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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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Hi @heavyphil -
Yeah, I’ve had a TRUS before just to measure my prostate, so I know what that is. However, some information I came across online indicates a TRUS guided biopsy is through the perineal area, with the TRUS guiding the placement. Others just say it is TRUS with needle attached to the TRuS and entry through the rectum. So I am slightly confused on conflicting terminology. That being said, I have also read many things that say the traditional TRUS biopsy (not through the perineum) is the gold standard (with a low risk of complications). So juts curious why you are saying to run if that is the plan? Not questioning - just curious to get further input. (I do plan to get clarification from my doctor). I think I would prefer through perineum, but I haven’t seen anything to indicate that the standard method is bad. (Except for one article I was skimming which I thought sounded pretty negative against biopsies and treatment in general and when it got to metformin and ivermectin as alternative treatments, I promptly stopped reading and closed the page)
Hey spaceguy, the TRUS is called the gold standard because that’s all that was done for years. It is done thru the rectum.
The transperineal approach avoids the rectum (and bacteria) altogether and affords greater access to more parts of the gland, which the rectal approach cannot achieve. See if you can find a diagram online and you will see what I mean.
If you are comfortable with TRUS, go with it; I went looking for a Uro who did TP and it was the best decision I ever made. Best,
Phil
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3 ReactionsYou may want to request a DRE and a FREE PSA test.
Yes, as stated in my post from a few days ago, after the latest PSA (5.0) which included %Free (12) and Free which was 0.59, I went to see Urologist. He performed a DRE, and his only comment there was that one side was more firm than the other side. But given the rise 1 to 2.2, 2.2 to 5, in 2 years, no indications of infection or prostatitis, he thought a biopsy was warranted.
Sorry. I missed that post. I had the same DRE result as you did. 3 different MDs. The sides were 'different' and not 'normal' feeling on palpation. No lump, just firm. My FREE Psa was very telling. Easy for me to say now; the entire process from biopsy through the surgery was sincerely not bad. The worst is the anticipation and unknown. Once it is behind you, you can focus on treatment and healing. All the best.
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3 ReactionsHi heavyphil, thank you for your advice. After i confirmed that my doctor was not doing transperineal, I read some more papers online about the two options to determine if I wanted to change my appointment. I was kind of leaning towards changing to transperineal, purely from an infection risk standpoint. However, in the end most of what I read indicated infection is really rare in either case. I also searched and could not easily figure out which urologists in my area performed transperineal biopsies (they don't make it easy to figure out). So in the end I decided to stick with the appointment I had. I determined it would take me at least a week to find a urologist who did transperineal and then I would have to get an appointment to see them because they wouldn't perform a biopsy without doing their own exam and tests, and then they would schedule me for the biopsy after that and that whole process could take several weeks if not months. I didn't know if I could handle that much more waiting. I also liked the urologist I went to see. He asked a lot of questions, allowed me to ask questions too. As he was performing his exam based on questions he asked, he did more thorough exams based on my answers. When he asked about family history, I explained my father died in his late 50s, long before they would have been testing men for prostate cancer. However, I mentioned a maternal uncle who died from prostate cancer and he listened and included that in his note as familial history. When he performed the DRE he was more thorough than PCPs have been in the past, feeling around on the prostate vs a quick squeeze. He noted it didn't seem too large, but that one side was firm. So based on his thoroughness and also asking how I felt, he didn't want me losing sleep over waiting 6 months or a year for another PSA. He noted if I had prostatitis that my PSA would be much higher so he thought it was unlikely an infection. After the exam and questions he said its possible everything is fine but given PSA history over last 2 years, family history, etc, there is reason to be concerned, and doing a biopsy now was warranted.
All that being said, this morning was the day. So I thought I would give some details about the process and how it went, since so many people say its quick and easy and relatively pain free. I did find a couple studies that said positioning the patient on their back with legs in stirrups was less painful than lying on their side. It also said that this position allowed better views with the ultrasound for the doctor. Although it seems most go with the side position. When I went in the room, I saw a chair type place to sit, so I thought maybe I would not be on my side. I asked the nurse and she said I would be on the side. (The 'chair' reclined, the legs came uo and it became completely flat) Nurse prepped me. A shot of antibiotic in the right glute. A little bit later she put lidocaine in my rectum, using her finger I think. Neither of those caused any pain or discomfort.
Then the doctor came in and talked to me for a minute, going over the procedure and the risks again. When I first got their I saw the probe - and it is not the same probe used for a regular TRUS. In my research of prostate biopsies, it said the probe was about the size of a man's thumb. Yes, a man's thumb if he happened to be a giant or a cave troll. When he got started, first it was his finger - I assume to feel the way and maybe to prep you for it us coming. He then said, 'ok now the probe' or something like that and the probe entering me was so painful, both the pressure of it and the size/shape. Probably doesn't help that the head of the probe is kind of a weird shape, so as he turned it, it hurt. He then did two shots internally to numb the pain. Let's just say the earlier topical lidocaine didn't help much. Or maybe it did and the pain would have been unbearable without it? Again painful. He then said we are going to start taking samples now. I slowed him down by asking a couple questions and then he started. Those first 4 samples were very painful - when the needle jabbed, it didn't hurt - just like a little thump. But positioning of the needle or whatever was going on down there prior to the needle injecting to the prostate - that hurt. The last one on the right didn't really hurt. He then moved to the left side of prostate and on the left side I didn't feel much at all. So perhaps it was that the left side shot worked better or perhaps he didn't wait long enough to start on the right.
I can actually see why the lying on the back position could possibly be less painful. It seems like a more anatomically correct position to be in, if somebody is trying to insert a large object into your anus and rectum. I could also see how that would be a better orientation for the doctor to be able to position the probe - I think it would be easier to look at the perineum and visualize where the prostate is and guide the probe, vs sliding it from the side.
At that point it was over, he reiterated it would take 5-10 business days to get results etc and he left. The nurse stayed on to clean up and to give me 5 -10 minutes to lie there to make sure everything was ok and that I didn't feel light headed. She checked me to make sure I didn't have any unusual bleeding and said I could get dressed and leave when I was ready.
I got dressed after cleaning myself a little better and went to my car. I stopped at the bathroom to make sure I could urinate. I had no problem - when I started there were two little blood clots that came out but other than that my urine color seemed normal. By the time i got to the car, I was feeling a lot of discomfort in my rectal area, so I took two tylenol.
I came home and showered and got in bed and by about two hours after the end of the procedure I was only feeling mild discomfort.
Anyway, sorry for being so long winded and a little graphic, but I figure people looking for more information like first hand accounts - vs the medical website information you find online that says - "quick and easy procedure with mild discomfort. Doctor uses ultrasound to guide procedure, takes some samples and you are on your way." 🙂
I will say, if I ever have to get another biopsy, I will be asking for transperineal and positioned on the back as well.
Now I just have to wait 2 weeks for results, so the waiting begins again.
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3 Reactions@spaceguy
I have to say when first reading your post I thought you were promoting transrectal.
I have read some who have had it done that way not have a problem and most like you stating things like you mentioned. I was original told I would have mine done transrectal but I insisted on transperinial. I did not want the increased chance of infection even though 1-2%
Also we have to look at mental affect of having something done rectally and awake. Stress and anxiety are already high with prostate cancer threat only to have such a procedure done where transperinial is usually done with anesthesia with no anxiety or stress and no pain.
Those on MCC that did have done transrectal and then got infections will tell you bad mistake. Some had horrible experiences with the infection. My urolgoist was so pompous about it saying, "oh if you do get the infection you would only have to spend a couple of days in hospital." WOW I thought "Just a couple of days!" How callous!!
The types of transperenial biopsies are far superior to those of transrectal. I had mine done with a MRI/Fusion technique. When I woke up someone would have had to tell me I had biopsies done as no pain no discomfort and even more important the stress an axiety of having it done transrectal and fear of having a serious infection after procedure.
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3 ReactionsYeah, saw that coming…but you did manage to keep your sense of humor -a cave troll!- so that’s critical in this whole process and bodes well for your ability to handle anything thrown your way.
Totally get it, going with the Uro you liked and I am the same way. My wife rides me for it all the time!! Mr Nice Guy…but NOT when it comes to my life.
Learn from this experience that this is not a popularity contest and It’s all about YOU. The hell with making practitioners uncomfortable or being afraid that they won’t like you if you question their judgement or their preferences.
From this point on you MUST, MUST, MUST question everything anyone says to you, OK? And you can be very polite about it too.
I have been on this forum for a little over a year and the absolute worst things I’ve heard have nothing to do with the cancer; but the treatment(s) rendered to a compliant, ill-informed, trusting patient! So many men who wish they knew this or knew that before submitting to treatment they were assured would ‘cure’ them…so many regrets and unfortunately, there are no backsies, no redos, no Mulligans. You got thru your biopsy, no biggie. But if you have a result that puts you in treatment mode, look on it as your new full time job as editor or proofreader at a major publication. You must only deal in FACTS, not emotions.
Like Ronald Reagan said, “Trust, but verify”…
Wise words, indeed!
Phil
I wonder if Trump verifys everything he says. Lolx3