PSA reading of 8.5

PSA Readings
Ribushe,

Welcome to the board and a belated happy birthday! While I disagree with hopeful and optimistic on potential dangers of biopsies (we have a long history of respectful disagreement on this subject) I do agree that a biopsy is the only definitive way in which you can determine whether or not you have prostate cancer and how much of a danger it might be.

There are several things to keep in mind when you consider your PSA reading although I am quite confident your urologist is going to want to perform a biopsy "just to be sure." BTW, he will also bank about $5K for the 30-minute procedure. Biopsies are money makers for urologists.

The PSA test is notoriously unreliable in detecting prostate cancer with about a 50% chance of detecting anything worrisome. About the same as flipping a coin. A series of PSA readings over time gives you more of an indication of what is going on but since this is your first you don't have a history. PSA density (the ratio of PSA to prostate volume) can give you a better idea of whether or not you have something to worry about as is PSA velocity and PSA doubling times.

A PSA reading can change depending upon the time of day. It can be boosted by certain OTC medications, a UTI, exercise like bike riding, sex within 48 hours of your blood test, and even a hard stool that puts pressure on the prostate. PSA increases as a man grows older and most PSA scores below 10 are a result of BPH which is not dangerous although it can cause uncomfortable symptoms such as the inability to completely empty your bladder, getting up throughout the night to urinate, weak stream, and so forth...all of which are common with men your age.

Another interest statistic is that 60% of men in their 60s and 70% of men in their 70s have some (mostly indolent) prostate cancer that will never pose a threat to their health. In Western countries 1 in 6 men will be diagnosed with prostate cancer but there are a whole lot more that are never diagnosed but never have it affect their health.

The 4.0 PSA level as normal was an arbitrary number proposed by a Dr. Catalona back in the late 80s as a means to measure relative risk. There have never been any studies to determine what the right number to be worried about is. Some say it should be lower (of course you get more biopsies this way) and others propose higher numbers. Nobody has done a study to my knowledge to determine what a age-based PSA should be for otherwise healthy men without physical symptoms. I wouldn't be too worried about a single data point that showed an 8.5. Are there any physical symptoms? Did your GP detect anything unusual during a DRE? Could you have an undiagnosed UTI? These are all factors that a competent urologist should take into consideration before jumping into a biopsy procedure.

Also, be aware that while most biopsies are only mildly uncomfortable you will have bloody ejaculate for several weeks following and since biopsies are mostly done with needle guns that go from your lower colon into the prostate there is a risk of infection and sepsis. This occurs about 5 percent of the time.

I was persuaded to have a biopsy with a PSA of 4.2 at age 59. Nobody asked if I had sex the day before, whether or not I had any other symptoms, or made any attempt to rule out another cause. At that point I didn't even know what PSA stood for and only had a vague idea where the prostate was even located. Most men are in similar situations when their doctor tells them their PSA is "high."

If I had it to do all over again I would have asked to retake the PSA exam and make sure I didn't have sex the night before. I would avoid Advil and other anti-inflammatory OTC medication for at least 48 hours before the test. If I were a bike rider I would give that up for a few days before the test. I would ask the doctor to test for a UTI that I might be unaware of and I would ask him to estimate the size of my prostate from the DRE and determine whether or not the PSA was likely coming from BPH. After I had ruled out all of those things, I would then submit to a biopsy but keep in mind that at your age, most men stand a pretty good chance of having the biopsy come back positive although it could well be an indolent form of cancer.

On the other hand, assuming you are otherwise in good health with another 15-20 years life expectancy then running this to ground at this time is a prudent thing to do.

A MRI will not detect early, low risk stages of cancer. It also cannot stage cancer or determine its Gleason score or percent involvement which are all critical in determining which course of treatment (if any) you might choose to pursue.

Best of luck to you.

K

bdhilton said:

Isn’t it funny how we
Isn’t it funny how we always figure this stuff out after the fact…like your statement “…I was persuaded to have a biopsy with a PSA of 4.2 at age 59. Nobody asked if I had sex the day before, whether or not I had any other symptoms, or made any attempt to rule out another cause…” Sometimes I believe we understand our cancer better than the doctors treating us….All the best

I think
that you are exactly right. If we only knew then what we know now...

mrspjd said:

Hindsight is usually 20/20. This begs the question, a question often considered too taboo to ask here (or anywhere) to post-tx PCa patients: “Knowing what you know now about PCa, would you have made different decisions/choices?" If so, what things would you have done differently? What choices would be the same?

I Would Have Made The Same Choice
No change for me!

I did fairly extensive research in the month or so after I was diagnosed w/PCa and almost immediately decided that I did NOT want to have surgery done on me. WAY too many risks and unknowns.

So, for me, the choice was only between AS or some form of radiation. Wasn't entirely comfortable w/AS (why do "nothing" if there's an acceptable treatment?) or LDR brachytherapy (didn't like the seeds remaining in my body and the side effect risks) which was the only radiation choice offered to me by Kaiser (my carrier at the time). Didn't know anything about HDR brachytherapy then and no Proton Beam facility was conveniently located near me, apart from the fact that PB wasn't covered by any carrier under my medical insurance program.

Fortunately, I "found" out about CyberKnife (CK) and also found out that it was approved for coverage by Blue Shield (an alternate carrier available to me under my medical insurance program) only a few months before I was diagnosed; that it was offered near me at UCSF which accepted Blue Shield through a participating medical group; and, that I would be able to switch to Blue Shield from Kaiser during the "open enrollment" period only a few months after I discovered the availability of CK.

A lot of things had to fall into place to make it all happen. The time from diagnosis to open enrollment was only 4 months. Had to wait 2 more months for the carrier change to take effect and another 3 months to get scheduled in for treatment. Missing open enrollment would have delayed treatment for another year.

So, IMHO, it was just meant to be and, although a determination on my recovery is still pending, I have no doubt that I would have made the same choice.

Kongo said:

PSA Readings
Ribushe,

Welcome to the board and a belated happy birthday! While I disagree with hopeful and optimistic on potential dangers of biopsies (we have a long history of respectful disagreement on this subject) I do agree that a biopsy is the only definitive way in which you can determine whether or not you have prostate cancer and how much of a danger it might be.

There are several things to keep in mind when you consider your PSA reading although I am quite confident your urologist is going to want to perform a biopsy "just to be sure." BTW, he will also bank about $5K for the 30-minute procedure. Biopsies are money makers for urologists.

The PSA test is notoriously unreliable in detecting prostate cancer with about a 50% chance of detecting anything worrisome. About the same as flipping a coin. A series of PSA readings over time gives you more of an indication of what is going on but since this is your first you don't have a history. PSA density (the ratio of PSA to prostate volume) can give you a better idea of whether or not you have something to worry about as is PSA velocity and PSA doubling times.

A PSA reading can change depending upon the time of day. It can be boosted by certain OTC medications, a UTI, exercise like bike riding, sex within 48 hours of your blood test, and even a hard stool that puts pressure on the prostate. PSA increases as a man grows older and most PSA scores below 10 are a result of BPH which is not dangerous although it can cause uncomfortable symptoms such as the inability to completely empty your bladder, getting up throughout the night to urinate, weak stream, and so forth...all of which are common with men your age.

Another interest statistic is that 60% of men in their 60s and 70% of men in their 70s have some (mostly indolent) prostate cancer that will never pose a threat to their health. In Western countries 1 in 6 men will be diagnosed with prostate cancer but there are a whole lot more that are never diagnosed but never have it affect their health.

The 4.0 PSA level as normal was an arbitrary number proposed by a Dr. Catalona back in the late 80s as a means to measure relative risk. There have never been any studies to determine what the right number to be worried about is. Some say it should be lower (of course you get more biopsies this way) and others propose higher numbers. Nobody has done a study to my knowledge to determine what a age-based PSA should be for otherwise healthy men without physical symptoms. I wouldn't be too worried about a single data point that showed an 8.5. Are there any physical symptoms? Did your GP detect anything unusual during a DRE? Could you have an undiagnosed UTI? These are all factors that a competent urologist should take into consideration before jumping into a biopsy procedure.

Also, be aware that while most biopsies are only mildly uncomfortable you will have bloody ejaculate for several weeks following and since biopsies are mostly done with needle guns that go from your lower colon into the prostate there is a risk of infection and sepsis. This occurs about 5 percent of the time.

I was persuaded to have a biopsy with a PSA of 4.2 at age 59. Nobody asked if I had sex the day before, whether or not I had any other symptoms, or made any attempt to rule out another cause. At that point I didn't even know what PSA stood for and only had a vague idea where the prostate was even located. Most men are in similar situations when their doctor tells them their PSA is "high."

If I had it to do all over again I would have asked to retake the PSA exam and make sure I didn't have sex the night before. I would avoid Advil and other anti-inflammatory OTC medication for at least 48 hours before the test. If I were a bike rider I would give that up for a few days before the test. I would ask the doctor to test for a UTI that I might be unaware of and I would ask him to estimate the size of my prostate from the DRE and determine whether or not the PSA was likely coming from BPH. After I had ruled out all of those things, I would then submit to a biopsy but keep in mind that at your age, most men stand a pretty good chance of having the biopsy come back positive although it could well be an indolent form of cancer.

On the other hand, assuming you are otherwise in good health with another 15-20 years life expectancy then running this to ground at this time is a prudent thing to do.

A MRI will not detect early, low risk stages of cancer. It also cannot stage cancer or determine its Gleason score or percent involvement which are all critical in determining which course of treatment (if any) you might choose to pursue.

Best of luck to you.

K

Kongo, I registered to thank you

Kongo, I registered to thank you. You wrote this back in 2012 and today, I'm pretty sure you saved my father's life. He is 71 years old, has Alzheimer's Disease and any kind of sedation (such as the anesthsia they'd use for the biopsy) is very, very dangerous to him. With a PSA of 8.0 and an enlarged prostate, the urologist was pushing HARD for him to do a biopsy. Without having read your post first, I argued against the biopsy. The urologist finally agreed to a 3 month course of antibiotics and a re-check afterwards. Thank god, for your post! Now, if the PSA comes back at 8 again, I can make a case for continued PSA checks instead of biopsy. My god, it's soooo alarming how close we came to peril! Thank you, thank you, thank you!