PSA trending up What should I do?

Bobz,

You are absolute correct on the assertions above. Why diagnose something that may only cause problems?

However, it all started from the reason that took you along the years to test the PSA. You have been screening for a health condition that should be addressed if found anomalous. This is what your GP has found and now he is just proceeding to the next step; a biopsy.

Continuing with the screening without a definite result is senseless. The PSA doesn't guide further on the issue, just informing that something is happening (benign or cancerous). The positive DRE ("firmness" on one side) is also limited but highly suggestive of a more aggressive condition. You are asymptomatic but the condition could be more critical if any cancer in fact exists and that have spread away from the prostate. As commented by Old Salt above, there are several treatments which include benign or cancerous situations that you should care before the problem develops further.

I wonder about your fitness at the age of 70 or any other illness you may be confronting. We believe to be fit till something occurs and start accepting occurrences under the disguise of the "old age". Surely many prefer to continue life as usual doing nothing, but accept to die when the body can't respond anymore. However, one may avoid such suffering via a treatment.

The next step is to know the reason for the findings by the GP. A biopsy is invasive but you can get also a diagnosis close to 100% via sophisticated image studies that would always be required in future if in a positive biopsy senario. These are non invasive and can provide a clue on the situation. Choline based PET and MRI exams are more reliable than the traditional bone scan, CT or MRI, in particular when the PSA is lower than 10 (yours is PSA=6.1 ng/ml). The multi-parametric magnetic resonance imaging (mpMRI) has become sort of standard and is practiced at big PCa institutions.

Please read this;

http://www.medicalnewstoday.com/articles/274625.php

In any case, a biopsy is the best and simple way to analyze your condition and is not so invasive as many comment. I did it and felt no pain or found post effects. Surely you need to know what is happening. Whatever you decide, the result will give you peace of mind.

Best wishes.

VGama

I endorse what VASCO, OLD SALT, and MAX recommend. I underwent a biopsy 26 years ago and do not recall that it was very painful. Learning that I had prostate cancer was an unpleasant thought, but I continue to enjoy life at the age of 91. Best of luck to you.

Jerry

Hi,

I think I would request an MRI with dye first to help guide the urologist during his biopsy samples.

Dave 3+4

My viewpoint is that first you should ask yourself , what would I do if they confirm cancer? If the answer is nothing then why put yourself through more potential bad news and anxiety. Some patients/doctors/countries don't even do PSA tests after a certain age because most prostate cancers are slow growing and there are other competing moratlity issues for many older men. A man that lives until 85 has a very high chance of dying with, but not of prostate cancer. Please keep in mind though that if you decide to ride it out, by the time you would have strong symptoms if it is cancer, there are treatments to help you manage your condition but it is unlikely to be cureable at that point. It may be the right decision for you but just think it through. 

However, if you are otherwise healthy with no significant competing mortality risks (likely to live into your 80's) and you are both mentally and physically capable of tolerating treatment and you understand the side effects vs the likely outcome then you should consider being treated. My father underwent a major cancer operation at age 87 but he was amazingly strong for his age (fought in two wars, worked construction for 40 years), tolerated the operation well and lived for many more years.

A high and rising PSA is a red flag but not enough information to decide what you have and what if any treatment is appropriate. They may also want to see how fast it is rising, what your history or baseline was and what your free PSA is. A biopsy is the standard of care at this point and there is some risk of side effects but they are pretty low. If you would not seek treatment then again maybe, you should not proceed because even a low risk of side effects would make no sense but if would decide to get treated if its cancer then its a small risk as part of the process to live a normal life expenctancy. There are a few new options. A Tesla 3 endo rectal coil MRI with contrast is the first prostate image technology that can provide imaging that is useful at this stage and can help determine what you have. They can then use that image to join (fusion biopsy) with the guided biopsy to make sure that they sample the most suspicious areas to confirm. After the 3T MRI you can decide if you want to proceed to biopsy depending on what they find. I paused at this point myself but my doctor impressed on me that no doctor at a major facility would treat me without the biopsy confirmation (at least for now) so I proceeded. Some pain, some bleeding but it was not bad for me. The first few ejaculations are a little unerving (bloody) but that clears up as well. There are cancers that are slow growing and not agressive and may be suitable for watchful waiting and there are more aggressive, more advanced cancers that have to be dealt with quickly to have a chance at a good result. There are also some benign explanations for a rising PSA. Again, without further testing you don't know where you stand. If you decide to get further information and if cancer is confirmed then there are many options. Surgery, radiation, freezing, sound waves, etc. Some are more suited for older men that may have some health issues.

I was 61 when I was diagnosed and I have an advanced form of the disease that does not have the greatest outlook but I am otherwise very healthy with literally no known additional medical issues. I did the 3T MRI with contrast, a fusion biopsy, radical prostatectomy (surgery) and now hormone therapy and radiation. An 81 year old friend of mine developed a high PSA but opted to do nothing because of his age and other health issues. Sadly he passed last year and as expected, it was not from prostate cancer so in that regard he made the right call.

One of the best things that you can do is do some research and select really good doctors so that you get good, well informed advice. If you like to read, get Patrick Walsh's book or Balentine Carter's book (he did my surgery). Both books are excellent.

Good luck to you, I hope this helps.

Another thought. My wife and I have unfortunately have a ton of experience with cancer and various doctors/hospitals (ourselves, family, close friends etc.). Given the type of questions that you are asking, we have found that the best places for open minded opinions that explain both sides of your choices and have the most up to date study data to help guide you are the research hospitals and even better if the doctors are on salary. If you have access to such a place (Mayo, Hopkins, MSK, UCLA, Northwestern, etc.) you have a much better chance of getting a very informed recommendation that considers your age, health status, etc before giving you a recommendation based on extensive study data. They have tables that summarize the outcomes for thousand of patients and can give pretty accurate estimates as to your outlook. Some patients don't find that type of stark info helpful but it sounds like you want to know where you stand. Take a look at US News and World Report and their annual hospital rankings for Urology. and also for cancer. We have found the top places to be excellent. If you decide to get treated, make sure that the doctor has done a bunch of them. My surgeon has done over 4,000 operations and while the number does not need to be that high, make sure its hundereds.

Best of luck and treat every day like a gift.