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Newbie - PSA Test Approach/Results - Concerns; Next Steps

CTown1
Posts: 1
Joined: Sep 2016

Thank you in advance for reading this somewhat lengthy post and your responses.

I am a 59-year-old blessed with good health.  I have missed one day of work this past decade, do not take any meds and do a few casual 5Ks every year.  Following a summer vacation, I got mild bronchitis (hotel or airplane?) and saw doctor to confirm and get antibiotics.  Hadn’t seen doc in a while so he wanted to do blood work (cholesterol, glucose/diabetes, etc.).  After blood work, got call from doc’s office and they said my PSA (didn’t even know what that was) was high (=9) and I should see urologist.  There was some doubt in the back of my mind if I should have even had blood work done since I did have bronchitis infection…

Week later go to urologist and he did digital rectal exam (DRE) – prostate not enlarged - and said based on my reported PSA level = 9 he wanted me back a week later to do rectal ultrasound.  He also had me do another PSA blood test AFTER the DRE.

Came back a week and had the rectal ultrasound and he looked at the photo/showed to me (I couldn’t even tell what I was even looking at) and said there was cause for concern and wanted to schedule a biopsy.  He also said my PSA level = 12 based on his/second test.

Before I actually schedule my biopsy, I’ve done research.  Many articles state you should avoid a biopsy unless really needed.   Several articles stated you shouldn’t do PSA/blood work in general (if at all possible) if you have an infection (which I had with test #1).  Second item, was you should NOT do PSA after DRE, as this may elevate results (and 2nd test level = 12 was higher than first test level = 9).  So I did an independent PSA test four weeks after test #2 (after DRE) and PSA with test #3 was back down to level = 9, reinforcing what I’d read about not doing PSA right after DRE.

So I read about 4Kscore blood test that is supposed to be better indicator than PSA, so that’s my next step and THEN if this test shows more likely prostate cancer, then I’ll do biopsy. 

Sound like a good approach?

4Kscore prostate blood test link below:

https://health.clevelandclinic.org/2015/05/new-blood-test-helps-you-avoid-unnecessary-prostate-cancer-biopsies/

 

 

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3225
Joined: May 2012

Welcome, CTown.

Hopefully you do not have PCa. But the only way to determine that is a biopsy.  Other than pain and expense, a biopsy is harmless, and the value it brings vastly outweighs those two minor factors. Compared to most of the tests in current medicine, a prostate biopsy is relatively cheap.

You list the particulars of your lifestyle, which is essentially irrelevant. PCa is an equal-opportunity disease, and strikes the fit and the fat, the vegan and the bacon lover the same.

A PSA of 9 is cause for thorough investigation. A PSA of 12 is even more so.

My read of your comments is that you are second-guessing protocols and your own doctor. If you don't trust him, get a different one. But a board certified urologist is going to tell a man with a PSA of 9 to have a biopsy. 

Experts differ on how much, if any, effect a PSA blood draw following sex or DRE will make on the results. My own surgeon says 'virtually none.'  Most doctors who do feel it is relevant do not consider the effect to be so large as to be of relevance in most cases.  It seems apparantlyvthat your own doctor is of this opinion. Writers here commonly submit studies arguing both sides.

The Cleveland Clinic, which you reference, is world-class. I have not been able to open the link yet, but usually these sorts of studies are funded by insurance companies wanting to pay for fewer tests.  Every year or so some authority reinvents the wheel and discovers a great new way to disgnose and oredict the severity of PCa.  Most of these are forgotton not long after the ink is dried, and proceedurally diagnosing PCa is little different today than ten years ago, although imaging trchniques have dramatically improved, as have available drugs and radiation skills.  And regardless of what the study concludes, it ideas are not yet normative in the US.  In the last few years there has similiarly emerged numerous studies that even recommend that in most  cases PSA tests be given less often, and the results more or less ignored.  Here too, the hand of insurance cmpanies is at work.  There are too many men here whose disease was discovered following elevlated PSA s to ever count or list.  My own GP was one of these, but I thought him foolish and went to a urologist who recommended an immediate biopsy, which came back positive with Stsge II disease.

Get the other test if you see fit.  In 90%/or more new PCa cases, there is no reason to rush things.   You asked if your approach thus far is good. My layman's view: I think not.  But the mega insurers might like it a lot..

 

max

mikedayton62
Posts: 22
Joined: Sep 2016

In June of this year my PSA at my annual physical was 10, up from 6 in previous years. I had the idea that this reading was anomalous, because I had not been celibate before the test. I saw my urologist two weeks later, and had been celibate, and the new PSA was 12. A couple of weeks later I had the biopsy, which discovered Gleason 6 cancer in one of 12 cores. This was verified when an MRI revealed an 8mm tumor.

I think it is very important to know your Gleason score, which comes from a biopsy. This score will guide you as to the urgency of your resopnse. If yours is a Gleason 6, you could opt for Active Surveillance, but if it is 8 or higher it would show a more aggressive cancer and would indicate the need for more immediate action.

Please do not disregard your PSA score. I wanted to disregard mine, but I went to the urologist anyway, and I am glad I did. 9 is a cause for concern and further testing.

tonycue
Posts: 39
Joined: Aug 2016

Hi Mikedayton, noticed your post and thought I'd ask a question....I am awaiting results of a saturation template biopsy because of a "something" seen on a 3T MRI scan.....I was under the impression that any cancer that showed up on MRI had to be "clinically significant" ie G7 or above....could you give me more details please....I'm currently sweating out a 2 week wait

     Thanks in advance

         Tony

VascodaGama's picture
VascodaGama
Posts: 2957
Joined: Nov 2010

I agree with above survivors comments. Only a biopsy can diagnose prostate cancer. Newer forms of tests are helpful in sorting out those cases whose data (tests, symptoms, etc) contrasts against the typical diagnosis. These would not provide a positive result as trustful as analysis under the microscopy by a specialist pathologist.

The normal (maximum) level of PSA in a 59 yo male is PSA= 2.9 ng/ml. Yours is three times above this value and it has been confirmed with one month interval. Other reasons for an high PSA would be BPH which usually is accompanied with urinary problems and pain. You can get a localized ultrasound to verify any anomaly (size of prostate) that could relate your PSA to such hyperplasia case.

I am skeptical about the benefit of that PSA done after a DRE. I wonder why the doctor requested you to draw blood for the PSA after DRE, as you comment. I would look for other physician to follow your case (can you trust that doctor?).

Best

VG

hopeful and opt...
Posts: 2218
Joined: Apr 2009

A PSA of 9 warrants a biopsy

It is a necessary evil

I've had 6 biopsies during my 7 1/2 years of active surveillance......

There are various types of biopsies...please feel free to click my name on thr left to see information about three dimensional biopsy.

Old Salt
Posts: 720
Joined: Aug 2014

I copied the following:

No, the 4Kscore test is not FDA approved, but is offered as a Laboratory Developed Test (LDT) through BioReference Laboratories and GenPath Diagnostics, both CLIA-Certified and CAP-Accredited laboratories and wholly owned subsidiaries of OPKO Health.

Unless you don't mind to pay 'out of pocket', you should ask your insurance whether the 4K score test is covered.

 

PS: I agree with the others that running the test doesn't make good sense in the scenario given

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