PSA jump in 2 weeks
I am a 50 year old and I have been diagnosed in April with Gleason 3+4 but only 5 to 10% of pattern 4 in 3 cores.
I have been on active surveillance since then but my PSA has moved from 4 to 5 to 6 in the past 6 months. I did my annual blood work on 12/28 and PSA was 6. But I just did a PSA test as part of the active surveillance on 1/12 and it is 8.33…
I have been under a lot of intense stress in the past 2 weeks due to personal issues.
Is it possible that the stress explains a 2 points jump in 2 weeks ?
I want to highlight that I did not exercise or had sexual activity 48 hours before the test as recommended…
Comments
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Hi fjubier -
I was always told that yes, stress can cause PSA to rise. I found this information for you - hope it helps -
Can a state of stress and anxiety make PCa worse?
Anxiety is surprisingly common among prostate cancer patients. Patients sometimes ask us if their PCa was brought on by stress in their life. While no research has proven that stress or anxiety causes cancer to start, scientists have known for years that anxiety’s lingering cascade of neurotransmitters, hormones and other biological molecules can lead to a rise in PSA and even inflame existing PCa.
A 1999 paper reported that abnormal PSA, a signal of prostate disease, was three times higher for men with high levels of stress![i] An important study on stress and BPH (benign prostatic hyperplasia, a non malignant gland enlargement) concluded that “…stress conditions may be associated with the development or aggravation of prostatic disease.”[ii] A 2021 PCa paper by Bellinger, et al. describes a biological link between poor coping and worse PCa outcomes, suggesting that stress-triggered anxiety interacts with physiological stress responses in a way that can ramp up tumor activity.[iii] Thus, stress and anxiety set up an unfortunate loop: anxiety leads to rising PSA, and rising PSA fosters more anxiety. - source - Sperling Prostate Center
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It could be stress, but more importantly it could be something other than stress. At a minimum, I’d want to test it again in a couple of weeks to see what it is doing. The long term trend you cited is chugging along in the wrong direction.
It wasn’t 100% clear…what is the history of your PSA tests over the last years?
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I was on AS at Hopkins with 6 of 12 cores 3+3 with 2 cores over 50% volume. My AS doc encouraged treatment saying they didn't have anyone in the program with those volumes at my age (50). A few months later my PSA broke 5 and I decided to proceed with treatment. Pathology after surgery was 3+4.
I'm curious what conditions will bump you out of AS when you go in with 3+4? Have you had MRI or other scans?
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Some background for me - Oldernow
My PSA was between 5 and 9 starting in the late 90's. I had 5 negative biopsies through 2018 but then my PSA started climbing. By 2022 it was up to 20. I ended up having a MRI that showed suspicious regions. In the fall of 2022, had a trans-perineal biopsy using the MRI data as a guide at Cleveland Clinic - Found a few areas of cancer with a Gleason score of 3+4.
A biopsy sample was sent out for genomic testing. This Decipher test showed my cancer was at the high end of the moderate range for metastasis. My urologist and a consulting radiation oncologist decided that at my age (76) the best course of action was 28 radiation sessions while on ADT (Androgen Deprivation Therapy). ADT drastically cuts your testosterone to starve any remaining cancer cells of their favorite source of nourishment. The radiation sessions were short but time consuming with travel to and from the hospital for 28 weekdays in a row. The ADT was/is another story. Lots of negative side effects from the 6 month injections. I have had two with the third scheduled for early April 2024.
The combination of radiation and ADT seems to be working. My PSA went from 20 at the start of radiation last summer to a current level of <.03 (considered undetectable). The ADT took my testosterone lever from a normal 556 range to less than 10. I am told that after the third shot wears off sometime in October that the testosterone should slowly start recovering and the nasty side effects should go away. I'll continue getting PSA tests over the next few years to make sure it doesn't start going up again. I guess after a few years of a stable low PSA it could be considered a cure. Not sure about that however.
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I remember my doctor saying that early 2024 that I should repeat MRI and biopsy after I saw him in September and PSA had moved to 5…so I guess those are my next steps…but my AS days are over and probably some sort of treatment is required. I was leaning to do some needle focal therapy like Cryo or Nanoknife since the cancer is located in on the anterior left part of the prostate.
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If you have not already, get second opinions on treatments. Find surgeon, radiologist and doc that does focal treatments you are interested in. Find the best facility that specializes in those treatments. Weigh all your options. In the end, it's a gamble on the right decision but, you want to be as informed as you can be. Best of luck going forward.
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You're welcome -
Yes - decision time is difficult. I never had the option of AS. For years the doctor said that since the biopsies hadn't found cancer that my high PSA was probably due to an unusually large prostate. When they finally found cancer by using the trans-perineal approach (which allows better access to the prostate) it was too late for any form of AS. As my urologist said - "You have to do something"
Sadly, my adventures aren't over yet. I have developed what looks like radiation proctitis. I'm currently scheduled for a full colonoscopy on Feb. 1. Hopefully the symptoms I am having will be self limiting so I can avoid starting yet another round of treatments.
Stay strong and continue to get as much information as you can. I always make sure I am well armed with as much information as I have available before each doctor visit. I guess that gives me a feeling of power. The doctors are always impressed with the fact that I take the time to learn about all the available options. I am never afraid to ask questions...
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I agree with you about getting more information when it comes down to treatment. When I was proposed AS I knew that this could be only temporary with Gleason 3+4 even with a minimum of pattern 4 in 3 cores…
I know that a lot of men at 50 choose the surgery but I hope I can do less invasive treatment…
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Dont mess around here ..li was 57 i chose radiation six years later it’s back Wednesday I have a decision to make either cryotherapy which I don’t think will work or surgery which will be rough. I wish to God I had done surgery. This is my opinion take it as you may choice number one if it still contained prostrate surgery, take it out minimal side effects and hopefully walk away for good. If it comes back, you have a back up plan radiation and then you have a third back up. Hopefully you’ll never have to get to that which isADT . I would not mess around. I’m sorry that I did not take it out six years ago. That’s just my opinion. Good luck with your journey
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