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High PSA of 35 I would like an opinion

Ralphtoo
Posts: 2
Joined: Aug 2020

I'm 51 with no family prostate history.  I recently started to feel sick one night.  Then I started to feel the need to urgently pee but when I did I almost had to force it out.  It was quite painful too.  

So I went to my GP who did a urine test that showed no UTI.  So I got a blood test and my PSA was 35.  My two previous PSA's in 2016 was 2 & December 2018 1.6.  The doctor wanted me to wait 5 weeks and repeat the PSA test.  I wasn't entirely happy with this so I went to a 2nd GP.  He said the result was interesting and had treated high PSA levels simlar to this before.  He did a DRE and said my prostate was enlarged & firm.  Not sure if that's good or not?.  So he put me on 4 weeks of Nufloxib.  And also wants to do a repeat PSA test in 5 weeks as well.  He has also referred me to a urologist if the PSA is still high by then.  

Anyway the symptoms have gone away but it does still feel tight and uncomfortable in my bladder pelvic region.  I also had some lower back pain but that appears to be going away now as well.

These symptoms that lead to the high PSA level came on all of sudden.  I have had over the last couple of months (not recently though) some mornings where I wake up with some nausea until I pee but apart from that I've had no other symptoms,  I only have to pee once a night (not always) and my stream is full on.  So no issues really until recently.

So with no UTI and such a sudden rise in PSA from low to pretty high what could cause this?. Of course I'm fearing cancer but I've read that prostate cancer usually comes on slow with no symptoms.  So what do you think?. 

Thanks

VascodaGama's picture
VascodaGama
Posts: 3234
Joined: Nov 2010

Ralph,

Welcome to the board. I think that both doctors you have consulted followed the proper and typical steps to diagnose your situation. Both address the possibility in existing UTI and the later put on antibiotics (Nufloxib), which seems that have already alleviated the symptoms.

The positive DRE could be a cause of inflammation or BPH (benign prostatic hyperplasia) that can be the reason for the high PSA. In one month you will know what is happening. In any case, at 51 years old and with no inflammation or BPH issues the PSA shouldn’t be higher than 2.8 ng/dl if one wants to rule out existing cancer. A higher value could imply the need for a biopsy to clarify the situation, in particular due to the positive DRE.

The level in the PSA test is sensitive to any massage of the prostate. One shouldn’t have sex the night before drawing blood for the test, ride a bike or tractor, or masturbate, as the movements could lead to high PSA results.

I hope it all resolves in your favor.

VG

Ralphtoo
Posts: 2
Joined: Aug 2020

Thanks for that.

I've been extensively going down the Dr Google route.  There's a lot of very confusing and conflictiong information and opinions about this.  I'm hoping it's just prostatitus or BPH, but most things I've read say 35 is pretty high and also reading about PSA velocity has really freaked me out!!!!.  This thing came on pretty suddenly and normally I wouldn't be concerned but the combination of symptoms and the sudden rise in PSA has got me worried about Advanced Pca.  Can it come on that quick (19 months or so) though ????.  

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3489
Joined: May 2012

Ralph,

There are medical certitudes, and then there are subjective/impressionistic views and 'wisdom' that doctors acquire over time.  The 'certitudes' regarding PCa diagnosis come only from biopsy, but even biopsies are fairly given to false negatives (showing no disease when it is in fact present).

A PSA of 35 by itself proves nothing, but it damn strongly suggests aggressive PCa.  Hope for the best and assume the worst.  My urologist teaches PCa surgery all over the country via seminars and in our own medical school, and did his own residency at MD Anderson, Houston.   I have asked him personally what he thinks of the notion that a PSA test after sex or strenuous activity might be falsely high, and he said he does not believe it, and has never seen such a scenario in his own practice.   I had chronic prostatitis for 30 years (yes, years), and it never caused a high PSA result for me.  A grossly enlarged prostate prior to removal never caused a PSA increase in my one, ancedotal case either.  (Most prostatitis is non-bacterial/non-viral, and hence antibiotics have no effect on it.)

It is best to assume nothing but use due diligence and request an MRI-guided biopsy now.  Please update us, as your scenario is a clinical outlier.  And avoid Google 'research.'   If you want to read in the mean time, use the Harvard Medical School site, or Johns Hopkins, or Sloan, or MD Anderson, or the Cleveland Clinic.  All are free and offer only professional assessments of diseases.   

Avoid the hemp oil/yoga crowds, of which there are many.

ASAdvocate
Posts: 139
Joined: Apr 2017

I have read accounts where men had PSA spikes up to 60, and it then returned to normal and no cancer was ever found. I think the world record for non-cancerous PSA was over 200. But, those inflammation spikes don't last long.

There are other tests, like free PSA, PHI, 4K score, that would add more data points. An MRI could determine if possibly cancerous lesions exist. All of those are reasonable next steps if the next PSA test does not show a dramatic drop.

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