CSN Login
Members Online: 4

You are here

High PSA Advice Needed

zina55
Posts: 8
Joined: Nov 2003

Hello everybody,

I need advice on the following situation: 64  years old, no symptoms.

December 2014 PSA - 2.43

2016 PSA - 4.89

2017 PSA - 4.10

PCP recommends to have another PSA test in 6 months.

Is this the correct route here? Should I request another PSA sooner? How soon? Should I see a urologist? Should I ask for more testiing: MRI, biopsy?

Thank you very much. 

Old Salt
Posts: 720
Joined: Aug 2014

Did your doctor do a Digital Rectal Exam? I hope he did and found nothing suspicious.

zina55
Posts: 8
Joined: Nov 2003

Old Salt,

He did DRE and said that it was normal.

Thank you for your reply.

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Since your PSA went up and then dropped back a bit, your doc was not concerned enough to recommend a biospy, opting instead to do an semi-annual PSA test instead of waiting a year. 

A consistent rise, year to year, would be more concerning.   That's what happened to my PSA, going from 1-2, to 2-3 to 4+, which called for an immediate biospy w/a finding of a low grade Gleason 6 prostate cancer.

Your PSA results don't seem concerning enough to call for a quarterly PSA test at this time BUT I think what you want done is really up to you.

If you are worried that you "may" have prostate cancer and just want to alleviate that concern, just ask for a biospy.  That's the only test that will tell you with reasonable certainty whether you have prostate cancer or not.  

There is the possibility of a false negative  but continued PSA testing with increasing returns will be a red flag indicating the need for another biospy.  Semiannual PSA testing should be sufficient to catch such a problem before the latent cancer grows beyond control.

More frequent PSA testing will not EVER tell you whether you actually have prostate cancer or not.  A rising trend in PSA is only an indicator of the possibility of prostate cancer.  High PSA levels can also be caused by other things having nothing to do w/cancer.

So, if you want to know NOW whether you have prostate cancer or not, the only thing to do  is to request a biopsy.  An MRI, bone scan and other testing is only called for if there is already a positive biopsy result.

You just need to decide whether to get a biospy now or not.  Good luck!

 

 

zina55
Posts: 8
Joined: Nov 2003

Thank you, Swingshiftworker, for taking your time to give me such a detailed explanation. I am actually asking regarding my husband, and I did not even know that his PSA was elevated last year. I wanted to make sure that what his PCP suggests is reasonable, and that he is not wasting presious time to address the problem. I also read that when PSA jumps from one year to another by 2 or more, it is probably not cancer, and when it goes down on its own (without treatment), it is probably not cancer. 

Your reply is reassuring that we can wait and see how he will test in 6 months, and I will also request a Free PSA test. My husband does not want to do a biopsy.

Thank you again.

Clevelandguy
Posts: 456
Joined: Jun 2015

Hi,

Keep an eye on it with more PSA testing, I feel it's the rising of the PSA number after several tests that should be monitored.  My doctor told me he had a man with a PSA in the 2.5 range that tested postiive for PCa.  My PSA slowly rose over a period of years, then my doctor ordered the MRI to check me out.  If you continue to see a general rise in your PSA numbers after multiple tests it could indicate that something is going on with your prostate.  My doctor monitored my PSA every six months for a few years. IMO, an MRI should be done before the biopsy to pinpoint where to take the biopsy samples.  If you don't do the MRI 1st then you are just shooting in the dark with the core samples.

Dave 3+4

zina55
Posts: 8
Joined: Nov 2003

Dave,

Thank you for your reply. It makes all sense to have an MRI done first to know where to take biopsy. Fow how many years did your doc just monitor you? Did you have an endorectal MRI done? 

 

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Zina: It is not generally accepted practice YET to have an MRI done before it is determined that a patient is cancer positive based on a biopsy.

While some doctors may order a pre-biospy MRI, a medical insurance carrier may NOT approve the procedure because it is not yet viewed as medically necessary.  Biopsies on the other hand are routinely ordered to determine the existance of prostate cancer.  So, while you can request a pre-biospy MRI, your insurance carrier may not approve it and (unless you're rich) you definitely do not want to pay for it yourself. 

On the other hand, a post-positive MRI to determine the location of the cancer would be more routinely approved and, if you are going to do that, the best test to do is not just a simply MRI but a combined MRI/MRSI (also known as a 3T MRI) spectrographic scan which will scan for choline which is a marker for cancer and would be the MOST accurate pre-treatment scan you could do in order to determine the locaiton and extent of the cancer.

Clevelandguy
Posts: 456
Joined: Jun 2015

Hi Zina55,

 

My PSA was monitored for about 4 yrs. until I got the MRI done.  I just had a straight MRI with contrast dye, no coil up the butt.

 

Dave 3+4

zina55
Posts: 8
Joined: Nov 2003

Thank you, Dave. Ok, then we will sit tight and wait to see what the next test shows in 6 months. Looking back at your journey, is there anything that you think you should have done differently?

Again, thank you for sharing your experiences.

 

Clevelandguy
Posts: 456
Joined: Jun 2015

Hi Zina55,

With Pca I don't think the journey ever ends, I will always have it in the back of mind about Pca.  It will be 3 years this Sept. since my prostate was removed with the help of a robot, undetectable PSA since the surgery.  I don't think I would do anything different, the worst part was the catheter for 10 days after surgery.  Some people choose surgery some choose radiation, it's up to you.  Each option has it's own unique group of side effects.  Good luck in your journey, keep us informed on what's going on.

Dave 3+4

zina55
Posts: 8
Joined: Nov 2003

Thank you, Dave. All the best to you as well.

Clevelandguy
Posts: 456
Joined: Jun 2015

My MRI was covered under my health insurance, no problem.

 

Dave 3+4

Subscribe to Comments for "High PSA Advice Needed"