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I'm surprised @kujhawk1978 is recommending you follow up on this, not that it would hurt. I would suspect that in the absence of other data, you would repeat the test in either 6 months or a year, whether at the behest of your primary care or a urologist. My primary care did the DRE [finger insertion to check for size and lumps] and then offered me either a referral or an mpMRI, but that was with a PSA of 10, confirmed as 8.8 on retest. Back when I was in my 40s I was followed for several years with a PSA in the 3-4 range. The higher PSA came at 65. A lot of things affect PSA, including vigorous physical activity involving the pelvis (aka biking) and sex. You may have abstained for those for several days before your PSA to ensure you got a good reading.
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My case is similar to yours. Random PSA test showed 12.6 and 2 weeks later it was 9.3, then a month later 8.5 and finally after 3 months back to 9.6. DRE was normal but BPH symptoms are there. Cystoscopy showed a decent urinary path. Bladder was fine. The urologist said 'we' don't get too excited about 9ish PSA numbers if they aren't progressing. I had to talk him into setting up an MRI and that will be scheduled sometime in a few months. My next appointment isn't until December (6 months). My question is, should I be more aggressive or let it play out?
I'm 84 by the way (and healthy and active otherwise).
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My PSA was 2.1 when I was diagnosed accidentally.
in 2010 I had an unexplained DVT, PE and Pneumonia.
My PCP had recently completed continuing medical education where the discussion of the link between cancer and DTV and PEs was discussed. Since we had the discussion about aging, in part how lifestyle was a factor, diet, exercise , managing stress, in part seeing your doctors and having routine physicals and appropriate diagnostic testing and then, the incontrollable factor, genetic crapshoot, she had ordered a colonoscopy. That showed polyps though not cancerous, so, instead of 10 years, I was scheduled to do it again in three years. In December 2013 the gastroenterologist took the time to examine my prostate while I was under anesthesia, (he was the same one in 2010 so guess he did the same then, found nothing to alert him) In the recovery room, he recommended I see my urologist, I did, he did the DRE and said we should follow up with a biopsy. the rest is history.
My reasoning is as my PCP and I discussed, there are two factors you can control in aging, lifestyle and regular visits with your medical team. In my case, the latter is what may have saved my life, finding my PCa early enough. The recommendations of the infamous task force on PSA testing were a result of overtreating. The unintended consequences may be more men being diagnosed with advanced vice localized PCa.
I have no doubt the medical community was over treating in days past. I think today, the pendulum has shifted to more active surveillance based on clinical data, though as evidenced by various folks on this and other forums, there are still those who....
No harm, no foul, my medical team knows when I ask for diagnostic tests, I generally have a reason and as I say, you're not paying for it, so write the script, put the order in...
So, my approach is why not, either confirm or deny using medical diagnostic testing. If it's not, great, if it is, well, knowing is great too,
There are a number of factors which impact PSA testing as we generally all know. I probably should have addressed those in my comments. Your suggestions of another PSA test while accounting for "known" influencers of PSA levels is also a reasonable suggestion.
Kevin