Fiance referred to urologist over psa

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.

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 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.

 

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

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 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

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

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