Concerning follow up PSA test. I'm worried this could be bad How concerning is this.

anotherday
anotherday Member Posts: 8 Member
in Prostate Cancer #1

40 year old male. Last year and a little before I had some macro (a hand full of times over about a year) and micro hematuria. I haven't had any visible blood since. About 6 months ago I went and had an ultra sound, blood work, DRE, and a cystoscopy. My PSA was 3.2ng/ml and my prostate was slightly enlarged but otherwise everything was fine. I was told whatever caused the blood wasn't dangerous. I just had a PSA test done for the 6 month follow up. My level is 4.6ng/ml . I got the test results from the testing service before seeing the doctor.

That is a 1.4ng/ml increase in 6 months. From what I have read that sounds very concerning. How concerned should I be? Incase any ask I did not engage in sexual activity before giving the test. I did exercise, ran a mile, the day before. I didn't ride a bike/exercise bike.

Looking for any information.

Comments

  • Rob.Ski
    Rob.Ski Member Posts: 182 Member
    #2

    PSA is elevated for your age and rising. Doesn't mean it's cancer but, warrants further investigation. Not sure 2 PSA test is a enough for a trend. I'd be asking if MRI is in order and when next PSA check will be. R

  • Clevelandguy
    Clevelandguy Member Posts: 1,265 Member
    #3

    Hi,

    Like Rob.ski said an MRI will determine if there is anything suspicious and also measure the size of your Prostate. Only a biopsy tissue sample will confirm if you have cancer and also grade it’s aggressiveness(Gleason score). There is also a chance you could have Benign Prostate Hyperplasia which is most of the time non cancerous but will cause your PSA to rise. When appropriate your Urologist will schedule the necessary tests to start your investigation of your rising PSA.

    Dave 3+4

  • swl1956
    swl1956 Member Posts: 194 Member
    #4

    Agree with above! Ask urologist for MRI. If anything is suspicious, then they should order a biopsy. Don't panic, but be diligent about getting it checked out. Sometimes you have to push these doctors a little and if you're not satisfied, get a second opinion.

  • anotherday
    anotherday Member Posts: 8 Member
    #5

    Thank you for your responses. It has been hard to find clear information on what rate might mean in my situation but I understand the concern associated with the base value.

  • Steve1961
    Steve1961 Member Posts: 656 Member
    edited February 14 #6

    if I was you i would demand an MRI if you’re urologist doesn’t want to give you one go somewhere else … 60% a normal PSA for a man 40 years old should be under 2.0 it’s very alarming. I don’t mean to frighten you but they say a rise in PSA of over 1.0 in a year could mean aggressive cancer so do your due diligence and move on it do you know what I hate to say this but you could go tell your doctor that you’ve been talking to some of your relatives and tell him that you had an uncle that died from prostate cancer at a young age sometimes you have to do this to get what you want out of these doctors doctors You want to catch it early like I said, demand an MRI if not, go somewhere else. Keep going until you find somebody that will give you one.

  • anotherday
    anotherday Member Posts: 8 Member
    #7

    Update: Redid the PSA test without intense exercise before hand this time. It went down to 3.8. However, Free PSA percentage was bad, an even 10%. I am waiting for more details but I am heading to biopsy ultimately. I have a bad feeling beyond the base percentage risk. Regarding treatment I never had kids, and while it wasn't likely to happen in the future even before all this. Even if I am not dying having the theoretical possibility taken away will be awful, as that possibility was a comfort of sorts.

  • Old Salt
    Old Salt Member Posts: 1,585 Member
    #8

    Why are you concerned about kids? You can store your sperm ahead of treatment…

  • anotherday
    anotherday Member Posts: 8 Member
    #9
    https://csn.cancer.org/discussion/comment/1721164#Comment_1721164

    Even if I recover my increased risk of mortality would make having children seem unadvisable in most scenarios.

  • anotherday
    anotherday Member Posts: 8 Member
    #10

    I have some follow up questions I don't know if anyone can help with but here they are:

    1. In NC who are good services to use for treatment?
    2. Are there any who do transperinial biopsy in the Charlotte area?
    3. Is there any reason to prefer transrectal of transperinial. I haven't seen one and don't want to be septic. I have seen something about pain but nothing too clear.

    My Free PSA is 10%. They are already saying biopsy so I am assuming that is more about determining treatment. I will ask about MRI first (maybe that is the plan) for targeting. I read that PSA under 10% also corresponds to more aggressive cancer and cancer that is significant in size but I can't find any specifics. Does anyone know a source for further information.

  • Old Salt
    Old Salt Member Posts: 1,585 Member
    #11

    YES and NO to your questions:

    No, a biopsy is just about finding where the cancer is in your prostate and how aggressive it might be (Gleason score).

    Yes, a transperineal biopsy is the preferred (and newer) way these days, but I do not know who in the Charlotte area is capable of doing one. On the other hand, many have had a transrectal biopsy (including me) without problems. As is the case in general, experience is an important factor for a good outcome. MRI first makes a lot of sense; recommended!

    Well known cancer centers in NC:

    Duke Cancer Center

    UNC Lineberger

    Wake Forest Baptist

  • Wheel
    Wheel Member Posts: 194 Member
    #12

    increased risk of mortality? Many are here 20 years. Anything can happen in that time. New advancements and updated treatments in cancer frequently occur over a five year period through clinical trials into these new drugs and immunotherapy. I had my daughter at 50 0ver twenty years ago the same year being diagnosed with lymphoma. The life expectancy average back then 11 years.

  • Marlon
    Marlon Member Posts: 146 Member
    #13

    If you haven't read a good reference book yet, it can help explain a lot of things and help you have informed questions. This is the one that was recommended to me and I've been passing on: https://www.amazon.com/Patrick-Walshs-Surviving-Prostate-Cancer/dp/1455504181

    The way I look at it, is even with MRI and biopsy, they dont really know what is going on until they are in there. Radiation is blasting a whole area and hoping you get it all, and surgery is taking out what they can see, and hoping it hasn't already spread. Sometimes both are needed.

  • anotherday
    anotherday Member Posts: 8 Member
    #14
    https://csn.cancer.org/discussion/comment/1721200#Comment_1721200

    Yes, I picked it up earlier today. I have been reading through the most pertinent sections but I don't have time to cover everything before my appoint tomorrow (The appointment is just to go over things and schedule tests).

  • anotherday
    anotherday Member Posts: 8 Member
    #15

    Thanks,

  • LuckyKYGuy
    LuckyKYGuy Member Posts: 32 Member
    #16

    The biopsy procedure is uncomfortable but not painful. I had two biopsies a year and a half apart. The first diagnosed me with Gleason of 6. My PSA was 5.4. I chose active surveillance.

    18 months later Gleason was 7/8 so I had RARP. I’m 59…two grown kids…but the thing I dreaded most was losing urinary continence and ejaculation.


    Now four months post op and follow up PSA the first time was undetectable and having another in a couple weeks.


    IF, and that’s a big IF, you get diagnosed there are plenty of options and fortunately your PSA isn’t off the charts to suggest you have not caught things early enough to have all the options at your disposal.

    Take one day at time and just know that at the onset all of this sounds really terrible but….doing nothing at all is the most terrible thing you can do.


    You’ll find a ton of support here Keep us updated

  • anotherday
    anotherday Member Posts: 8 Member
    #17
    https://csn.cancer.org/discussion/comment/1721218#Comment_1721218

    Thank you for the encouraging post LuckyKYGuy; I truly appreciate it. I will provide updates as they come but I think it will be quiet for a few weeks at least.

  • VascodaGama
    VascodaGama Member Posts: 3,731 Member
    #18

    Hi,

    The PSA may be high for a 40 years old but, for the moment you haven't been diagnosed yet with cancer.

    You don't have to rush for any thing. Just listen to what the doctor has to say, and before advancing with an opinion or suggestion request a MRI. This will be helpful now in the investigation process and will serve in the future as comparison data for other image studies, if any.

    Remember that you can always ask for a second opinion from another specialist.

    One thing we know as survivors is that prostate cancer doesn't spread overnight. You have time to look for the best.

    Best wishes

    VG

Discussion Boards