PSA velocity, what am I looking at here?

gsmith1247

PSA last year was 2.0, and this past December was 5.78. The urologist ordered a 4k test: score 59, 10% free PSA, and my PSA was almost 12. That is a vast PSA increase in just 3 months.

Going to Johns Hopkins now. MRI on 4/12 and biopsy to follow. I did have an abdominal/ pelvis CT done for possible diverticulitis a month ago and nothing funny was found. With that PSA, the incredible velocity, and the 4k what am I looking at here? I have a 20-year history of BPH, started TRT over a year ago, and my PSA was pretty stable until then.

Old Salt

I am glad you are looking into your prostate situation further. Your consultation with the Johns Hopkins group should be very informative. I bet (not a lot of dollars) that they will recommend discontinuing TRT.

Clevelandguy

Hi,

You could be looking at a combo of BPH and cancer, only the biopsy will identify and grade your cancer results if you indeed do have cancer. “started TRT over a year ago, and my PSA was pretty stable until then”, hopefully you know testosterone can feed the cancer growth, that’s why a lot of Prostate cancer men use ADT to lower their Testosterone thus starving the growth of the cancer. Got to agree with Old Salt, I would discontinue the TRT and see if your PSA goes down.

Dave 3+4

dgrinnan

Keep pushing. Even if they come back and say you are in the clear I would push your doctor to do frequent and regular PSA test. My PSA went from 2.2 in October of 2022 to 69 in September of 2023. At that point it had spread to bones and lymph nodes. If it had been caught much sooner my treatment any possible outcome would be completely different than I am facing. Even my experience urologist was surprised by the jump from 2 to 69 in just one year.

gsmith1247

MRI done at Johns Hopkins on 4/12/24:

I'm very happy about the results but reading a lot that MRI can miss cancer. Could a radiologist miss the mark that badly? Especially from someplace like JH? Still have a biopsy scheduled for the end of the month but doesn't look like there is a target to shoot for.

IMPRESSION:
1. No suspicious abnormality on MR imaging.
2. Prostatitis.

Overall PI-RADS = 2/5
Overall Follow-Up Score (PRECISE) = Baseline study. NA/5

FINDINGS:

IMAGE QUALITY: Diagnostic.

HEMORRHAGE:
No areas of high T1 signal suggesting hemorrhage.

PROSTATE VOLUME:
Prostate measures: 5.2 cm TV x 3.7 cm AP x 3.7 cm CC, volume 37.0 cc.

Prostate volume calculated in DynaCAD Prostate Boundary segmentation: 41.0 cc

PERIPHERAL ZONE:
Linear T2 hypointensity without restricted diffusion or asymmetric perfusion, which can be seen with prostatitis.

TRANSITION ZONE:
Moderate hypertrophy with heterogeneous T2-signal.
No focal areas with suspicious morphology.

SEMINAL VESICLES: Normal, symmetric.

NEUROVASCULAR BUNDLES: Normal, symmetric.

BLADDER NECK: Normal

MEMBRANOUS URETHRA: Normal

LYMPH NODES: None enlarged.

BONE MARROW: Normal signal intensity.

Old Salt

That MRI report is as good as it gets. I hope that the biopsy will be negative as well.

But there needs to be a plausible explanation for the high PSA (almost 12 ng/ml) noted recently. Prostatitis?

dgrinnan

I have two different friends. One has a PSA of 12 and the other one was 8. Both came back negative for cancer. they are both in there 60's. that said. I also know two people that showed no cancer and due to other perceived issues with their prostate cancer was found on the removal of their prostate. Again, based on my jumped from 2.8 to 69 in a year I recommend more frequent than a year PSA checks. Had I done mine sooner than annual I would have possibly caught mine before it metastases.