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Elevated PSA Test Result

mridude
Posts: 4
Joined: Mar 2017

I am 60 years old.  My PSA test in May 2015 was 2.8.

February 2016 my PSA test was 4.9 and my doctor recommended I see a urologist, who immediately recommended a biopsy based on the 4.9 PSA.  I asked if maybe we should retest PSA first, which I did. The PSA test done 2 weeks later was 3.7.  The urologist recommended test again in 3 or 4 months, whch I did. 2.8 PSA.

Fast forward to last week. PSA test of 4.9 again. 

I know when I go see the urologist he will recommend a biopsy. Maybe I should?  What if I retest and it is lower again? 

I do not have any other prostate issue type symptoms. Normal urination. No pain. Nothing. I am very fit and always have been.  

I have a family history of cancer.  Lung (Mother 62), breast (sister 52) and pancreative cancer (other sister 48)...but no prostate that I am aware.

Cancer scares the daylights out of me.

Will Doran
Posts: 207
Joined: Sep 2015

mridude,

Don't wait.  It was suggested that I have a biopsy years back when my PSA showed a 4 .7.  I didn't do it, because I was told it was becasue I was riding road bicycle for up to 3 hours per day.  DRE was done and I was told I had one of the smallest Prostates they had ever examined.  Fast forward to August 2013, and by accident, when I had an interneal bleed,  we found that my PSA was at 69.  I had no symptoms.  Biopsy was done, Gleason score was 3+4=7.  I had Robotic Assisted Surgery December 2013.  Post surgery pathology showed 40% involvment of prostate and one lymph node had a very tiny spot.  I was listed as a Stage pT3bN1.  Treated as a Stage 4.  I had Lupron injections and then 8 weeks of Radiation as clean up to the prostate cavity.  I remained on the Lupron for two full years.  PSA went to <0.010.  Testosterone was at 11.  Now Testosterone is at 380, with normal being somethign like 250 - 1,100.  My PSA is up a little bit to 0.145.  We are watching the PSA.   If it comes up more I will have to go back on Lupron, either full time or intermittent, for as long as that works to keep the "T" level down.  I am not a doctor and can only tell you what I've learned and been through.  My mother died of bone cancer and my father had prostate cancer and lived to be 93.  Sister?    Don't know, she died early from alcohol abuse.  So, don't wait.  Get Biopsy done and study and learn all you can so you can make decisions that are best for you.

Good Luck

Love Peace and God Bless

Will

                                                                                                                                                                                                            

mridude
Posts: 4
Joined: Mar 2017

Thanks for sharing your experience. I have an appt this AM to see my urologist. I'm sure a biopsy is in the cards for me. Probably next week. 

Old Salt
Posts: 720
Joined: Aug 2014

I don't see the need for an immediate biopsy as your PSA seems to be going up and down. That's usually an indicator of a recurrent infection (prostatitis).

I would definitely want a biopsy if the PSA continues to go up. What about another PSA in 3 months? If so, no sex prior and no other activities that raise the PSA!

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Given your family cancer history, I'd suggest you get the biospy done ASAP. 

My PSA was around 4 and I was asymptomatic (most men are) when it was recommended to me.  Biospsy came back Gleason 6, which was confimed in a 2nd opinion.  Unknown to me until recently, my father had prostate cancer and my mother had various cancers (uterine, breast and lymphatic) as well.

The main risk of the procedure is infection, which is why they give you cipro to take afterward.  Some men also experience pain/discomfort but I did not. 

The only way to tell w/reasonable certainty if you have prostate cancer or not is to get a biopsy. So, if you delay, you'll never know whether you have prostate cancer or not and the delay in that knowledge could be cruical to your treatment and well being in the long term.

That said, there is a possibility of a false negative from a biopsy.  So, just because the biopsy comes back negative doesn't mean that you do NOT actually have prostate cancer.  The biospy sampling just didn't "find" it.  This is why regular PSA testing is advised.  If your PSA continues to rise after a negative biospy, a further biospy obviously would be called for.

Whatever you decide to do, good luck!

 

 

mridude
Posts: 4
Joined: Mar 2017

Biopsy is scheduled for one week from today. Thanks to everyone for your opinions!

Clevelandguy
Posts: 456
Joined: Jun 2015

Hi,

I would get an MRI 1st to guide the biopsy on where to take the core samples, your just shooting in the dark if you don't know where to aim.

Dave 3+4

mridude
Posts: 4
Joined: Mar 2017

Thats actually a really good idea. I will ask my Urologist. 

Swingshiftworker
Posts: 1013
Joined: Mar 2010

As I mentioned in another thread, a pre-biospy MRI is NOT yet a generally accepted medical practice and your medical insurer MAY not approve it because it is not viewed by the insurer as yet medically necessary.

Also, I do not believe that an MRI can clearly designate areas w/in the prostate for biospy and, even if it can, the prostate is a very small organ (the size of walnut they say, unless it's enlarged) and urologists have long used a sampling pattern by means of transrectal ultrasound which has been generally very effective in finding cancer if it exists.

That said, if you ask for a pre-biospy MRI and it's approved, that's great.  It can't hurt but it's really not all that clear how much it will help.  A post-positive MRI/MRSI (3T spectrographic) scan on the other hand would be an entirely different matter.  Such a scan post-biopsy would probably be routinely approved and would be the best means to determine the location and extent of the cancer.

Clevelandguy
Posts: 456
Joined: Jun 2015

I don't know about your doctor but mine did it to help pinpoint the area to biopsy.  It was a "accepted" medical procedure for his doctor group. Different doctors different techniques.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

I've had five so far....it is the state of the art and more effective than a random biopsy.

Also I know of some men who have had T3 MRI guided biosies before being diagnosed. Insurance covered these procedures

Soori78
Posts: 1
Joined: Apr 2017

Seventeen years ago at the request of my primary Doctor after my yearly exam, i went to the Urologist for a biopsy , which turned out to be Cancer. Went through the options and decided to do the surgery. The cancer was just starting to break through the capsule of the prostate. Everything was fine until five years later , and the PSA started to rise. We did 33 radiation treatments in a row with no visable side effects. PSA stayed down for a long time but a few years ago it started up again. Oncologist wasn't alarmed , because  it wasn't going up by twos. Feel OK, just that i have some blood in urine when i strain with a bowel movement, and i have night sweats every night. I know that the radiation nicked the bladder causing the blood in the urine, but can't figure out the night sweats. Age 61 when diagnosed, and now 78./

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3294
Joined: May 2012

Soo,

Not many things cause night sweats, which is a histimine imbalance, regardless of what is causing the imbalance. One cause is menopause in women -- which we can rule out !  The most common cause is Lymphoma.

I recommend you ask your doctor specifically to address this.  And be aware: Prostate cancer that enters the lymphatic nodes is NOT Lymphoma, it is prostate cancer in lymph nodes.  Lymphoma is an unrelated disease.  Another note:  a urologist is going to know little to nothing about Lymphoma; only  a medical oncologist can treat it properly, although a urologist or urological surgeon could probably lead you in the right direction regarding diagnosis.

max

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