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What is a Quick Rise in PSA?
I've scanned through quite a few of these topics, but didn't come across any yet that seemed too similar to my situation so I wanted to describe my situation and ask the community. I plan to follow up with my PCP for medical advice when I get my retest results and will follow up with my Urologist if the retest comes back the same, just looking for thoughts and maybe pointers to good information while I wait for the results.
I am 55, I have had BPH for a number of years now, over 10 for sure. But my PSA value has never been high due to that BPH, so it would be odd for it to trigger a high value now. I was steadily 0.6 to around 0.75 for several years and then I bumped up to between 0.9 and 1.1 - varied between those two numbers for about the last 7 years. So I have probably 12+ years of PSA numbers.
I had my annual last week and my PSA was 2.5. I checked my number from last year (and my annual was almost exactly 1 year before) and it was 1.1. My doctor included a note that I should stop by the lab to repeat the test, but it was still well within normal range. A little digging told me normal range is not really below 4 anymore, but is really dependent on age and race and could be 2.5 for me. 3.5 at most. But still - I see his point that, one reading isn't reason to panic and also values can be far higher than that. Note: my PCP did not perform a DRE at my annual. So no information to help there, nor would it have impacted the results.
Then I realized I had a test from October that was also 1.1. So I realized my value went from 1.1 to 2.5 in 8 months. So while the value itself may not be particularly concerning as a single data point, in context of steady values of 1 for many years, then more than doubling in 8 months time, it may be.
I have tried to research what constitutes a sharp rise in PSA and i have come across PSA velocity, and my value is more than double the 0.75. But it is still difficult to find good information on the web about PSA values and PSA velocity and any relation to age and how they factor and when and if someone should be concerned.
Any thoughts about my increase in PSA and what it could mean? Is it fast? Is it too fast? Is 2.5 a number that could be concerning, especially when 8 months ago it was 1.1?
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Thank you every body for the comments and feedback, they are all helpful.
DREs don’t scare me, actually lately I think they embarrass doctors more than patients. And in the past with my BPH I have had cystoscopies and urodynamics tests that are about as invasive as you can get, so not much phases me on the exam front anymore. 😄
Right now I am waiting for retest results to see if the number is in the same range. In regard to the things that can affect the readings- I was at my annual and the other blood work and urinalysis showed no sign of infection. The doctor did not perform a DRE, no vigorous exercise or vigorous bike riding right before my exam (or the last month), no ejaculation (although this is one of the few I could find data on how much it effects readings and the effect seems pretty minimal, we’re talking 0.1-0.2 range 12-24 hrs out), I am not on any of the medications they list, my bloodwork for my liver was all good as well. There could be other factors they don’t list.
I have not received an email from the system yet but after I just finished typing this, I decided to login and see if my new results were in yet. It’s hard waiting for an Email to appear. The new result was there, 2.2 ng/ml. So, I expect my PCP will add a note within the next few hours when he gets notified and has time to send me a note, but I will plan to contact my Urologist, and see how he wants to proceed. I would think at a minimum a DRE and a PSA retest in however many months.
PSA is not a diagnostic test -- it will only tell you the percentage of men having cancer with that number, age, etc. but you want a yes/no answer: "Do I have cancer?" So another test (with no bike riding or sex/ejaculation for 72 hours prior) is the next step to get there. Also schedule a visit with a urologist to discuss the results and what to do to provide you the knowledge you seek.
Everything else is fact-free speculation at this point...stay away from what-ifs, you're worried enough already.
A quick rise in PSA means cancer, so get a biopsy.
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).
Most urologists use a 20% or more year over year increase in PSA as a red flag. The absolute number isn't as important as the rate of rise. In your case there was more than a 100% rate of rise year over year. If it were me I would schedule an appointment with a urologist. Most likely a contrasted MRI is in your future.
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3 ReactionsYour number doubled in one year. That is the troubling sign. Mine doubled, and I fought with the VA urologist who told me it was "normal" range, and I needed to stop asking for a biopsy. I went outside the VA and I was a Gleason 10, aggressive, stage 3C. Went on to radiation/orgovyx. Thank God I did not believe the "normal" remark, instead looked at the doubling.
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3 Reactions@stew80 if it were me, I would be aggressive with making sure that I got that MRI as soon as possible at least it would give you some clue visually regarding your status. At the same time that you’re getting that, I would also make sure that you get a second or third opinion via telehealth regarding that image and your numbers.
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3 ReactionsToo high of a bump up . 100% or more . Have to do some Diagnostic work and poss a biopsy . God Bless .
My oncologist does all my PSA tracking. I've spent 2+ years below one after a year triple treatment year (Radiation, Chemo, ADT) for Advanced Stage 4. It recently started rising again. I like that my oncologist already as a plan in place including s trial. Glad you're in the tracking mode.
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1 ReactionMy PSA level remained stagnant at 2.9 after I had brachytherapy for a period of eighteen months. After that had a blood test which came back with a raised PSA at 12.5. My niece who is a radiation oncologist ordered me to undergo a pet scan. The results revealed presence of the carcinoma in the prostrate which was luckily still very much regional. I have since been on radiation for a month and I am still left with two weeks of radiation. I have so far not experienced any ill effect other than bleeding on one occasion. I ran a half marathon yesterday and so far there is no ill effect. out of my experience my sense tells me a sudden raise in the PSA level calls for a medical investigation
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