What PSA Score sent you to a Urologist?

Posted by jayhall @jayhall, May 17 12:47pm

I get PSA blood work done every 6 months. Last year my PSA was 3.25 and six months later it had increased to 5.5. My PCP sent me to a Urologist. The Urologist confirmed that if you score 5 or about it's wise to get a biopsy etc, to rule out Cancer and develop a treatment plan for your PSA. I'm curious what PSA score sent you to a Urologist.

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I think that if both samples were sent to the same lab, then there is an issue to address. I would want another blood test in 45 days and if your PSA comes back 5.5 or more then an MRI and a biopsy would be in order. This work should be in a cancer center of high quality. Good luck!

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My PSA was 67 when my cancer was discovered.

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The first time I was diagnosed with PCa my PSA was 4.14 and rose to just below 8 in 6 months.

The second time I was diagnosed (after receiving focal treatment) my PSA rose from 2.55 to 3.41 in 6 months then continued to rise from 3.41 to 7.01 8 months later when I was diagnosed with recurrent Stage 3 PCa. It’s not just the value one needs to consider. It’s also how quickly the PSA continues to rise.

You may want to consider asking your urologist to do a PSA ISO blood test. It’s a better indicator of whether further investigation is needed.

Good luck to you!

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Not a doctor, just a layman; but you can calculate your PSA doubling time (PSADT) from the information you have provided (see this website):

https://www.mdcalc.com/calc/10198/psa-doubling-time-psadt-calculator#next-steps

According to the NCCN Guidelines for Patients Early-Stage Prostate Cancer (pg 65):

"PSA doubling time - This test measures the time that the PSA level takes to double. If it doubles in a short amount of time (6 months or less, for example), it suggests that the cancer is growing quickly."

If I were you I'd get another PSA blood level test performed as soon as I achieved the necessary prerequisites - refrain from exercise (especially bike riding) and ejaculation for at least 48 hours prior to getting tested.

Just this week I obtained two PSA tests within 15 minutes of each other from two different labs. The variation was 0.70 ng/mL units or 12% (5.9 v 6.6). So even if you have ensured the necessary prerequisites the difference in PSA measurements can be significant - from lab to lab - everything else being equal.

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Keep in mind that it is not the absolute PSA number that is important--it is the trend of increase in the PSA over time that indicates when further investigation is warranted. My husband had a low PSA when he was first diagnosed in 2005. He had no symptoms, but his internist did a digital rectal exam as part of an annual physical and sent him to a urologist based on feeling something in the prostate that was not normal. The urologist did a biopsy, which revealed pretty aggressive cancer in both sides of the prostate. My husband was only 58 when diagnosed, so he chose brachytherapy and external beam radiation and not surgery. He was in remission for 6 years before his first recurrence, which led to spots on his spine and his cancer being labelled Stage 4 in 2011. He has had another recurrence and various treatments along the way, and is currently getting Pluvicto treatments. His PSA has never been above single digits all these years--it was the rate of doubling that led to the detection of recurrences.

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@lag

Keep in mind that it is not the absolute PSA number that is important--it is the trend of increase in the PSA over time that indicates when further investigation is warranted. My husband had a low PSA when he was first diagnosed in 2005. He had no symptoms, but his internist did a digital rectal exam as part of an annual physical and sent him to a urologist based on feeling something in the prostate that was not normal. The urologist did a biopsy, which revealed pretty aggressive cancer in both sides of the prostate. My husband was only 58 when diagnosed, so he chose brachytherapy and external beam radiation and not surgery. He was in remission for 6 years before his first recurrence, which led to spots on his spine and his cancer being labelled Stage 4 in 2011. He has had another recurrence and various treatments along the way, and is currently getting Pluvicto treatments. His PSA has never been above single digits all these years--it was the rate of doubling that led to the detection of recurrences.

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Best wishes to both of you on your journey together.

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Mine was 6.3 when I got biopsied - Gleason 4+4. RARP done 1/31/2023. 3rd PSA test since was done yesterday

Still undetectable

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I went from 3.5 at a check up to 6.7 on the next check up 6 mos later - and that sent me to the urologist and an MRI where they discovered a lesion that turned out to be cancerous.

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I was referred to a urologist when my PSA reached 4.63 after a 3.26 reading in my previous test. According to my lab report, 0 to 4 is considered normal. My urologist confirmed that “4 is the magic number”. My prostate did get biopsied which showed Gleason 3+4 in two samples.

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I had my first PSA test done at age 67 . My PSA was 10.9 and 6 weeks later it was 11.0 , my doctor told me to make a urologist appointment which I did and it ended up being a PA ( Physician assistant ) she said for me to schedule a biopsy - I said I would like the hi resolution MRI first before getting a blind biopsy and she said that would not be appropriate ( I think Kaiser has a rule against MRI's for elevated PSA readings ) maybe it's the cost ......
I have been trying to schedule a second opinion with a urologist it's been a couple months but they have cancelled my appointment 2x now so I'm still in " limbo " . My next scheduled appointment is in July .

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