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PSA up

JimmieJoe
Posts: 15
Joined: Feb 2011

In April, 2011 I was diagnosed with prostate cancer (T1C) Gleason 3+3=6 one out of 12 cores positive and urologist said 1mm focus. We decided on watchful waiting and I went back after 6 months from diagnosis and my PSA had gone up to 7.2! I was put on antibotics because the urologist wanted to see if it might be from an infection. I was told that my cancer was very minute and not agressive, now I'm concerned. Anybody had this experience?

hopeful and opt...
Posts: 1364
Joined: Apr 2009

You do not mention what your previous psa's have been? Have you had sex, exercised before the test? which elevates.

Additionally PSA is an indicator only, and is not the best benchmark of cancer progression.

The biopsy is the critical test

Active Surveillance since 3/09

click my name to about me page. to see what I've been doing, and some information.

The last time I had a biopsy, my psa rose to 3.8. .....my doc told me that he doesn't care about the psa...only the biopsy.

JimmieJoe
Posts: 15
Joined: Feb 2011

No, no sex for 4 nights before. My PSA scores have been 3.2, 3.9, 5.4, 4.9 and now 7.2. Cancer was found in 1 core out of 12 (T1C), gleason 3+3=6. I was told it was very low grade. 11/23, it jumped to 7.2 and I am on Cipro 500 mg once a day and will return in 4 weeks for another test. Urologist says may be an infection. I drive a truck and am sitting for 10 hours or more, but I do urinate when I have to go. I do have urgency, but a good stream.

hopeful and opt...
Posts: 1364
Joined: Apr 2009

that when you are bouncing up and down, there is a vibration on the prostate that can cause the psa to rise....It could be a lot of things including an infection which you are being treated for.

By the way, what was the involvement of the core that was cancerous, the percent cancer.

Did you have a second opinion on the results of the biopsy from an independent world class pathothogist, there are only about 10 labs in the country who qualify.

did you have any other diagnosis tests?

JimmieJoe
Posts: 15
Joined: Feb 2011

The involvement was 1/10th of 1 core. No other test were scheduled. I go back in 4 weeks and get PSA done again and if it is still high will repeat biopsy. I've had 2 already since diagnosis. This seems very extremem to me. No, I haven't had my biopsy results read by any other lab. What are some suggestions for labs that give second opinions?

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

JimmieJoe,

As others pointed out, many things can cause an increased PSA reading including prostatitus or a UTI so your doctor is following a smart course to rule those out with several weeks of Cipro. Other things like sex before a blood draw, a DRE before a blood draw, even a hard stool can cause a temporary rise in PSA. Some OTC medications such as Advil can cause PSA to go up. Other obvious culprits are BPH or an enlarged prostate. The prostate is just a big gland. If it's squeezed, the cells tend to emit PSA naturally. Prostate cancer in early and intermediate stages also produce PSA and suspicious rises in PSA levels beyond "normal" may be an indication of the presence of prostate cancer.

A typical needle biopsy only samples less than 1% of the total prostate volume so there may well be other areas that have yet to be looked at. There are risks associated with biopsies including infection which happens about 4% of the time and can be quite serious. My personal opinion is that biopsies can also spread cancer based on prostate examinations after removal that show cancer growing along needle tracks from biopsies. Of course, that's the only way we have of getting a definitive diagnosis for cancer but I would avoid them as much as possible.

K

hopeful and opt...
Posts: 1364
Joined: Apr 2009

I read somewhere that the PSA is not always the best indicator of cancer growth; since I am not home now, my source is not available.

Eventhough Kongo and I have different viewpoints about biopsies causing cancer growth, and we went through this dance more than once, I agree with Kongo that this procedure need to be done only when required.

hopeful and opt...
Posts: 1364
Joined: Apr 2009

Two expert labs are boswick and johns hopkins, simply have the people who have your slides pack them and send them out; you can contact your docs office, or the current lab.

Swingshiftworker
Posts: 658
Joined: Mar 2010

FWIW, after my biopsy, my PSA rose from 4.5 in Jan 2010 to 29.7!!! in Mar 2010.

In Jun 2010, PSA dropped to 5.9
In Sep 2010, received CyberKnife radiation treatment
In Dec 2010, PSA spiked again to 12.30 (apparently due to the treatment)
In Sep 2011, PSA dropped to 3.56

So, the biopsy could be the reason for the rise in your PSA. As others have already mentioned, normal activities can also affect PSA -- sex, DRE, riding a bike, exercise etc. If you can rule those things out, the most likely cause of your elevated PSA -- other than the growth of the cancer itself -- is the biopsy. Unfortunately, there's really no way to discriminate between one cause or another.

That's one of the "risks" and weaknesses of Active Surveillance (AS). PSA as a measure is not all that accurate and can be affected by all kinds of things resulting in considerable variability. That's why doctors are mostly concerned with the "trend" of the PSA scores and do not rely on any one score alone.

So, if you're committed to AS, all you can do is continue to take PSA tests every 3 months (or 2 months, if you are really concerned but 1 month is probably too frequently) and see which way the wind blows. If it's just the biopsy, your PSA scores should drop to around the pre-biopsy level.

If your scores remain above that, I think there is cause for concern -- especially if the scores are rising. If your PSA scores are rapidly rising (ie., very high velocity as indicated by a short doubling time period), I suggest that you ask to be screened w/an endorectal MRI and MRSI to pinpoint the location and scope of the cancer. Here is why you should get BOTH of these tests done: http://www.prostate-cancer.org/education/staging/UCSF_CombinedMRI_MRSI.html.

If you have any indication of cancer growth, don't wait too long to make a treatment decision. There are men here who have reported low PSA scores but found that they had a higher stage and more malignant cancer than was indicated just by their biopsy and PSA scores.

It's often stated in support of AS that the 5yr mortality rate (risk) w/and w/o treatment is about the same but there is a chance that you have a form of PCa that may continue to grow unabated during the time you wait which may make later treatment problematic.

That's why I chose to immediately treat my early stage cancer (T1c, Gleason 6 like yours) w/CyberKnife radiation. It offered the best possibility of killing the cancer without the detrimental effects of surgery and other less precise radiation treatment methods.

Why live w/the uncertainty of AS when you can get treatment that will not negatively affect your quality of life? It was a no brainer for me and others, but you'll obviously have to make your own choice.

Good luck!

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