Fiance referred to urologist over psa

ANWANK
ANWANK Member Posts: 13

Hi all. So my fiance went to dr for a check up and they checked his PSA while there. He is a 45 year old male. His results show only a 4.04. What I have read is that this isn't really high at all so I am not sure why the dr wants him to see a urologist over this. He does have a family history of prostate cancer. His father died from it and his brother just had his prostate removed earlier this year over it. But his brother's score was around 16 I believe. Is the dr just being extra vigilant or is this score a concern at his age? I like to have some idea of what the possibilities could be so that I am prepared to be there for him in any case. Thank you all for any information and many blessings to you all.

«1

Comments

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    edited December 2017 #2
    Good call by the GP

    Good idea to to see a urologist, a specialist............The PSA is an indicatior only, and a doctor also looks  at the historical rate of change, I wonder if there had been other PSA's. Also a digital rectal exam( finger wave in the anus) may or may not be normal. With a PSA of 4 there, and family history there is a possiblity of prostate cancee..

    Your finace may wish to ask the uroloigst for a FREE psa and PCA3 as tools to see if a biopsy is appropriate.

    Best to be viligent............and if there is cancer, early detection is treatable.

  • Tech70
    Tech70 Member Posts: 70 Member
    My PSA was lower

    I was diagnosed with very low risk PCa in November with a PSA of 3.5.  However, it had risen from a reading of 2.7 the previous year and so my family doctor recommended seeing a urologist.  I have no history of PCa in my family.  There are a number of tests that can predict the probability of detecting PCa on biopsy prior to actually doing a biopsy.  Can't hurt to check things out.

  • VascodaGama
    VascodaGama Member Posts: 3,516 Member
    At 45 years old, the gray zone starts at 2.3 ng/ml

    Your fiancée's PSA is high for his age and the fact for having a father and brother with the disease, he is at 4 times higher risk for contracting the cancer then other man. At 45 any PSA value above 2.3 is of concern. Surely this high value can be a cause of hyperplasia or infection (UTI) too. I think he should visit the urologist and follow proper procedures to find the reason of such PSA.

    Best,

    VG

  • RobLee
    RobLee Member Posts: 269 Member
    Elevated PSA

    As noted, your fiance's PSA is high for a man his age, though it is not yet cause for alarm.  However, he should have this tested again after a few months, as well as possible other tests. I do not mean to scare you, but if the urologist dismisses his PSA, that does not mean that everything is okay. 

    My PSA was rising steadily and my urologist told me pretty much what others have said here, that it is of no concern if it rises slowly and other tests are negative. Such was my case. But a year later my PSA was 9 and he did a biopsy, which was also negative. Again, to me this meant "there's nothing wrong". More PSA tests over the next two years showed a doubling every 12 months. When it reached 25 I went to another urologist. By then it was already too late.

    Hopefully your fiance has a doctor who is better at piecing together the evidence rather than waiting until it is too obvious to ignore. Just saying he needs to be his own advocate and stay on top of this before it gets out of hand.

     

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,737 Member
    RobLee said:

    Elevated PSA

    As noted, your fiance's PSA is high for a man his age, though it is not yet cause for alarm.  However, he should have this tested again after a few months, as well as possible other tests. I do not mean to scare you, but if the urologist dismisses his PSA, that does not mean that everything is okay. 

    My PSA was rising steadily and my urologist told me pretty much what others have said here, that it is of no concern if it rises slowly and other tests are negative. Such was my case. But a year later my PSA was 9 and he did a biopsy, which was also negative. Again, to me this meant "there's nothing wrong". More PSA tests over the next two years showed a doubling every 12 months. When it reached 25 I went to another urologist. By then it was already too late.

    Hopefully your fiance has a doctor who is better at piecing together the evidence rather than waiting until it is too obvious to ignore. Just saying he needs to be his own advocate and stay on top of this before it gets out of hand.

     

    Correct

    Anwank,

    A static (one-time) PSA result does not tell a doctor very much, unless of course it is very high.

    But as several guys mentioned, his number is high for his age. I had Stage II disease, and my PSA was never at any time over 4.1, and I was 58 years of age at the time of diagnosis.  A better indicator of disease is vectoring (also called Doubling Rate), or the rate of increase over time.  But if there is sufficient cause for investigation, only a biopsy can answer whether or not prostate cancer (PCa) is present.  In case he is ordered one, I will say that biopsies are brief, outpatient tissue draws that are also relatively cheap, in the medical scheme of things.

    My family doctor was of a new, popular line of thought, which says "PSA is usually no big deal; it is overused."  This line of thinking is derived from insurance companies.   He told me in 2014 to ignore my 4.1, despite annual increases over the previous two years.  

    I instead went straight to a urologist, and she said to get a biopsy right away.  And it came back  positive.

    Disregarding clinical data, while trendy, is not medical care, it is medical neglect.  Doctors sometimes say "I can live with these results for now."  But that is not the question: the question is can the patient live with them ?   As Vasco wrote, your fiance's father and brother both having had PCa dramatically increases his risk statistically.  And PCA that hits men at much younger than normal ages is ordinarily more aggressive than disease discovered in older men  (the average age of diagnosis for PCa in the US is 67).  Even if he is not sent for biopsy, he is of enough risk that at least an annual PSA should be done, if not every 6 months.

    It is good that he was referred to a urologist -- be thankful that he was.

    max

  • ANWANK
    ANWANK Member Posts: 13
    edited January 2018 #7
    Thank you

    Thank you to all of you for ur responses. I do know he has never had a prior psa test. The dr performed this because of his dad and more recently his brother. She did do a rectal exam and said everything seemed good. Also checked his urine and no uti or anything like that. His appointment is at the end of this month and it is just stressful now waiting for it. I am the worrier of this unit! But he has no idea how worried I am now!

  • ANWANK
    ANWANK Member Posts: 13

    Good call by the GP

    Good idea to to see a urologist, a specialist............The PSA is an indicatior only, and a doctor also looks  at the historical rate of change, I wonder if there had been other PSA's. Also a digital rectal exam( finger wave in the anus) may or may not be normal. With a PSA of 4 there, and family history there is a possiblity of prostate cancee..

    Your finace may wish to ask the uroloigst for a FREE psa and PCA3 as tools to see if a biopsy is appropriate.

    Best to be viligent............and if there is cancer, early detection is treatable.

    Thank you

    I am going to his appointment with him because he does not always get what the doctors are explaining to him. I will definitely ask about these tests. 

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    edited January 2018 #9
    ANWANK

    At the urologist appoitment, s/he might order a PSA.  There are various factors that increase the PSA level. Bycycle riding, sex before, even a hard stool, so please no "beautiful  moments" for a few nights before. 

     

  • ANWANK
    ANWANK Member Posts: 13

    ANWANK

    At the urologist appoitment, s/he might order a PSA.  There are various factors that increase the PSA level. Bycycle riding, sex before, even a hard stool, so please no "beautiful  moments" for a few nights before. 

     

    Thank you

    I did read about that. I already told him that we can not do anything for at least 72 hours prior and he is not to "relieve" himself because it could effect the test results if they test him again. I am a little stressed tonight because his brother that had treatment recently is being brought back in for testing because of issues he is having. Doctor wants to make sure it had not spread again. I have been learning over the last few days that his father had an aggressive cancer that spread and ultimately took his life, now there is the concern that his brother two years older than him may have some problems again. I am trying to stay positive and hopeful in the midst of all the information coming at me. He is also starting to understand the seriousness of all of this and I could see it on his face tonight that for the first time he was worried.

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    edited January 2018 #11
    .

    Great that you are doing your research, this is critical....read books, atteend support group(s) --ustoo.org is an organization that sponsors local support groups worldwide, google them.

    At the appoinment, you may wish to ask if you can record the session. At any rate you can take notes. 

    A bit of information....there is a correlation between prostate and breast cancer among family members...so the women in your fianace family need to get those mamagrams. Inform all blood relatives, even cousins. It's the right thing to do.

    Diet is important, heart healthy is prostate and breast cancer healthy. I for one am fairly stringent; do not eat dairy or red meat...primarily eat veggies and fish. UCSF published a diet for health to include but not limited to prostate cancer.

    https://www.google.com/search?authuser=0&ei=XfpSWurwPMGZjwTd2oW4Cg&q=ucsf+diet+for+prostate+health&oq=ucsf+diet+for+prostate+health&gs_l=psy-ab.3...24212.27182.0.29301.9.9.0.0.0.0.134.1014.2j7.9.0....0...1c.1.64.psy-ab..1.2.223...35i39k1.0.Vw6kTDSNYlU

     

  • ANWANK
    ANWANK Member Posts: 13
    Post Appointment

    Thank you to everyone for your responses and advice. His appointment was today. They repeated his PSA test so should know the results within a couple of days. Doctor recommended genetic testing to check for gene mutations because of his family history and for his two son's sake. They will be calling us within 24 hours. He will go in, be sedated and have biopsy. I asked the dr based on things I have read if it is true that trus biopsy is shooting darts in the dark. He said that if his biopsy comes back negative, he will submit for MRI biopsy but because of my fiance's insurance, they will not approve it until this biopsy has been done. Dr seemed to answer all my questions and did not sugar coat anything which I appreciate. So now it's a waiting game again

  • ANWANK
    ANWANK Member Posts: 13
    Biopsy Scheduled

    So his biopsy is scheduled for Feb 19. Still waiting on the last psa results. I am not really expecting any big change in it but would still be nice to know the result! I guess one silver lining of all of this and that the urologist he goes to is going to give him some medication at the biopsy to help lightly sedate him. I have seen some of the stories of these biopsies, and while many experiences are different, some have been disturbing and I do not want him to go through that, especially if his biopsy comes back negative and has to be repeated. Because the way his doctor talked, if it was negative he is going to submit to insurance for the MRI guided biopsy. I get the impression from the doctor that he expects a PC diagnosis. I suppose I should be relieved that the doctor is being so vigilant. He did explain to us that my fiance should not have a psa higher than 2.5 and typically it should only be about 0.7 or so. And we also found out that his brother got his treatment through the same practice so I guess that helps the doctor to be able to see his brother's medical records. So that is all I know for now. Again, I appreciate everyone's advice and support on here. You all have a blessed day

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    edited February 2018 #14
    biosy

    So far Ive had seven. Never was sedated. 

    I know a man who insisted on being put under for the biopsy, but this is not standard operation procedure.

    Good luck.........he will be fine

  • ANWANK
    ANWANK Member Posts: 13

    biosy

    So far Ive had seven. Never was sedated. 

    I know a man who insisted on being put under for the biopsy, but this is not standard operation procedure.

    Good luck.........he will be fine

    test update

    I could not imagine going thru that so many times unsedated. The dr office did call with another result. Said it was the percent free psa or something to that effect. the number was 15.7% Is this good or bad? I have no idea!

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,737 Member
    edited February 2018 #16
    ANWANK said:

    test update

    I could not imagine going thru that so many times unsedated. The dr office did call with another result. Said it was the percent free psa or something to that effect. the number was 15.7% Is this good or bad? I have no idea!

    Anawank,

    In most clinics, ordinary PSA results are known about 5 minutes after the blood is drawn. I always get my PSA results during the doctor visit, as soon as he walks in following my blood draw. 

    If you have however been describing a "free PSA test," I never studied the technology, and am unaware how long those results ordinarily take.  Someone will answer your question shortly.

    Traditionally, PCa biopsies get little or no deadening, and I've never heard of anyone getting heavy sedation, but I guess it is available in extreme conditions upon request.   Bone marrow biopsies are similiar: When I got one, it was with almost no deadening, although the proceedure is fairly brutal and primitive (I had a bpone marrow biopsy for Lymphoma, not PCa, but I suppose the test is the same for both). I didn't even know I was getting a bone marrow biopsy until after my meeting with the oncologist. At the end, he said "follow the nurse for your bone marrow extract." I had no deadening that I can recall from my PCa biopsy, but did receive antibiotics beforehand.

    Wishing the best for him,

    max

  • contento
    contento Member Posts: 75
    I don't know for sure if 15 %

    I don't know for sure if 15 % is a good # or not given the age factor. I think it's in the gray zone and the doc will probably recommend a biopsy.

    I had 3 biopsy's. Two were givin with a local anesthesia and the other I was put out.

    The local was fine and there wasn't any pain to speak of it was just a scary thing to go through.

    The last biopsy I had the doc wanted to put me out so I did. Obviously you feel nothing in this case.

    contento

  • VascodaGama
    VascodaGama Member Posts: 3,516 Member
    Free PSA tests the probability in existing cancer

    A,

    Free PSA is a test used to validate the Total PSA result when one wants to ascertain the possibility in existing cancer. In other words, low percentage of free serum PSA indicates high probability of existing cancer. High percentages (above 10%) equals to low probability in having cancer, even with high values of total PSA results (your fiancé’s case). Some doctors tend to use the Free PSA result to compare with negative biopsies, in the intent to avoid judgments of false negatives. Some even use the Free PSA to postpone a biopsy.

    Sincerely, I think it better for your fiancé with apparent PCa cases in his family, to get the answers to his case via the 14 needles traditional template biopsy. At the moment nobody has diagnosed him with cancer except that he is at high risk for having it. If worried, he can repeat the biopsy two years later in case this one comes negative this time.

    Best wishes,

    VG

  • ANWANK
    ANWANK Member Posts: 13
    edited February 2018 #19
    Update

    Ok everyone, so he had his biopsy today. And I am so thankful because they sedate you for it through the doctor he sees. So he slept through the entire thing. We should know the results by Friday. The doctor did tell me his prostate is bigger for his age so I thought that was a good sign. I also saw on his paperwork that it said his P2PSA was 21.9. I have never heard of this test before and they never gave us that result so I really have no idea what that is or what it means. Thanks everyone for the support

     

  • VascodaGama
    VascodaGama Member Posts: 3,516 Member
    Get a copy and file all test results and exam reports

    I am glad for knowing that he did a biopsy. It is still the best way to confirm the existence of cancer. The P2PSA is another test (more sophisticated than the traditional PSA) to evaluate probabilities in existing cancer. It is also used to avoid biopsys or postpone them, but just like the free PSA it does not diagnose cancer. The biopsy analyses a small volume of the gland's tissue which may also miss a tumor but it is the real conclusion used to advance with other tests (image studies, etc) to get a clinical stage, followed by a treatment.

    Let us know the results. You can paste here the copy of the report if want our opinion.

    Best,

    VG

  • ANWANK
    ANWANK Member Posts: 13
    Operative report

    Ok so obviously the biopsy results are not back yet but I did get the operative report. It says that his prostate volume is 58.8 and englarged in transitional zone. Which seems to me he would probably just have bph then? They took 12 cores. It does say his prostate health index score is 69 which I know is not good at all. But if he has bph, I would imagine that would effect this score?