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PSA , Biopsy & Avodart

batch2103
Posts: 6
Joined: Nov 2010

Dear follow forum members.

I am trying to make sense of my PSA numbers before biopsy, and PSA numbers after.

I have been attending the free screening at the UK Markey Medical Center here in Lexington, Kentucky.

My numbers were as follows:-

May 2007 – 3.53
June 2008 - 2.97
Sept 2009 – 4.68

After I received the numbers in September 2009, my doctor put me on Avodart and Flomax, as my prostate was enlarged and was suffering from urinary symptoms.

I had my PSA tested again in March of this year; my PSA was now 5.0, and my doctor explain that without Avodart my number would have been a 10.0, and that I should now have a biopsy. This I did in June where it was confirmed that I had Acute Prostatitis but no cancer. Two rounds of antibiotics later, and I thought my problems were over.

I had my PSA test (again at Markey Medical) this September. Where I have just turned in a 4.98, but this was only a few days after finishing my last round of antibiotics? The digital revealed a normal sized prostate and no cancer.

I am an avid cyclist and ride approximately 3,000 – 3.500 miles per annum, and I can tell I’m in discomfort again. I use a saddle with a relief channel for non-compression of perineum tissue.

I’m due to see my internist again in a couple of weeks and urologist at UK in mid-December, but I’m very much puzzled. Now I appreciate that PSA numbers by themselves don’t tell the whole truth, but I’m confused right now.

What are your thoughts please?

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Batch,

Welcome to the forum. You may know that many things can cause an elevated PSA, including prostatitus which you have been treated for. Other things that can cause elevated PSA readings include a hard stool before the blood draw, ejaculation within 48 hours of a blood test, BPH, and....you guessed it...bicycle riding. Given the amount of miles you are logging each year that along with your prostatitus could be causing a chronic elevated PSA reading.

Your doctor is correct that avodart and other similar drugs tend to mask true PSA readings and they use various thumb rules to estimate true PSA.

Something else to keep in mind that early stages of prostate cancer are often missed in biopsy samples. A clear biopsy doesn't mean you don't have cancer...it just means they didn't find it. Of course, one reason they didn't find it is that it isn't there.

I would have another PSA test before your meeting with your internist so you can talk about actual numbers when you sit down with him. If possible, I would avoid sex and bicycle riding before having your blood drawn. PSA has a half life in your bloodstream of about two days.

I don't think your PSA readings before going on Avodart were particularly worrisome given the amount of bicycle riding you do each year, particularly given that much of that PSA reading was probably being caused by an enlarged prostate and prostatitus.

Best of luck!

batch2103
Posts: 6
Joined: Nov 2010

Many thanks Kongo.

I think another PSA test is an excellent suggestion, so I have arranged to have this done next week when I have regular blood draw for the 4 month visit. I will hold off 'extracurricular activists' and see what numbers I produce this time.

Thanks again.

VascodaGama's picture
VascodaGama
Posts: 1528
Joined: Nov 2010

Hi batch,
Surely your age also influences normal PSA levels. And so it is the number of cores taken in the biopsy to rule PC out.
Kongo is giving you detailed advice of possible causes for higher than normal levels of PSA, but the constant number and its increase after a round of antibiotics, may be signaling something more suspicious. Take a good list of questions for your meeting with the urologist. You can find several sites recommending a series of questions. Here is one dedicated to PSA cases; www.beckmancoulter.com/products/splashpage/PSAValue/site/Patient_QA.html

Take care
VGama

worriedwife
Posts: 15
Joined: Oct 2010

I was wondering if Detrol LA also trips up the PSA>

I was on another blog before this. I am waiting on a second PSA test for my husband.
His initial post RP (year 2000) results were between .002 and .003. He had one at .006 which they consider almost 0.

6 months later (last month), he was at 3.7 so we are having a test done this week and results next week.

Since Avodart could change things, he has been on Detrol LA for about a year. Could that have caused a one time jump in his PSA levels.

I keep searching online for information and nothing comes close to personal experiences. Thank you.

VascodaGama's picture
VascodaGama
Posts: 1528
Joined: Nov 2010

I am not a medical expert, but from all I learned along my ten years of survival, I find it difficult that a drug for controlling bladder functions could cause a sudden surge of PSA. Without a Prostate Gland in place, an increase on PSA shall be related to a growing activity of cancer cells.
If your husband is undergoing a hormonal treatment to lower the testosterone levels in the body, but is experiencing an increase in PSA, then HT drugs are losing their effectiveness and the treatment needs some adjustment (increase dosage) or withdrawal.
Detrol LA has a similar structure to oestrogens and can interact with ketoconazole (P450 enzyme inhibitor class), a drug used for lowering testosterone for advanced Pca patients. Their use lowers the PSA, do not increase it.
Wishing you the best
VGama

worriedwife
Posts: 15
Joined: Oct 2010

Thank you for your response. He is not being treated yet. He only had the one
high PSA reading. We will get results of second test next week and then will
go from there. It was just odd that it rose so fast in 6 months.

thanks again.

cjzhang
Posts: 4
Joined: Dec 2010

Hi Worriedwife, I am so glad to find your thread. My father is now running into the same situation like your husband. He had PSA<0.1 in July. But yesterday his blood report came back with a PSA of 4.1. I can not believe it. I will take my dad for a 2nd test tomorrow at a different site. So what is your husband PSA number that took this week. Could you share this information with me. I am stressed out. My father just had his radical prostate surgery last June follow by radiation in December. It is too soon to have the PSA rise and such a fast rise. I am deeply worried.

Any information is very much appreciated!

Jessie

gator880
Posts: 21
Joined: Aug 2009

Batch,
Has anyone suggested a second biopsy? While it isn't something anyone volunteers for, a biopsy with samples taken meticulously from all over the prostate should help answer that question that lurks in the background...could the first biopsy be wrong and could it be cancer?? My husband's first urologists assured him he only had an enlarged prostate. His second tested more aggressively, biopsied, and found PCA. (Gleason 9, type 3B, even though PSA always 5 or under.) Be your own advocate and get answers.

batch2103
Posts: 6
Joined: Nov 2010

I will report back with my new PSA numbers on Tuesday 11/30. I went by the book, so we'll see what turns up this time around.

Thanks for all the responses!

batch2103
Posts: 6
Joined: Nov 2010

Well,

I got my numbers today and trying to make sense of it all.

I turned in a 8.3

Someone asked about my age; I'm 55.

I am due to see my urologist in 2 weeks time and we'll go from there. But I'm sure you can assimilate, this was not the number I was hoping for.

Oh boy ... but I sure appreciate the support!

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Batch,

Sorry that your PSA number is causing you more worries. I don't know how long the Avodart will continue to elevate PSA readings after you stop taking it but I would ask the doctors about it. Is there anything else going on that could cause the PSA to elevate such as an enlarged prostate, protatitus, or a urinary infection? Sometimes you can have a urinary infection and not realize it because the symptoms are so slight.

Even though you had a negative biopsy, I am sure you know that a negative pathology does not rule out PCa. It just means that they couldn't rate anything from where the needles went it. You ought to ask for a second opinion on your biopsy.

VascodaGama's picture
VascodaGama
Posts: 1528
Joined: Nov 2010

Hi batch

Sorry for your last PSA increase. I do not want to say the word but you may have been thinking of cancer. Your last PSA of 8.3 (Nov/2010) is a big increase from 4.68 of last year. Your attempt to stop a BPH failed and the 2-rounds of antibiotics did not “cure” the problem too. Your doctor will want you doing additional tests like a Endorectal MRI and a Transrectal ultrasound color Doppler. These new machines are successful in identifying suspicious markings in guys with PSA near to or lower than the 10th level.
The E-MRI helps to determine if the prostate cancer is confined to the gland, and it is a test used to detect the site of cancer in men suspected of having prostate cancer that is eluding diagnosis with other routine tests.
A new set of biopsy should clear up doughty thoughts, but this time, the sampling should be directional to the marks from the ultrasound tests.

Negative DRE is common in low Gleason pattern cancers even in the presence of a high PSA (myself had negative DER with PSA=22.4 and Gleason (2+3) at age 50).
You may as well try a new set of powerful antibiotics. However, to be assured of a real NEGATIVE, at your age all tests should be done.

Wishing you peace of mind, and good results from your next consultation.
VGama

mrspjd
Posts: 688
Joined: Apr 2010

Batch,
Sorry for the news of an increasing PSA in spite of your courses of antibiotics & Avodart. If I interpreted your info correctly, your last biopsy (12 cores?) was in June 2010, and was negative for any cancerous cores, but your md has determined you to have BPH and has treated you as such. Since your last biopsy was 6 months ago, and with the rising PSA, it might seem wise to find a 2nd opinion urologist, perhaps from a respected teaching hospital/cancer institute, and have another biopsy (especially if you are as concerned as your posts indicate). While a color doppler guided ultrasound biopsy would be best, there are only a few docs/technicians nationwide that can do the color doppler procedure with any amount of reliablity, so if that isn't possible, best to find an expert urologist for the black/white ultrasound biopsy.

While the endorectal MRI with Spectography using Tesla 3 equipment (the '3' is the latest version for high resolution pix and is not yet widely available) is the gold standard for diagnosing ECE (extracapsular/prostatic extension) PCa, it is an expensive test and most facilities/skilled docs will recommend it only AFTER a biopsy has found cancerous cores showing indications of PNI (perineural invasion) or ECE (extracapsular/prostatic extension). The E-MRI may identify PCa local spread outside the prostate to the seminal vesicles and/or the local pelvic lymph nodes. If an E-MRI is ultimately recommended, it should be 6-8 wks after biopsy in order for any prostatic swelling, etc. to minimize. Many times a bone scan and/or a pelvic CT will be recommended before any MRI in order to first rule out distant metastases, especially if the biopsy results indicate a need for those add'l tests. Most times, the pelvic CT and bone scans come back negative as they cannot detect microscopic cancer cells. But we are putting the cart before the horse now, as it is hoped that you will never have to get to this stage of dx.

I don't know the stats for how "common" or "uncommon" a negative DRE is for low or high PSA scores, or whether, in fact, there is any correlation since every PCa is different in every man. My husband had a very low PSA of 2.4 at dx AND had a nodule found on DRE (by a very experienced/skilled urologist), so low PSA does not always rule out negative DRE!--not that this would apply to your presentation. And low PSA does not necessary mean indolent PCa, since more aggressive PCa does not make as much PSA.

Lastly, if you elect to have another biopsy at 6 months (which seems a proactive move) by the same or a different skilled/experienced urologist, I strongly recommend, as did Kongo, that you make arrangements to have the lab results (the actual lab slides) sent out for a 2nd opinion to a well known respected pathology lab (such as Johns-Hopkins, etc) that is an expert in reading PCa biopsy slides and providing 2nd opinions.

Hope you will continue to post your progress.
All the best,
mrs pjd

batch2103
Posts: 6
Joined: Nov 2010

Dear Mrs Pjd and ALL

Thanks so much for the information. I've been able to bring forward my appointment with the urologist by a week; as we are no longer dealing with a regular 6 months check-up, we're at the "what the heck is happening mode!"

I will keep you posted with UK.

Thanks & thanks again - truly.

Batch

batch2103
Posts: 6
Joined: Nov 2010

Back from my appointment this morning.

After much deliberation, the consensus of opinion is, that I have been able to hang-on to my infection, despite the two previous rounds of antibiotics.

So I am returning back to Flomax, and having a one months course of antibiotics and a muscle relaxant, as I am retaining urine. I go back in a month.

I was encouraged to take a more relaxed approach to my PSA numbers. The digital was 'normal' as was the last previous one.

Of course the other question is despite the unequivocal evidence of the benefits and merits of cycling, in my case. Is cycling adding to and exacerbating the problem?
With the great weather were enjoying right now, off the bike anyway (I hate spin classes).

Thanks for all your very much appreciated feedback.

Batch

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

batch,

A lingering infection is certainly plausible given your PSA history and odds are that you probably have nothing to worry about. I wouldn't give up bike riding for a PSA test. The exercise alone probably has more positive effect than whatever incremental PSA addition such an activity might cause. Life is too short to spend it worrying about what might or might not affect a PSA test. If you avoid the bike a few days before the blood draw, the PSA from that component will have been absorbed. Otherwise, just let the doctors know you're an avid biker and take it into account when you look at the score. Or maybe get one of those big, broad bicycle seats with a hole in it that minimizes pressure on the crotch.

mrspjd
Posts: 688
Joined: Apr 2010

Too late to edit original post dated 12/2/10, but realize clarification/correction needs to be made as follows: replace last two lines of 3rd Paragraph to read: "...does not always result in negative DRE!--not that this would apply to your presentation. And low PSA does not necessary mean indolent PCa, since certain types of more aggressive PCa may not make as much PSA." Thx.

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