PSA of 4.1 when never previously higher than 1.0

Update: so I made a short-term follow-up appointment with my urologist to have him do a DRE and to discuss his rationale for waiting 6 weeks to redo the PSA vs. an immediate MRI. He believes I have chronic prostatitis complicated by a long history of unexplained chronic testicular pain. (This diagnosis preceded the PSA result.). Note that I just had a contrast-enhanced MRI five weeks ago to evaluate my two hernia repairs for recurrence and look for other potential joint or soft-tissue problems that could explain low-grade pelvic-pain, the symptom that started this whole mess. Unfortunately, this MRI protocol offers little info on the prostate. It’s not good to have multiple gadolinium doses in close proximity, so that’s an additional reason for my hesitance to demand an MRI immediately. Things get so effing complicated sometimes. I’m doubtful that I’ll secure an appointment for a second opinion with a reputable urologist within the 6-week wait period for the PSA redo. So I’m going to have to rely on my existing doc whose credentials are, indeed, impeccable, and I do like him. So that’s where I am.

@cudabinacontenda
You have received some great post with information. MCC is a great source for information and personal dealings with a disease that hopefully one day can be prevented all together.

I wanted to pass on to you that looking at the 4.0 number (standard is that below that is normal PSA) is not what my PCP or R/O or Urologist at Mayo Clinic used to decide to do a MRI, biopsie, and many diagnostic tests. It was the continued rising of the PSA over years. I think you stated once a year you get them. I have been having a 3 month PSA test done for years prior to getting additional test done. My PCP started doing that (testing) every 3 months a couple of years prior diagnostic testing because of rising PSA numbers.

I don't think you need to worry about past CT affecting or giving you prostrate cancer. PC is a very common cancer among men with almost every urologist saying if you live long enough you will get it. Most of the time it is the type Andi that is slow growing and an unique form of cancer with abnormal cells that a lot of R/Os and urologist say subjective diagnosis thus the second opinions on any biopsies.

Many things can cause your PSA to go up. It is important to look at PSA over time and over many tests. Is it one spike and return, one spike and stays the same, or a spike and continuing to rise. It is the spike and continuing to rise that my Mayo doctors did not like. I NEVER got above 4.0 but my PCP decided to refer me to urologist who concurred and ordered diagnostic tests and it was prostrate cancer but caught very early.

I know you will be getting a lot of suggestions and feedback (which is why MCC is here) but insist you have a urologist who is experienced with prostrate cancer. Also consider second opinions. I did and they came back the same diagnosis and same treatment recommendations.

I think I am reading right that you had the only 1 high bump over the years. Have you had a follow up PSA since the little over 4.0? IF not I would be asking now for every 3 month PSA test and then see the trend to single spike, or spike and continuing to rise over time.

Yes, MCC has been so helpful as are your comments. I’m meeting with my urologist on Thursday for a DRE and to discuss the plan. I’m not happy waiting six weeks for a PSA redo and have seen some experts say four weeks is fine. So I want to talk with him about that too.

Cubanna , James here from Vancouver Island . Given what went on here I would get a retest . you could have done something that irritated the Prostate ( bike riding , sex , etc ) . The velocity concerns me a bit. its just the start of BPH, infection or PC . So , not a huge worry . Im also concern about your pain . you need a definitive answer to that . CT scans have such low radiation it wont be that , But I would consider a Ultra sound of MRI next with another blood test . your velocity is way too high . I biopsy to rule out PC may be a step too ! You feeling well other than your odd pain in pelvic region? What did your total hematology say ? White cell count OK ? Liver function test OK . What about blood sugars lipids ? keep us in the loop Sir . Dont worry too much - just be proactive ! Adios mi Amigo / Talk soon , James on Vancouver Island

Hi James, and thanks for your input. All my other blood tests were fine. I had an mri at the end of May before the PSA test to assess my two repaired hernias. I have a recurrence on the left side, but a seemingly intact repair on the right where the pain is. They also looked at all the hip and groin bones, joints, and soft tissue, as well as the lower spine. Some moderate arthritis in both hips could explain some of the pain, as could my long history of chronic testicular pain that multiple imaging tests over the years have never identified a clear cause. The hernia MRI also showed no fluid in the pelvis. My urologist said that, although that particular MRI protocol gives little info about the prostate, it would almost definitely expose an invasive tumor in the pelvic region. I’m seeing my urologist again on Thursday for a DRE and to clarify next steps.

Good morning. I'm a retired Radiologist with a personal history of prostate cancer. I wanted to offer my opinion mainly based on my experience and what I have learned during my 3 year journey with prostate cancer.

I believe most urologists consider year over year rate of rise PSA more important than the actual number. A 20% or more rate of rise in a year is concerning.

Contrasted MRI (I interpreted tens of thousands over my 45 year career) is a great test for almost every part of the body, including the prostate. Like most tests, it is not infallible. Current SOC is to obtain an MRI prior to biopsy to guide the biopsy to any suspicious areas. But a "negative" MRI does not exclude cancer in a suspicious clinical setting (nodule on DRE, rising PSA, etc).

Like all of us, we tend to try to rationalize why we don't have cancer. It's scary. But more scary is having cancer and not addressing it early when it's potentially curable. Case in point-From around 2018 to 2020 I had spiking PSA with a max of 5.6. It would rise and then come down. Negative DRE by urologist and a negative contrasted prostate MRI on a state-of-the-art 3T magnet. I even sent a blood sample to Mayo for fractionalization and they sent back results "PSA < 4, considered normal for age" so no fractionalization performed. I wanted to believe I didn't have cancer so I didn't do anything else at the time. My next visit to my PCP showed PSA now 7.5. Time for action. Urologist said repeat the MRI but biopsy no matter the result. MRI now revealed a 1 cm suspicious enhancing node. Biopsy revealed localized G8 cancer. Had RP 8 weeks later. Johns Hopkins upgraded to G9 (G8-10 are all high grade and treated the same). Three months later my PSA went from 0.016 to 0.37. PSMA PET revealed solitary T8 met. Treated with SBRT to the area. Four months later PSA 4.6 (!!). Another PSMA PET showed new positive pelvic node but no activity in treated T spine. Consult with very experienced MO at Johns Hopkins. Immediate triple therapy with Lupron, Darolutamide and Taxotere chemo. Whole pelvic radiation 3 months later. PSA rapidly undetectable and has remained so (one and a half years). Off Lupron after one year but Testosterone still at castrate level.

I believe the best course of action is to find the best, most experienced team of prostate physicians (urologist, MO, RO) at COE and hear what they have to say. Get second opinion. Choose who you believe to be the most informed and experienced and follow their advice. IMO, it is a fool's errand to take advice (no matter how well intentioned) from laypeople on a cancer forum. They don't know your case, they aren't experts in the field and most opinions are based on personal experience or having read some articles in the literature. This is not meant to denigrate anyone; we are all trying to do our best with a difficult situation.

Best of luck.

Thanks so much for this detailed write-up and sharing your personal story. I’m sorry you needed to go through so much to get to this stable place. I guess that your conclusion in your own case is that your doctor should have been more aggressive with the multiple spikes in your PSA and should have insisted on a biopsy even though the first MRI was negative. I understand that current protocol is that once you get to MRI, a biopsy is taken regardless.

I’m going to get my PSA rechecked and insist on DRE in the interim. I’m also researching experts for second opinions. I’m pessimistic by nature, but trying to hold onto some hope. My Mom’s younger brother had a PSA spike from less than 2 to 5, and it turned out to be prostatitis which I have a history of too. But I’m still very worried (actually scared) and doing what I need to do.

I’m a little worried about gadolinium given that I had an MRI months ago to assess my hernia repairs which I now understand shouldn’t have included contrast. I did have what I guess would be considered a mild reaction to it — I got a 5-inch-long, non-itchy rash on the top of my forearm that went away in about 36 hours. The agent was clariscan. I’m worried about multiple exposures, particularly in a relatively short period. And gadolinium retention has me really anxious in general.

Can you comment specifically about my above gadolinium concerns given your expertise? I’d greatly appreciate it.

Joe

Thanks Did you do Xtandi and Zolodex I did them an Xofigio PSA still high 31.4 mets in spine