation from that it might affect PSA. Blood in your semen is likely related and very likely the cause of the PSA rise.

Next, the PSA isn't a test for cancer. It's more of an "Engine check light" kind of thing. High PSA just means you need more tests to see what's wrong. Things that can raise PSA include, BPH (enlarged prostate), prostatitis (infection), sex before the test, bike riding, a bad day at the lab ... PC is the last thing on the list. PSA due to PC tends to climb slowly and never falls. and PC rarely has symptoms in the early stages.

What you have is a reason to get regular PSA tests and perhaps one or two other tests. The PHI (prostate health index) is a good one. The other question is, do you have any family members who've had PC - that would put you in a higher risk group.

In you're place, I'd just add PSA to my annual list of things to get checked, and go enjoy life.

If it ever started climbing again, you'd go back to the URO for another checkup.

Andrew
I'll be in the shop.
Age 57, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17, .3 10/17
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

ASAdvocate
Veteran Member


Date Joined Feb 2015
Total Posts : 747
   Posted 11/29/2017 10:44 AM (GMT -6)   
Ditto to what Andrew said, It is much more likely that you are dealing with prostatitis.

Just relax, and have six month PHI tests for a year. If those are good, then go annual.
DOB: May 1944
In AS program at Johns Hopkins
Five biopsies from 2009 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
August 2016: MRI unchanged from 2/2014; PSA=3.9; FPSA= 26; PHI =28

Jamie1970
New Member


Date Joined Nov 2017
Total Posts : 13
   Posted 11/29/2017 10:47 AM (GMT -6)   
Shop,

That seems to be the consensus from other men that I have spoken to with regards to this issue. I also have a friend who is a doctor at the local hospital who works in Oncology and he noted Prostatitis as well. With the DRE and Urine being negative those are good signs. My Urologist wasn't worried about it at 3.8 or at 2.7 but he wanted it down to 2.5 or below for my age so he put all options on the table. He wasn't very helpful when I asked for his suggestion at first but noted that if he were me he would wait and recheck and/or do a second round of Bactrim. Of course I have to be fed the stats to which puts me in the 20% marker.

No family history of PC in father, brother or anyone else.

I have to find a new Urologist in my area since my current one no longer accepts my insurance so a second opinion will be good.

Yes, I do not have any other symptoms, no issues with pain, urination, etc...

Lastly, he did say that IF I had PC then the antibiotics would not have dropped it so far down.

This very helpful and encouraging and IF PC were present it's so early that it's curable from what I'm told. I will see what my new Urologist says in January.

Jamie1970
New Member


Date Joined Nov 2017
Total Posts : 13
   Posted 11/29/2017 10:49 AM (GMT -6)   
ASAdvocate said...
Ditto to what Andrew said, It is much more likely that you are dealing with prostatitis.

Just relax, and have six month PHI tests for a year. If those are good, then go annual.



Thank you for the encouragement!

three 5's and a jack
Veteran Member


Date Joined Jul 2017
Total Posts : 517
   Posted 11/29/2017 10:57 AM (GMT -6)   
Jamie1970

Sounds to me like you are on the right track.

Exactly what the others said.

Just stay vigilant.

May all beings be well.

Roger
Looking for the 4th 5
69yo weight 7/1-283# on 10/17 216# projected 200# by treatment time
PSA 6.01 6/17 & 6.07 on 10/11/17 and 5.56 on 11/17/17
BX 8/04/17 DX 8/11/17 5/16 cores positive all on left
L mid/base 4/6 4+3=7 25%
L apex 1/2 3+4=7 30%
Sec opinion from UofW same GS7 but called overall 3+4=7
Markers and scans Dec 7/8 SBRT Dec 18-22 Swedish in Seattle Dr. Robert Meier

InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 9413
   Posted 11/29/2017 12:44 PM (GMT -6)   
PSA due to PC, rarely drops. Many docs wouldn't be concerned until you got closer to 4.0 or had a positive DRE.

It's likely this is only time you'll have to be concerned about this.

Andrew
I'll be in the shop.
Age 57, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17, .3 10/17
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

NKinney
Veteran Member


Date Joined Oct 2013
Total Posts : 1159
   Posted 11/29/2017 2:48 PM (GMT -6)   
I'm going to jump in to offer a very important correction/refinement that most newcomers like you don't understand yet (and many learn about only after it's too late!)...

Jamie1970 said...


This very helpful and encouraging and IF PC were present it's so early that it's curable from what I'm told.




The great majority of PC case incidence diagnosed from a biopsy which was done based on moderate PSA test results does not need "curing" at all. The previous decade was the peak of a PC overtreatment epidemic, and much of the literature out there is still in a "treat every case equally" mentality...whether it's a tiny speck of virtually harmless low-grade PC or aggressive high-grade PC.

Perhaps this is too much info for you for now, but just know that for a significant number of PC cases, the treatments are far worse than the disease...

Jamie1970
New Member


Date Joined Nov 2017
Total Posts : 13
   Posted 11/29/2017 3:26 PM (GMT -6)   
NKinney said...
I'm going to jump in to offer a very important correction/refinement that most newcomers like you don't understand yet (and many learn about only after it's too late!)...

Jamie1970 said...


This very helpful and encouraging and IF PC were present it's so early that it's curable from what I'm told.




The great majority of PC case incidence diagnosed from a biopsy which was done based on moderate PSA test results does not need "curing" at all. The previous decade was the peak of a PC overtreatment epidemic, and much of the literature out there is still in a "treat every case equally" mentality...whether it's a tiny speck of virtually harmless low-grade PC or aggressive high-grade PC.

Perhaps this is too much info for you for now, but just know that for a significant number of PC cases, the treatments are far worse than the disease...



Thank you for the follow up on this; I should have clarified my statement that this was from my Urologist and not directly from me or a Google search.

I do agree that over treatment has been an issue just from my time of my own research. I think it is the C word that immediately give someone like me a scare when I am new to all of this. However, that scare has pretty well subsided now. Much of that is just through prayer. Some of that is through the comments on this board and also with various friends who have had prostate issues.

What I didn't really know was that we men, for the most part, will deal with some sort of prostate issue in our lifetime, I just didn't think I would deal with it now. But, I'm glad that I am and will continue to stay on top of this each year going forward.

My Urologist is treating it as inflammation as suggested on this board already.

I did start a second round of Bactrim last night but stopped it this morning after a big reaction to it; flu like symptoms, sweating, fever of 101, chills, shakes, etc...So, I'm content at this point to have it checked again in a few months.

Thank you for the post and it was not too much information, if anything it gives me the thought of not overdoing anything that I don't have to at this point.

Jamie1970
New Member


Date Joined Nov 2017
Total Posts : 13
   Posted 11/29/2017 3:31 PM (GMT -6)   
But, I'm glad that I am and will continue to stay on top of this each year going forward.

**I should clarify this too that I'm not "glad that I am" but glad that this happened now so I can stay on top of things at an earlier age.

Jamie1970
New Member


Date Joined Nov 2017
Total Posts : 13
   Posted 1/2/2018 3:07 PM (GMT -6)   
So, a quick follow up to my initial post back in late November.

As I mentioned before my PSA was a 3.8 after going to see the URO for blood in the semen. DRE and urine all negative. After a bout of antibiotics the level went back down to 2.7. This was my third and final visit with this URO as he no longer accepts my insurance. He gave me the following options; Wait 3-4 months and retest, biopsy (which he personally would not do if it were him), PHI, Imaging, or second opinion. He even offered to refer me to his friend at John's Hopkins for a conversation (to be honest that freaked me out a bit).

I was able to find a new URO based on some of my research and some recommendations from a doctors and friends who know him or see him. He's also known as a conversational doctor which is what I need at this stage, just someone to talk to which the first guy was not.

The first thing that this doctor said to me on December 21st was, "my goal for today is to put your mind at ease." He had already reviewed my chart. Nothing about my 3.8 PSA concerned him and he and my first URO were pretty much unfazed about the blood in the semen. Both, in fact, were speaking some of the same language which was refreshing because what IF I got two totally different opinions?

He took the time to go through PC, PSA, etc...and explain it to me like it was never explained before. His DRE was also negative and he said I had an indistinct prostate; which he said is nothing to be alarmed about. He will test me again in May and see where it is at and he said don't be alarmed IF your PSA is high again. He said the fact that it came down is a good sign of prostatitis and nothing more.

So, basically we are in the monitoring stage at this point. He went on to stay that most men will have some sort of prostate cancer in them if you did an autopsy on them when they died. In other words, it's common or at least more common than I thought. He also said that the medical community has put out a lot of scary information about PC that we are now paying the price for; evidently he feels as if we've scared more men that we should have.

Sorry for the long post and you may disagree with some of his statements but overall I was very pleased at what he had to say and we will go from there. I'm very pleased with him and his willingness to have the conversation with me.

Dogdays
Regular Member


Date Joined Jan 2017
Total Posts : 200
   Posted 1/2/2018 7:55 PM (GMT -6)   
Seems to me that you found a good doctor. Someone who took the time to explain things to you and ease your fears.
Best of luck.
Age at Dx. 63
PSA 1/08 1.4, 12/16 12.17, 4/17 3.8, 7/17 1.05, 10/17 <.05 (HT)
GS 9 (4+5)
CT Scan and bone scan 1/17 both negative
2/2/17 prostate MRI.
2/27/17 pelvic bone biopsy done. No mets
3/7/17 Started HT. Degarelix, 4/17 lupron (1-2 years)
7/7/17 LDR Brachy (Zelefsky MSK)
8/25/17 SHARP (SBRT) finished at MSK

Jamie1970
New Member


Date Joined Nov 2017
Total Posts : 13
   Posted 5/25/2018 10:20 AM (GMT -6)   
Hello,

I'm back! Well as you can see my PSA level was 3.9 back in October; two weeks of Bactrim took it down to 2.7; I went to my new URO in December and he was not worried. Yesterday I had my PSA test results and it jumped to 5.6; he still believes it is inflammation or infection but way say you guys?

PeterDisAbelard.
Forum Moderator


Date Joined Jul 2012
Total Posts : 6080
   Posted 5/25/2018 10:48 AM (GMT -6)   
It does sound like prostatitis (some sort of inflammation or a mild infection) more than prostate cancer (PCa). PCa usually causes a constantly rising PSA while prostatitis more often causes a PSA that zigs and zags. The blood in your urine that you reported earlier also sounds like prostatitis. (PCa doesn't generally bleed.)

You might ask your uro about a Prostate Health Index (PHI) test. It's a new-ish blood test that looks at PSA and a few related biomarkers and gives a score that does a better job than PSA of distinguishing PCa from prostatitis. It doesn't give perfect answers either but it might be more useful to you than just relying on PSA.
65 Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012: 1&2 neg, 3 pos 1/14 6(3+3) 3-4% (2nd opn. 7(3+4)), 4 neg
DaVinci 6/14/12. "some" nerve sparing on left
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
24 mo ADT3 7/12 - 7/14
Adj IMRT 66.6 Gy 10/17/12-12/13/12
8/2012-3/2015: Incont., Trimix, VED, PSA<0.015.
AUS & IPP installed 3/5/2015
Forum Moderator - Not a medical professional

MacroMan
Regular Member


Date Joined Aug 2017
Total Posts : 63
   Posted 5/25/2018 4:52 PM (GMT -6)   
My PSA was on the high side two years ago, so my GP started to monitor my PSA every 3 months.

It turned out I did have cancer but I also had a fluctuating PSA due to the likes of prostatitis, although it was never diagnosed.

Just before I was to start RT I took 325mg of aspirin a couple hours before a PSA blood test. My PSA dropped from 6.1 before my biopsy in late September to 5.2 in mid December.
DOB: Oct 1955 Greater Vancouver
PSA 4.4 May '16
5.79 Oct '16
5.0 Jan '17
7.1 Apr '17
6.1 Sept '17
4.2 Mar '18 T337ng/dl
MRI Jun'17 Prostate Fusion Biopsy late Sept '17 Prostate Size ~30cc
Dx Oct. 16, 2017
1 core (Right Side -Mid medial) of 13 showed cancer (adenocarcinoma) GS 8 4+4 40%
IMRT 23 sessions Start date Dec. 18, 2017. End date Jan.18 2018
Brachy Feb 1st 2018 Iodine 125 84 seeds

Jamie1970
New Member


Date Joined Nov 2017
Total Posts : 13
   Posted 8/15/2018 2:52 PM (GMT -6)   
Hey guys,

My PSA was 3.8 late last year and then down to 2.7 after antibiotics around Christmas; I went back in May to have it rechecked and it went to 5.5 then I went back last month and it went down to 4.7 so now I go back on Monday after another PSA test...My URO said he thinks it's prostatitis but if it does not drop down too much then he will consider biopsy. He is doing a regular PSA and a FREE PSA this time.

I typically pee once to twice a night but no other complications that I've noticed and no other blood in the semen like last fall.

Thoughts? I really want to avoid a biopsy as much as possible....

InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 9413
   Posted 8/15/2018 3:12 PM (GMT -6)   
Get a PHI (prostate health index) test. That might give better info.

What's the free PSA % ?

It is bouncing around like prostatitis. I'd be reluctant to do a biopsy, but I can see the URO suggestion one.

Andrew
I'll be in the shop.
Age 58, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17, .3 10/17 .3 4/18
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post
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