PSA velocity, what am I looking at here?

gsmith1247
gsmith1247 Member Posts: 7 Member
edited May 20 in Prostate Cancer #1

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.

Comments

  • Old Salt
    Old Salt Member Posts: 1,505 Member
    #2

    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
    Clevelandguy Member Posts: 1,180 Member
    #3

    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
    dgrinnan Member Posts: 12 Member
    #4

    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
    gsmith1247 Member Posts: 7 Member
    #5

    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
    Old Salt Member Posts: 1,505 Member
    #6

    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
    dgrinnan Member Posts: 12 Member
    edited April 17 #7

    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.

  • gsmith1247
    gsmith1247 Member Posts: 7 Member
    #8

    Biopsy on Tuesday, just got results.

    1.Prostate, RIGHT POSTERIOR (Biopsy): Benign prostatic tissue. 2.Prostate, RIGHT LATERAL (Biopsy): Benign prostatic tissue. 3.Prostate, RIGTH ANTERIOR (Biopsy): Benign prostatic tissue. 4.Prostate, LEFT POSTERIOR (Biopsy): Benign prostatic tissue. 5.Prostate, LEFT LATERAL (Biopsy): Benign prostatic tissue. 6.Prostate, LEFT ANTERIOR (Biopsy): Benign prostatic tissue. 

    Two pages after that, talking about blocks/sections but nothing pertinent. The doctor took 12 cores.

    Not sure where they go from here? I've had a negative CT scan, negative mpMRI, and now a negative biopsy. What am I missing?

  • dgrinnan
    dgrinnan Member Posts: 12 Member
    edited May 2 #9

    Good news on your biopsy. Not to be a downer on the heels of your good news, as advised before, I would request frequent PSA test. I would do every 3 months. 6 months minimum. If it develops you want to catch it as early as possible while it is still confined to the prostate. My doctor told me even though they take multiple samples during the biopsy, if it is early, it is possible to still miss a cancerous spot.

  • Old Salt
    Old Salt Member Posts: 1,505 Member
    edited May 2 #10

    Yes, that is very good news. Time to rejoice and relax.

    The higher than 'normal' PSA test (almost 12 ng/mL) can be explained by the prostatitis identified in the 4/12 MRI report.

    As suggested by dgrinnan, just follow up with PSA tests at an interval that is acceptable to you.

    Did the Hopkins people comment on the TRT?

  • swl1956
    swl1956 Member Posts: 123 Member
    #11

    Not sure if insurance would pay for a PSMA PET scan without a positive cancer diagnosis, but perhaps the scan might show cancer that has been missed with the biopsy? I requested this scan after my diagnosis. Was somewhat reassuring that metastasis had not occurred. It showed clearly the cancer was still in the gland and right where the MRI showed it to be.

  • gsmith1247
    gsmith1247 Member Posts: 7 Member
    #12

    I 100% hear you dgrinnan. My heart bleeds for your PSA going from 2.2 to 69. I will be asking for frequent PSA tests (thinking like every three months or so.) I don't know what else I can do.

  • gsmith1247
    gsmith1247 Member Posts: 7 Member
    #13
    https://csn.cancer.org/discussion/comment/1715018#Comment_1715018

    I have not heard anything yet from the doctor at JH. Nothing about the TrT, other than noting in my records that I stopped it after I got the 4k results.

  • gsmith1247
    gsmith1247 Member Posts: 7 Member
    #14

    I saw a regular Urologist at Hopkins for a follow-up. I have some mild urinary retention (150 cc), and there were trace leukocytes in my urine. They did a culture, and nothing grew.

    I asked about repeating PSA sooner rather than later, and they told me that it would be abnormally high within six months of biopsy and wait the six months and repeat. They prescribed oxybutynin to help with urinary symptoms but nothing for prostatitis. They told me that cancer could always be possible but highly unlikely with the clean MRI and the negative biopsy.

    We talked about TrT and concluded that it should not resume until PSA can be rechecked in September. I asked about a PSMA scan, and they told me that they are not done to diagnose and wouldn't be an appropriate use of that resource.

    I guess there really is nothing I can do but wait and see how my PSA is in September.

  • Old Salt
    Old Salt Member Posts: 1,505 Member
    #15

    All good news, as far as prostate cancer is concerned.

    I hope the oxybutynin will 'work'.

  • Rob.Ski
    Rob.Ski Member Posts: 172 Member
    #16

    First, your results are all good news and chances are you are in the clear. Keep in mind though, they really can't confirm you don't have cancer only that you do with a biopsy. MRI can miss early stages if there isn't a well defined tumor and even that is only confirmed as cancer with a biopsy. The biopsy can miss as well as it is only sampling. Definitely breath a sigh of relief but, as others suggested keep monitoring the PSA.

  • Clevelandguy
    Clevelandguy Member Posts: 1,180 Member
    #17

    Hi,

    Good news on your good test results, sounds like your higher PSA could be caused by your BPH.

    Dave 3+4

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