PSA numbers

Do PSA numbers ever go down without treatment?  My I had a biopsy in April. 12 cores - 4 with various staged of inflamation, 1 with HGPIN, 1 with ASAP and 6 benign.  The pathology report also stated that it was "highly suspicious for adenocarcinoma."  My PSA at the time was 4.27.  I'm a 64 year old man.

Comments

  • Clevelandguy
    Clevelandguy Member Posts: 750 Member
    Depends

    Hi Musicman,

    Your PSA number can go up if you had it drawn the day after you had sex or if you have just did a long ride on a bike.  Normally they do not go down, they just go up over time with no treatment.  From what I know anything over 4.0 should draw some attention from your doctor.  In my case they started taking it every 6 months after it hit 4.0.  If they hit the cancer on the biopsy you will get a Gleason score number.  The first number is the most comon type of cancer cells and the second number is the lessor amount of cancer cells taken during the biopsy.  The numbers usually start at 3(mild) to 5 or 6(severe) as far as how agressive your cancer is. On me they did an MRI with a radiactive dye which helped the doctor decide where to take the biopsy samples.  From the info you gave it sounds like the biopsy did not detect any cancer.

    Dave 3+4

  • musicmanone
    musicmanone Member Posts: 8
    edited August 2018 #3

    Depends

    Hi Musicman,

    Your PSA number can go up if you had it drawn the day after you had sex or if you have just did a long ride on a bike.  Normally they do not go down, they just go up over time with no treatment.  From what I know anything over 4.0 should draw some attention from your doctor.  In my case they started taking it every 6 months after it hit 4.0.  If they hit the cancer on the biopsy you will get a Gleason score number.  The first number is the most comon type of cancer cells and the second number is the lessor amount of cancer cells taken during the biopsy.  The numbers usually start at 3(mild) to 5 or 6(severe) as far as how agressive your cancer is. On me they did an MRI with a radiactive dye which helped the doctor decide where to take the biopsy samples.  From the info you gave it sounds like the biopsy did not detect any cancer.

    Dave 3+4

    I'll have another PSA test in

    I'll have another PSA test in October and probably another biopsy.

  • Old Salt
    Old Salt Member Posts: 899 Member
    Yes, they do sometimes

    In addition to what was mentioned earlier, PSA can go up significantly as a result of prostate inflammation. And then it will come down again. Note that your biopsy revealed inflammation.

     

    PS: Your description of the biopsy is confusing. What were the Gleason scores and what is ASAP? 

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    .

    PSA is an indicator only; and is not precise; one observation does not give adequate information for indication, one must read a series of PSA observations to be used as an indicator.....please provide history of PSA's taken and dates of PSA , if any. Any other diagnostic tests, ie FREE PSA, PCA3 or any gene tests?

    A biopsy is  critical information; as Old Salt requested please provide more information about the biopsy that was done.

  • lighterwood67
    lighterwood67 Member Posts: 320 Member
    My understanding

    It is my understanding, at this time, that a biopsy is the definitive test for prostate cancer.  There can be several factors leading up to the biopsy, but the biopsy is the defining moment.  I too had a 3T MRI, prior to my biopsy.  The MRI identified "suspicious" areas, the biopsy confirmed cancer with a gleason of 4+3=7.  In my opinion, the pathology report of a biopsy should be definitive not "suspicious".  The folks on this site will need a lot more information to help with your questions.  Just remember, these folks are telling you what their experiences are.  Your journey is yours.  You make your decisions based on what the medical professionals tell you.  The folks on this site can tell you the results of the medical decisions recommended to them.  We are the results of what the medical field has to offer to survive prostate cancer.  We are the best test tubes, that talk, that you can possibly have.  Good luck on your journey.

  • musicmanone
    musicmanone Member Posts: 8
    edited August 2018 #7
    Old Salt said:

    Yes, they do sometimes

    In addition to what was mentioned earlier, PSA can go up significantly as a result of prostate inflammation. And then it will come down again. Note that your biopsy revealed inflammation.

     

    PS: Your description of the biopsy is confusing. What were the Gleason scores and what is ASAP? 

    Biopsy report / PSA history

    Below is the complete biopsy report:

    Surgical Pathology Report - Auth (Verified)
    Specimen
    Prostate needle core biopsies:
    1- Left base.            2- Left mid.            3- Left apex.
    4- Left lateral base.    5- Left lateral mid.    6- Left lateral apex.
    7- Right base.           8- Right mid.           9- Right apex.
    10-Right lateral base.   11-Right lateral mid.   12-Right lateral
    apex.


    Clinical Information
    Preoperative diagnosis:  R97.20
    Postoperative diagnosis:
    Pertinent Clinical Data:  PSA Last Result: 4.27; Date: 3/27/18

    Diagnosis
    Prostate Needle Biopsies:

    Site            Diagnosis                       Gleason %Involved
    #Cores

    1- L Base       Benign prostate tissue

    2- L Mid        Benign prostate tissue

    3- L Apex       Benign prostate tissue

    4- L Lat Base   Focal chronic inflammation

    5- L Lat Mid    Benign prostate tissue

    6- L Lat Apex   ASAP - See Comment

    7- R Base       Benign prostate tissue

    8- R Mid        Mild chronic inflammation


    9- R Apex       Mild chronic inflammation

    10-R Lat Base   Benign prostate tissue

    11-R Lat Mid    Focal chronic inflammation

    12-R Lat Apex   HGPIN
    Performed at: TMF Central Lab
    CLIA #15D0357169, 530 N Lafayette Blvd South Bend IN 46601

    Performed by:                    Odeta Lapkus, M.D.
    ----------------------------------------------------
    Electronically verified by:   Odeta Lapkus, M.D.

    Verified: 04/30/18 15:39
    OL/OL


    Two markedly atypical glands are identified.  Immunohistochemical
    stains for cytokeratin 34BE12 and p63 fail to demonstrated basal
    cells in the atypical glands.  These findings are highly suspicious
    for adenocarcinoma.

    Gross Description
    Site            Color          # of Pieces  Length (mm)

    1- L Base       tan                 1       12
    2- L Mid        tan                 1       16
    3- L Apex       tan                 1       16
    4- L Lat Base   tan                 1       11
    5- L Lat Mid    tan                 3       1,2,12
    6- L Lat Apex   tan                 1       20
    7- R Base       tan                 1       14
    8- R Mid        tan                 1       15
    9- R Apex       tan                 1       16
    10-R Lat Base   tan                 1       13
    11-R Lat Mid    tan                 1       10
    12-R Lat Apex   tan                 1       17

    GXP/

    Microscopic Description
    Sections from blocks submitted at gross exam are microscopically
    reviewed.

     

    Following are the last 5 years of PSA readings:

    2013 - 0.70 ng/ml

    2014 - 0.86 ng/ml

    2015 - 1.02 ng/ml

    2016 - 1.19 ng.ml

    2017 - doctor forgot to request

    2018 - 4.27

     

    I appreciate all of your comments.

  • Clevelandguy
    Clevelandguy Member Posts: 750 Member

    Hi,

    By looking at your biopsy report it does not appear to me that you have prostate cancer but do have an inflamed prostate which might be the cause for your increased PSA reading.  Sounds like you are going down the right path and see if your urologist can pinpoint the area to make more samples in your next biopsy with an MRI to guide them.  As stated above you don't have PCA unless the biopsy tells you that you do.

    Dave 3+4 

  • musicmanone
    musicmanone Member Posts: 8
    edited August 2018 #9
    Old Salt said:

    Yes, they do sometimes

    In addition to what was mentioned earlier, PSA can go up significantly as a result of prostate inflammation. And then it will come down again. Note that your biopsy revealed inflammation.

     

    PS: Your description of the biopsy is confusing. What were the Gleason scores and what is ASAP? 

    ASAP and HGPIN

    This information is from a report from Harvard Medical School -\

    There is no consensus about the correct terminology to use for such lesions. Often you’ll see the term atypical small acinar proliferation, or ASAP, but it could also be labeled atypical hyperplasia, atypia, atypical glands, or focal glandular atypia.

    Fortunately, such atypical findings are reported in only about 8% of pathology reports, according to a review of 39 studies involving needle biopsy specimens. But the trend toward doing more biopsies and finding smaller cancers has led to an increase in atypical diagnoses. Studies have shown that nearly half of the men who receive such an atypical diagnosis initially will find they have prostate cancer during a follow-up biopsy. This happens regardless of PSA levels or results of a digital rectal exam (DRE), which appear to be unrelated. In addition, compared to other pathologic diagnoses, atypical findings have the highest likelihood of being changed on expert review, usually to a diagnosis of cancer.

    High-grade PIN, short for prostatic intraepithelial neoplasia, is another broad diagnostic category. This finding involves a subjective reading of the pathology slides and also generates debate about follow-up and treatment. It is now thought that high-grade PIN might increase a man’s risk of developing cancer, but because the steps involved in cancer progression are still elusive, the degree of risk remains unclear. It is usually not considered an important factor when associated with a definitive diagnosis of cancer.

  • contento
    contento Member Posts: 75
    Musicmanone, I agree with

    Musicmanone, I agree with what the guys posted above. The biopsy is the ultimate indicator but does not always identify the cancer. Considering your rising psa history I think your doing the right thing by staying diligent with your checkups i.e. 6 month biopsy's. Don't be lulled into thinking the rising psa is something other than prostate cancer until you can prove that's the case. Then you can relax. Until then my advice is to stay diligent.....contento

  • lighterwood67
    lighterwood67 Member Posts: 320 Member

    ASAP and HGPIN

    This information is from a report from Harvard Medical School -\

    There is no consensus about the correct terminology to use for such lesions. Often you’ll see the term atypical small acinar proliferation, or ASAP, but it could also be labeled atypical hyperplasia, atypia, atypical glands, or focal glandular atypia.

    Fortunately, such atypical findings are reported in only about 8% of pathology reports, according to a review of 39 studies involving needle biopsy specimens. But the trend toward doing more biopsies and finding smaller cancers has led to an increase in atypical diagnoses. Studies have shown that nearly half of the men who receive such an atypical diagnosis initially will find they have prostate cancer during a follow-up biopsy. This happens regardless of PSA levels or results of a digital rectal exam (DRE), which appear to be unrelated. In addition, compared to other pathologic diagnoses, atypical findings have the highest likelihood of being changed on expert review, usually to a diagnosis of cancer.

    High-grade PIN, short for prostatic intraepithelial neoplasia, is another broad diagnostic category. This finding involves a subjective reading of the pathology slides and also generates debate about follow-up and treatment. It is now thought that high-grade PIN might increase a man’s risk of developing cancer, but because the steps involved in cancer progression are still elusive, the degree of risk remains unclear. It is usually not considered an important factor when associated with a definitive diagnosis of cancer.

    On track

    Looks like you are on track, to staying on top of this issue.  I had a 3T MRI prior to biopsy.  My surgeon told me if I would have not have gotten the 3T MRI a 12 core biopsy would probably not have found my cancer.  They took 20 plus cores out of the prostate.  Pretty clean A through I.  Then J, K, and M showed up cancerous.  If I were you I would get a 3T MRI and get an MRI fusion prostate biopsy.  Of course all of this type of stuff is your decision.  I am only a test tube that talks, but I have been there.  Anyway looks like you are on top of this.  Good luck on your journey.

  • musicmanone
    musicmanone Member Posts: 8
    edited August 2018 #12
    Old Salt said:

    Good info

    Thanks for providing the complete pathology report; it cleared up several questions that I had.

    Especially because the report raises an important issue (see below), I strongly suggest that you have the slides send to the specialists at Johns Hopkins for a second evaluation. Dr Epstein is THE authority in the field.

    Two markedly atypical glands are identified.  Immunohistochemical
    stains for cytokeratin 34BE12 and p63 fail to demonstrated basal
    cells in the atypical glands.  These findings are highly suspicious
    for adenocarcinoma.

    What would something like

    What would something like that cost?

  • Old Salt
    Old Salt Member Posts: 899 Member

    What would something like

    What would something like that cost?

    $250

    See if it's covered by your insurance

    http://pathology.jhu.edu/department/services/secondopinion.cfm

  • Old Salt
    Old Salt Member Posts: 899 Member

    ASAP and HGPIN

    This information is from a report from Harvard Medical School -\

    There is no consensus about the correct terminology to use for such lesions. Often you’ll see the term atypical small acinar proliferation, or ASAP, but it could also be labeled atypical hyperplasia, atypia, atypical glands, or focal glandular atypia.

    Fortunately, such atypical findings are reported in only about 8% of pathology reports, according to a review of 39 studies involving needle biopsy specimens. But the trend toward doing more biopsies and finding smaller cancers has led to an increase in atypical diagnoses. Studies have shown that nearly half of the men who receive such an atypical diagnosis initially will find they have prostate cancer during a follow-up biopsy. This happens regardless of PSA levels or results of a digital rectal exam (DRE), which appear to be unrelated. In addition, compared to other pathologic diagnoses, atypical findings have the highest likelihood of being changed on expert review, usually to a diagnosis of cancer.

    High-grade PIN, short for prostatic intraepithelial neoplasia, is another broad diagnostic category. This finding involves a subjective reading of the pathology slides and also generates debate about follow-up and treatment. It is now thought that high-grade PIN might increase a man’s risk of developing cancer, but because the steps involved in cancer progression are still elusive, the degree of risk remains unclear. It is usually not considered an important factor when associated with a definitive diagnosis of cancer.

    Good info

    Thanks for providing the complete pathology report; it cleared up several questions that I had.

    Especially because the report raises an important issue (see below), I strongly suggest that you have the slides send to the specialists at Johns Hopkins for a second evaluation. Dr Epstein is THE authority in the field.

    Two markedly atypical glands are identified.  Immunohistochemical
    stains for cytokeratin 34BE12 and p63 fail to demonstrated basal
    cells in the atypical glands.  These findings are highly suspicious
    for adenocarcinoma.