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Thoughts on a stable but high PSA

ozelli
Posts: 1
Joined: Jan 2019

Hi,

This is a very informative site and I want to thank all the contributors.  My history is that my Dad dies from PC. He was 77. First diagnosed at 63. He had radiation tratment.

 

I am 57.

 

My PSA levels are as follows:

11/2016   5.75

 

11/2017   5.80

 

12/2018   7.10

 

01/2019   5.96

 

I am of the opinion that I shouldn't be too concerned with the elevated PSA of late 2018. I surf most days and think that I may have stained my groin which may explain that high number.

 

No particular symptoms although the stream when I get up during the night is kind of weak. Up twice a night on average. My Mum who was a nurse for 40 years says I should do nothing at this stage.

 

Big fan of AS. Are there any boards devoted to AS? If someone could provide a link, that would be greatly appreciated.

 

Concerned but not overtly so.

SantaZia
Posts: 69
Joined: Apr 2018

Hi Ozeli, it looks like you need a biospy to determine if you have PC. Those PSA readings are high especially for someone your age. Sometimes a T3MRI is covered by insurance and this might be useful prior to the MRI especially if you have a large prostate.  AS requires regular testing and a biospy is a good place to start. I wanted AS too, but my data didn't support it. You might read The Key to Prostate Cancer: Ten Experts, Mark Scholz  He is based in LA and might be someone to consult with if you qualify for AS.   Good Luck!

Georges Calvez
Posts: 172
Joined: Sep 2018

Hi there,

That is a bit difficult.
I would say that there is a moderate chance you have prostate cancer, on the other hand you may not.
I would suggest that you try a DRE, cheap and cheerful and it can be indicative.
After that I would suggest a PCA3 urine test if it is available, also not definitive.
https://www.healthline.com/health/prostate-cancer/pca3-test#who-should-d...
One of the problems with PSA is that it indicates prostate cancer, it correlates quite poorly with the type and amount of cancer that you have.
One of the problems which you have already identified is the risk of over treatment but on the other hand the earlier the treatment the more chance of a very positive outcome.

Best of luck and best wishes,

Georges

Clevelandguy
Posts: 384
Joined: Jun 2015

Hi,

Usually anything above 4 that stays elevated is something to be concerned about.  Good suggestions above, might want to get an MRI to help diagnose your condition.  I doubt a groin strain could cause your PSA to be high.

Dave 3+4

greenteaguy
Posts: 2
Joined: Jan 2019

I  agree.  It is better to be safe than sorry.

VascodaGama's picture
VascodaGama
Posts: 2938
Joined: Nov 2010

Ozelli,

Welcome to the board. You got good answers from above survivors. In my opinion, I do not see your PSA as stable but as dangerously high to be discarded as a concern.
In your age, anything higher than 2.6 (ng/ml) should be checked and your family history reinforces the need for further investigation on this high PSA. I am surprised for your comment regarding your mother’s recommendation to do nothing. Is she trying to avoid another stressful situation in dealing with another cancer case in the family or does she know about issues not shared here that makes her to believe that the case is not for concern.

A high PSA can be a cause of hyperplasia (benign issue) or could have been triggered if you had sex or ride a bike the day before drawing blood for the test. But it is hard to believe that the same has occurred at each test along the 4 years. A PSA due to benign hyperplasia typically is represented in a sort of seesaw graphical of sharp increases and decreases (not as stable as yours). On the other hand, prostate cancer (PCa) shows a graph of constant increases of narrow variations (more likely of your case). One must also consider that some type of PCa produce little or no PSA at all.

Accordingly, the PSA alone cannot diagnose the cause of a prostatic issue but your dad’s PCa case places you at 4 times higher risk than the usual folk to contract the disease. In your shoes I would schedule a consultation with an urologist and get additional tests. You need a DRE and check the size of the gland (image exam)  as big ones produce more PSA. In any case, only a biopsy can tell you if you have the problematic hereditary prostate cancer (same genes) of your father. It would tell you if AS is proper in your case.

Best wishes,

VGama

 

ozelli1
Posts: 2
Joined: Jan 2019

Sorry for the late reply but was seemingly blocked from logging in. No idea why but could have been that I clicked twice on the confirmation email. New ID now.

 

I had a DRE and what I believe to be an ultra-sound of some kind. I am Australian but in Japan. It said I had a volume of 29cc which the doc suggested to be enlarged but from what I have read, seems not far from normal.

ozelli1
Posts: 2
Joined: Jan 2019

I guess the point I wanted to make was that if over a period of three years the PSA number didn't waver too much, could one not consider the cancer (that is probably there) be not too aggressive?

Tech70
Posts: 47
Joined: Nov 2017

About 18 months ago, my PSA took a jump from 2.7 to 3.5.  On the advice of my primary care physician, I visited a urologist.  A DRE was negative, but she stated that the only definitive test for PCa was a biopsy, which I had.  Results were 2 cores out of 12 positive, each <10% of the core, Gleason 3+3.  As a followup, I had a 3T MRI which showed no lesion of concern.  A confirmatory biopsy was essentially the same as the first.  Since beginning treatment, my PSA's have been 3.6, 3.3, 4.0, and 3.2,  I had genomic testing (Oncotype DX) on the positive samples from the two biopsys and the results were a non-agressive from of the disease.  I am therefore following AS protocol.  I am scheduled for another biopsy this June.  Gist of all this: the only way to detect PCa is a biopsy.  You can have PCa which does not show on a 3T multiparametic MRI with contrast.  You need to see a urologist and get a biopsy.  BTW, a prostate of 29 cc is not large at all; mine is around 80 cc.

VascodaGama's picture
VascodaGama
Posts: 2938
Joined: Nov 2010

Ozelli,

I agree with the comments of Tech70 above. He is on AS because he got a Gleason grade but you have nothing yet. I wonder about the results and who did the DRE. Few doctors are experienced to provide a reliable result just by the touch. The size of the gland (29 cc) is not consistent with a case of hyperplasia too.  

Please note that the PSA doesn't inform on the aggressiveness of a cancerous cell. The grades in aggressivity in a cell are scaled in Gleason patterns/characteristics that go from Well Differentiated (grade 1) to Poorly Differentiated (grade 5). A prostate cancer case is grade via the Gleason score (X + Y = Grade) which is the sum of the type of cells identified by the pathologist (on biopsy cores). For instance, Gleason score 6 is 3+3, the lowest in aggressivity, but score 10 is 5+5, the highest in aggressivity. A Gleason score 7, intermediate grade, could be 3+4 or 4+3, being the later considered more aggressive. What's yours?

I wonder if you are aware on the AS (active surveillance) approach and its purposes. This modality in caring a prostate cancer case is not doing nothing. It involves a series of timely tests and exams which regimen must be followed by the patient. The protocol of Tech above includes a series of biopsies (annually or biannually). Please read these links;

https://www.prostateconditions.org/about-prostate-conditions/prostate-cancer/newly-diagnosed/gleason-score

https://www.cancerresearchuk.org/about-cancer/prostate-cancer/treatment/monitoring-prostate-cancer/active-surveillance

Best,

VG

ASAdvocate
Posts: 108
Joined: Apr 2017

Thanks, VDG,  I hear so many men saying that they "are on AS", but they are not. I have been in Johns Hopkins' AS program for 10 years, and there are many "protocol scheduled" tests that men outside the program are not aware of. In fact, many AS programs do not consider you to be correctly enrolled unless you follow your diagnostic biopsy with an MRI and then a confirmatory fusion biopsy within a year or less.

Georges Calvez
Posts: 172
Joined: Sep 2018

Hi Ozelli,

There is only a weak correlation between the PSA result and the grade and severity of the prostate cancer.
Low grade cancers tend to produce more PSA for the same size tumour due to the fact that they are more like normal prostate cells but it is not a golden rule.
Prostate cancer cells do lots of things; divide and grow and metastase, the extent to which they do this is linked to the Gleason Grade but that is not absolute.
A Gleason Grade of 6 can metastase, it is rare but known, grade 7a and 7b may metastase but they are unpredictable, up to 10 which metastase vigorously.
Men who go on active surveillance are normally grade 6, maybe 7a if they are elderly, and the cancer must be slow growing and monitored for changes as it can decide to turn into a 7a.
I suspect that the odds maybe in your favour of having a low Gleason Score and a relatively benign cancer or maybe no cancer at all.
But you would be best to consult a urologist and have an MRI and a biopsy if that is what he suggests in my opinion.
It is the only way to find out and if you catch it early you have a better chance of a favourable outcome.

Best wishes,

Georges

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