1. < Prostate Cancer

PSA of 4.1 when never previously higher than 1.0

Posted by cudabinacontenda @cudabinacontenda, Jul 2 7:48am

My apologies for asking such a basic question in a community in which so many are courageously dealing with significant challenges. But I’m filled with anxiety right now. I’m 64 and today got my PSA reading of 4.1 which I understand is barely outside the normal range for my age. But last year, my reading was .94 and close to that for the past several years. In fact, never above 1.0. I went to a urologist just last week for periodic dull pain in my right pelvis that my GP suspected was potentially a recurrent hernia, but ultrasound and MRI were negative for hernia. Urologist thinks I have prostatitis given some history of it in my late 40s. He sent me for blood and urine tests which were entirely normal except for PSA. I’m worried because it’s well over my consistent personal normal. Can PSA suddenly rise to the top of the range in a little over a year without a serious underlying problem? I have a call into my urologist, but he may not get back to me for several days, and I’m a bit fearful given that I’ve had two abdominal CT scans in my life that I regret getting because of radiation exposure. No one in the family has had prostate cancer. What do you all think is the standard course of action here? I’m grateful for any feedback. Thanks, guys.

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kmat | @kmat | Jul 3 2:13pm

Doing some casual reading I came across the suggestion that covid-19 may be related to elevated psa? Not sure I got it all correct. Knowing me, wishful reading. But as I wait results of yesterday's T-3 MRI, anyone familiar with a possible connection between covid-19 and elevated psa? Thanks.

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1 reply
cudabinacontenda | @cudabinacontenda | Jul 3 3:09pm
In reply to @kmat "Doing some casual reading I came across the suggestion that covid-19 may be related to elevated..." + (show)
@kmat

Doing some casual reading I came across the suggestion that covid-19 may be related to elevated psa? Not sure I got it all correct. Knowing me, wishful reading. But as I wait results of yesterday's T-3 MRI, anyone familiar with a possible connection between covid-19 and elevated psa? Thanks.

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I did a quick search and saw one study of PSA tripling in active Covid. Interesting because I was sick the previous week but ran out of tests. Who’d have thought there’d be reasons to hope we had Covid! Good luck with the MRI results, kmat.

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kmat | @kmat | Jul 3 4:44pm

Ah...it may be a pipe dream on my part. The MRI won't be so, well, fanciful. Thanks for your warm and encouraging comment cudabinacontenda.

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trusam1 | @trusam1 | Jul 3 9:03pm

I haven't seen mention yet of the reminder to avoid anything which might lead to a sudden temporary spike in PSA, specifically bike riding, ejaculation, other prostate stimulation ( such as a digital rectal exam or enema) within 48-72 hours prior to the blood test.

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cudabinacontenda | @cudabinacontenda | Jul 4 8:06am
In reply to @sarmajor "A lot of GPs tend to have a pretty casual outlook on spiking PSA results. Mine..." + (show)
@sarmajor

A lot of GPs tend to have a pretty casual outlook on spiking PSA results. Mine listened to me when mine went from .8 to 3.1 in a year. I asked for an urology referral and got one right away. The urologist asked about family history which included a brother and father with prostate cancer. He moved me right into a biopsy which confirmed a stage 2 diagnosis.
If it’s only 7 or 8 weeks between PSA tests you should be fine. The speed with which you got things going is to be commended. Good luck.

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Thanks, Sarmajor. I’m sorry to hear that your spike turned out to be cancer. I hope everything is turning out ok for you. I’m worried, but trying to be hopeful.

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clandeboye1 | @clandeboye1 | Jul 4 9:04am
In reply to @robertmizek "Stage 3 metastatic prostate cancer patient here weighing in. Speaking for the rest of our group..." + (show)
@robertmizek

Stage 3 metastatic prostate cancer patient here weighing in.

Speaking for the rest of our group I’m glad you’re here asking such an important question. I hope you don’t have to join our community but if you do, we’ll be here for you.

A marker of prostate cancer is often a short period of time in which your PSA value doubles. As a matter fact it’s called doubling time. A doubling time less than 12 months is highly suspicious for aggressive prostate cancer. Based on the numbers you shared, your PSA has doubled twice in 12 months. It’s not necessarily cause for panic, however it is cause for further investigation in a timely manner. While it’s true that prostate cancer is typically slow moving, that’s not always the case.

In 2020 my PSA doubled in less than 12 months. At my request, my physician ordered a PSA 4K test. That test came back with an opinion of high likelihood of significant disease. I then had an MRI, which showed a PI-RADS 4 lesion. I then had a mapping biopsy that resulted in the diagnosis of prostate cancer. I was treated with low-dose Brachytherapy and thought I’d beat it. In 2023 my PSA started to rise again and doubled twice in the period of 11 months. An MRI revealed two large lesions and lymph node involvement. I then received a PSA-PSMA scan, which confirmed the very high likelihood of the return of prostate cancer. Since then I’ve had salvage radical prostatectomy and I’m currently undergoing 24 months of first and second generation ADT as well as eight weeks of IMRT radiation.

Based on my experience, if I were in your shoes, I would ask my physician to either give me a PSA–4K test or PSA–ISO test as soon as possible. If either of those tests reveal a high likelihood of significant disease, I would ask for a three Tesla MRI as the next step. If that comes back with a high PIRADS score I would request an MRI guided FUSION biopsy. I would not settle for anything less. The first time I was biopsied in 2020 I did not receive an MRI guided biopsy and the inferior biopsy I received missed significant high risk disease, which is why I’m in the mess that I am in.

The bottom line is you always have to be your own advocate. Good luck to you and please let us know how things work out.

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I had an MRI T3 which indicated a T2 Signal & PI-RADS 5 following which I had a MRI Fusion Biopsy . The pathology results were negative . The recommended number of cores for the fusion Biopsy is 2 to 4 . I had 5 cores taken .
Unhappy with the conflicting results given the T Signal plus the Rads 5 . I proceeded with a 2nd
T3 MRI , this time with contrast , followed by a 2nd MRI Fusion Biopsy . This time my new Urologist took 16 Cores. The result 6 Cores were Gleason ( Grade 1 ) 3+3 = 6 Cancer .
I am 84 years young . Why did my original Urologist - The previous Head of Surgery and Head of Urology, at a leading big city hospital , not take more samples at the 1st Biopsy . Particularly given my age to prevent the need for a 2nd Biopsy .
It makes you wonder , when typically the more cores are more accurate .
p.s. Both Biopsies were "Transparineal " NOT " the more risky for infection " Transrectal " .
p.p.s. Most Urologists term the MRI Fusion Biopsy -- REAL TIME . This is incorrrect as
images can be slightly distorted in tthe fusion process .
The latest " REAL TIME BIOPSY " is called "An IN-BORE or Gantry Biopsy "
You are in the MRI machine during the Biopsy . Most clinics and hospitals have yet to
catch up with this new procedure -- Equipment costs .

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1 reply
retireditguy | @retireditguy | Jul 4 9:45am
In reply to @cudabinacontenda "Glad to hear you’re doing well, docasio. Can you please describe the diagnostic MRI? Did they..." + (show)
@cudabinacontenda

Glad to hear you’re doing well, docasio. Can you please describe the diagnostic MRI? Did they use contrast? Did they use a rectal insert? It seems very involved.

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I had an MRI due to a rising PSA that went from 2.6 to 4.5 on my annual physical. My urologist asked for another PSA test and ordered an MRI with contrast. The MRI was a piece of cake. The MRI tech gave me an IV, and then I layed in the MRI for about 20 minutes with a set of headphones playing music. The hardest part was just trying to lay still. The MRI showed a lesion and the radiologist report (which I got at the portal of the lab which did my MRI) said about a 50% chance it was cancer. Interestingly the follow up PSA had come down to 3.6. Got a high res fusion biopsy and found plenty of cancer, so the drop in the psa was a false signal.

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cudabinacontenda | @cudabinacontenda | Jul 4 10:12am

Sorry to hear that you got bad news. Some MRIs are a little more involved and uncomfortable, so at least that particular experience wasn’t a burden. I hope it all turns out ok for you.

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1 reply
retireditguy | @retireditguy | Jul 4 5:17pm
In reply to @cudabinacontenda "Sorry to hear that you got bad news. Some MRIs are a little more involved and..." + (show)
@cudabinacontenda

Sorry to hear that you got bad news. Some MRIs are a little more involved and uncomfortable, so at least that particular experience wasn’t a burden. I hope it all turns out ok for you.

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Thanks! Actually, it's turned out pretty great so far. Since the fusion biopsy found cancer at 7 of 11 locations (22 cores), pretty evenly split between 3 + 3 = 6 and 3 +4 = 7, I decided to pursue treatment. Since it appeared localized to the prostate and since I am a 70 year old in otherwise good health, I elected for robotic nerve sparing radical prostatectomy. I had the surgery on 6/24 with catheter removal 3 days ago on 7/1. I went to Mayo Phoenix, which is a recognized cancer center of excellence. Right now I'm 99% continent with only 1 minor accident so far (which was due to an unusual physical movement). I haven't tried having a sexual encounter yet so I have no idea if I have any ED. The surgical pathology report showed no cancer found outside the prostate. If you do find you have prostate cancer (which I sincerely hope you don't), I do have 2 recommendations: First, if it's an option available to you then go to a recognized cancer center of excellence. I had to travel 300 miles to do so, but I think it was worth it. Second, I found the following book to be very helpful: Dr. Patrick Walsh's Guide to Surviving Prostate Cancer Paperback – October 3, 2023. Best $20 I ever spent.

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cudabinacontenda | @cudabinacontenda | Jul 5 6:05am
In reply to @clandeboye1 "I had an MRI T3 which indicated a T2 Signal & PI-RADS 5 following which I..." + (show)
@clandeboye1

I had an MRI T3 which indicated a T2 Signal & PI-RADS 5 following which I had a MRI Fusion Biopsy . The pathology results were negative . The recommended number of cores for the fusion Biopsy is 2 to 4 . I had 5 cores taken .
Unhappy with the conflicting results given the T Signal plus the Rads 5 . I proceeded with a 2nd
T3 MRI , this time with contrast , followed by a 2nd MRI Fusion Biopsy . This time my new Urologist took 16 Cores. The result 6 Cores were Gleason ( Grade 1 ) 3+3 = 6 Cancer .
I am 84 years young . Why did my original Urologist - The previous Head of Surgery and Head of Urology, at a leading big city hospital , not take more samples at the 1st Biopsy . Particularly given my age to prevent the need for a 2nd Biopsy .
It makes you wonder , when typically the more cores are more accurate .
p.s. Both Biopsies were "Transparineal " NOT " the more risky for infection " Transrectal " .
p.p.s. Most Urologists term the MRI Fusion Biopsy -- REAL TIME . This is incorrrect as
images can be slightly distorted in tthe fusion process .
The latest " REAL TIME BIOPSY " is called "An IN-BORE or Gantry Biopsy "
You are in the MRI machine during the Biopsy . Most clinics and hospitals have yet to
catch up with this new procedure -- Equipment costs .

Jump to this post

I’m sorry to hear that things have been so complicated in your diagnosis. I’ve been quite disappointed in some of my doctors on various health matters. And techs have mishandled at least two of my MRIs over the past few years that I’m still upset about. I hope your care team eventually gets you to where you need to be.

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