47 Years Old - PSA Test Result of 3.3

Hello,
I've read through some threads including this one that highlighted a somewhat similar case:
https://www.healingwell.com/community/default.aspx?f=35&m=2379464

I just feel the need to start my own. I appreciate already the support that I can see this forums offers.

Brief history:
Father died at age 79 of prostate cancer. I believe his was first diagnosed in his early 60s.
I had my first PSA test at age 41 and my doctor did not express concern with my result of 1.73. He has since tested me every 2-3 years.

So I had my blood-work today and get a call from my doctor just a couple hours later. He seemed quite concerned as he informed me that my result was 3.3 up from 2.4 two years ago. Given that trajectory and my family history, he wants me to see a urologist and get fully tested.

I know that 4 is the usual level of concern but I have the added risk factors of trajectory and family history. So, I'm swallowing this news and pretty much preparing for the worst.

Then, on a hunch, I went to the patient portal of my doctor's site to look for other results. This is what he said about my 2.4 result from 2017:
"Last PSA from 3 years ago was 3.69 so this is improved".

HUH????! So five years ago my PSA was almost .4 higher and NOW he's concerned? What about when it went from 1.73 to 3.69? Why no concern then?

To summarize:
Age 41 - PSA 1.73
Age 42 - PSA 3.69
Age 45 - PSA 2.40
Age 47 - PSA 3.30

What do you guys think? Do I really need to see a urologist and have the biopsy that he'll likely recommend? Would you insist on another PSA test first?

I really would appreciate any feedback. Thank you.

Thanks for your response. I was not informed about exercise or sex before I had the PSA test as part of my physical. I did heavy weight lifting the night before and had sex.

I happen to be on antibiotics right now for a sinus infection. All these factors seem to weigh in favor of retesting in a month rather than running to a urologist.

Thanks for your advice. Do you recommend that I wait and see a urologist before getting the free PSA test? Or do you think I should insist that my primary care doctor set one up immediately? He told that his office has contacted a local urologist and will be referring me. Not sure how long the process will take.

Jason, Only going from my experience but I tell all the new guys pretty much the same. You want to become your own advocate which you are starting to do Find a good team and a good facility. You never mentioned any symptoms so don't know if you are experiencing any of these. I would find a good urologist who I am sure would want you to do another psa check and as the guys have said take it easy a couple of days before. If you do have a biopsy and the results don't look good remember you have time to do a lot of research and check out all your options. Hopefully you will come back here and just tell us it was a case of prostatitis.

Larry


.

---

Male 63 DX @ 60
Dad had PC
2002. Psa. .08
2014. Psa. 3.8
2016. Psa. 19
3-08-17 RP Mayo,Mn
Gleason 9, pt3bno, SVI, EPE, 35 LN-
4- 17 Hernia surgery
6- 17 psa 0.13
7- 17 psa 0.12 3TMRI coil - clear
8- 17 shoulder replaced
10- 17 psa 0.16
10-12-17 Lupron
12- 17 psa <0.10
12-18-17 SRT
2-7-18 SRT done 72gy
4-18 psa <0.10
10-18 psa <0.10
3-19-19 Laminectomy Surgery
5-8-19 psa <0.10
10-19 <0.10

Your mild ED symptoms are a concern - Esp with above than normal PSA for your age. I had mild ED symptoms as well.

Many urologist somehow either don’t know or don’t prescribe the PHi test - it may be because of business reason.

I would get a prescription from your primary care doc and not wait for the URO. As someone said above - you have to be your own advocate.

..and resonating from above , don’t just go to a URO , get to the best URO you can find.

---

49 DX@48 PSA 03/17 4.45 DRE: Firm Right Base, 3 wk cypro, PSA 04/17: 3.2
04/18 Biopsy Right: Base 4+3, Middle 3+4, Apex: HPIN
Left 6 cores : -ve
5/20 MRI: Pirads 5, ECE:+ve
RALP 05/26 - Dr. Bhandari
Path: downgraded to 3+4 Stage T2C
Prostrate: 49g Tumor:20%
LN/SV/ECE: -ve PNI: +ve
Cath Removed : 6/1
Full continence: 7/4
latest PSA 5/31/19<0.006

Welcome to HW. Doesn't look like a PC pattern to me.

Retest, but each time you test, no sex, heavy lifting, etc a couple of days before.

PC has no symptoms in its early stages. ED can be caused by may things. If it bothers you, see a URO.

While getting a URO consult is okay, don't feel like you have to rush out and do that. You have some weird numbers, but I don't see a lot of urgency in them.

---

I'll be in the shop.
Age 59, 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, .4 11/18
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012

Thanks to everyone who has offered such helpful advice and also been so welcoming.

I asked my doctor about the higher result from before and he replied that that was taken at a different lab so he said that it was "not comparative". I'm not sure why different labs would produce that much of a difference but I trust that he is familiar with the testing and that was his reason for not being concerned before.

News can't be unheard so for my own peace of mind at this point, I see no other option that to go to a urologist. My doctor recommended Dr. Daniel Blander. An Internet search seemed to confirm that he has lots of experience and generally good reviews. I'm really hoping that he'll be on the conservative side and do more tests and the exam before a biopsy. I would really prefer to have confirmation of my situation before going that route.

I've read in some threads here about the need for a catheter. Please tell me there is no chance of this from the biopsy test!

PSA 4.0 is simply a reference point. When my PSA rose from 2.0 to 3.4 over a period of about 2 years, my primary care doctor referred me to an urologist. A biopsy found Gleason 3 + 3 prostate cancer when I was 70 years old. It was very low volume cancer, only 10% in 2 cores out of 12. I had brachytherapy and expected that to be the end of my cancer. Then 2016, I had a extra-capsular recurrence that was treated with cyberknife and ADT. Then in 2018, my cancer became metastatic involving many lymph nodes. Now at the age of 79, I am on Lupron + Casodex.

It would be wise to watch for the next few months how your PSA behaves. Then now there is more sensitive MRI and scans that can detect prostate cancer.

---

Brachytherapy in June 2011 for Gleason 3 + 3 prostate cancer (2/12 core 10%)
ADT and Cyberknife 2016/17 for extra capsular recurrence
PSA remains undetectable until January 2018
PSA April 4, 2018: 0.2, July 13, 2018: 0.9, Aug 28, 2018: 1.3, Oct 4,2018: 1.8, Oct 22, 2018: 3.26, Nov 16: 4.48 PSADT: < 2 months
Metastatic prostate cancer in many lymph nodes. Started Casodex, first Lupron shot Nov 30

I was 49 when diagnosed with prostate cancer. PSA was 3.3.

---

Age 49 at DX
DX 2/7/17: G6 2/12 cores <5% in each
PSA 6.6 (double actual 3.3 due to Finasteride use)
RALP 8/24/17
pT2c R1
Gleason 7 (4+3 St. Joe's and Mayo)
+Margin
-ECE; -SVI; +PI
Tumor <10% of gland
PSA .40 9 weeks out
PSA .40 14 weeks out
PSA .52 15 weeks out (new lab- Mayo)
6-MO Lupron shot on 12/4/17
SRT 12/18/17-2/5/18: 68 Gy, 34 treatments
PSA <.10 5/8/18
PSA <.10 11/9/18
PSA <.10 5/15/19

JasonB176 said...
There was mention of an infection that could cause an abnormal reading but I’m guessing this is quite unlikely.

Actually, it's pretty common. One way to sorta-kinda tell the difference is that PSA from prostate infections or chronic prostate inflammation will jump around -- go up one test and down the next. Prostate cancer shows as a steady PSA rise, often not very fast and not necessarily higher than you see with an infection.

You need to keep an eye on your PSA because of your family history but some sort of prostatitis could easily explain your PSA history.

One other observation: Erectile dysfunction is not usually a symptom of prostate cancer -- its just something that happens to men around the same age as prostate cancer become more prevalent. If your ED is bothering you you can talk to your urologist about it as a separate issue. The drugs in the helpful pills are going generic one-by-one and the prices are coming way down, especially for sildenafil (the drug in Viagra). Sometimes insurance doesn't like to cover ED drugs but if you shop around they aren't that expensive to pay for yourself if you need to.

A final observation: While ED isn't a common effect of prostate cancer it is a common side-effect of prostate cancer treatments. In the not-at-all-certain event that you are diagnosed you don't want to rush willy-nilly into signing up for the first treatment you hear about. There are a number of options that will work equally well in terms of disease control but they can differ wildly in terms of side effect probabilities.

---

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% (2^nd 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

PeterDisAbelard. said...


Actually, it's pretty common. One way to sorta-kinda tell the difference is that PSA from prostate infections or chronic prostate inflammation will jump around -- go up one test and down the next. Prostate cancer shows as a steady PSA rise, often not very fast and not necessarily higher than you see with an infection.

You need to keep an eye on your PSA because of your family history but some sort of prostatitis could easily explain your PSA history.

One other observation: Erectile dysfunction is not usually a symptom of prostate cancer -- its just something that happens to men around the same age as prostate cancer become more prevalent. If your ED is bothering you you can talk to your urologist about it as a separate issue. The drugs in the helpful pills are going generic one-by-one and the prices are coming way down, especially for sildenafil (the drug in Viagra). Sometimes insurance doesn't like to cover ED drugs but if you shop around they aren't that expensive to pay for yourself if you need to.

A final observation: While ED isn't a common effect of prostate cancer it is a common side-effect of prostate cancer treatments. In the not-at-all-certain event that you are diagnosed you don't want to rush willy-nilly into signing up for the first treatment you hear about. There are a number of options that will work equally well in terms of disease control but they can differ wildly in terms of side effect probabilities.

Thanks for that info. The not knowing is eating me alive but it's helpful to know there is at least a chance that the diagnosis won't be cancer. Even if it is cancer, I can then proceed onward with a plan.

Hello Jason,
I was diagnosed with PC 1.5 years ago on my 49th birthday and had PSA 2.4 at the same level for several years. I recommend finding a good uro who can perform DRE and has more experience than regular PCP. With steadily rising PSA it looks like biopsy is on the horizon. When you go for PSA next time try not to do any physical activity 24 hours before bloodwork. It is also a good idea to educate yourself. I recommend a very simple to understand book: "prostate cancer: a new approach to treatment and healing".

---

Dx at 49
PSA
02/16 - 2.5
05/17 - 2.4
01/18 - 2.5
07/18 - 2.7 Free 23%
09/18 - 1.9
DRE 01/18 - firmness on left side
Biopsy 02/18 - 1 of 12 (8%) , Adenocarcinoma, G 6 (3+3), T2a
Pelvic CT 01/18 - Negative
3t MRI 6/18 - Prostate 26 CC
lesion LLM and LMA - 1.4cm (PIRADS-4)

10/18-11/18 IGRT
Post trement PSA
2/19 - 1.2
5/19- 0.9

My 7 cents (inflation):

> See a Uro, for gosh sakes. Your dad died of PCa, that puts you at higher risk. Your PSA numbers are squirrelly. Consult a specialist.

> Highly unlikely you'll need a catheter if you ever have a prostate biopsy. All invasive procedures have risks, and you'll hear plenty of biopsy horror stories, but for the vast majority of guys it's just a pain in the ass.

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Age 60 at dx 7/2017 biopsy G8 (4+4), 5/13 cores
RARP 8/2017 (Patel), pT3a N0 M0, 30% tumor; EPE+, SV-
PSA 1/2016, 2.9; 4/2017, 7.2; 9/2017 (post-RARP), 0.13; 10/2017, <0.05, 1/9/2018, 0.09, 2/23/2018, 0.08.
SRT 72Gy, 40 fractions, finished 5/8/2018, plus 12 months ADT, finished 2/2019
May 2019 uPSA <0.02, Aug 2019 PSA <0.13
Caution: I’m not an MD and don’t know what I’m talking about.