Getting PSA results with impossible fluctuation: What's up?

Well...

As others have indicated, PSA is not a definitive answer...

So, how do I know...!?

But, to my point, DRE and PSA may not necessarily provide a definitive answer to your question, do I or do I not have....if I do, what other clinical data do we need and how do we go about collecting it? If I do not, what is our plan for future monitoring?

Depending on your urologist, he, she, may be open to your questions and willing to explain their rationale for using or not, if not, well, for me, that's a red flag, move on...

PSA is a starter, clearly, looking for trends...keep in mind that consistency is important., same lab, same time of the day, same ire-draw routine 24-48 hours out...

I think the key is to have multiple data points using different means.

Some may be:
https://www.urotoday.com/recent-abstracts/urologic-oncology/prostate-cancer/163806-a-sensitive-and-specific-non-invasive-urine-biomarker-panel-for-prostate-cancer-detection-beyond-the-abstract.html
https://www.medpagetoday.com/urology/prostatecancer/118778
https://www.google.com/gasearch
https://www.google.com/gasearch
https://www.google.com/gasearch
Before a biopsy, consider this...
https://pmc.ncbi.nlm.nih.gov/articles/PMC4495493/
and this...From the Prostate Cancer Foundation website on screening...

...DRE cannot feel prostate abnormalities in the anterior (forward) area of the prostate, away from the rectum, and is often most useful only when the prostate cancer has grown sufficiently to cause cancer that can be felt with a finger. The DRE is no longer recommended as a standalone screening test for prostate cancer.

So, talk with your medical team, discuss a plan to collect sufficient clinical data to determine if you have PCa and how you are going to determine that.

and if not, what's the surveillance plan going forward!?

Kevin

@jeffmarc I attended a webinar of urologists a few years ago. Many of them were sadly commenting on how many thousands of unnecessary prostatectomies they had done over the years for 6(3+3) disease.

But, doctors will often do whatever they’re asked to do. I knew a guy who had a bilateral orchiectomy because he didn’t want to suffer the low-testosterone side effects of Lupron……

I recently was diagnosed with prostate cancer. Total score was 3 + 3. Thankfully I am currently on watch status. As a lymphoma survivor I am taking it in stride.

Hi folks. Just to repeat. According to my uro and my own research fully one third of Gleason 6(3/3) pts require intervention over 5-10 yrs. Ie one out of three. So yes you should NOT intervene on all Gleason 6 pts.BUT. as I've previously outlined I went from Gleason 6(3/3). To 7(4/3) with nasty pathology. PLEASE folks. As imperfect as diagnostic testing is currently don't throw baby out with bathwater.

@dmatisoff
Actually, they say that 50% of people on active surveillance end up having treatment because it advances. It did with my brother after six years.

Getting an MRI and a fusion biopsy really has become essential. Of course people can get a PSE test, which sort of eliminates the question about whether a biopsy is necessary.

I believe a 23 year Eurostudy of >100,000 who had regularly got PSA tests showed a 13% reduction in disease specific causes of death. If regularly followed numbers jump up and it cannot be explained retest at a reasonable interval. IMHO: Then the EpiSwitch ( 'PSE': Prostate Screening Epigenetic) test should separate the "...wheat from the chaff"...a multiparametric 3T MRI with dye enhancement might then be the next step .....an initial 'Gold' standard transperineally ultrasound
MRI fusion might be next.

@heavyphil I don’t get it. Why would you stop PSA testing. I think it is a great tool. It doesn’t cure or diagnose but it can monitor progression once you have established a diagnoses and degree of the condition.

@jeffmarc correct. 25-50%. Which is btw mayo and nih call Gleason 6 as cancer!))

@dmatisoff
UCSF did a talk about active surveillance 5/2025. Here is an interesting slide about the increase in Grade Group for 899 GG1 active surveillance men.

Is even 50% correct?

@tdoriausername Well, that was the problem - they recommended to stop PSA testing because too many men were being ‘harmed’ and it only prevented one man in a thousand from dying from the disease.
We know all too well the result of this misguided recommendation.
Personally, I think this was in response NOT to so many men wanting their prostates removed over cancer fears, but an attempt to stop so many unscrupulous or misguided urologists from telling men ‘You have prostate cancer and you’re gonna die if I don’t operate in you immediately!’
One day, my own GP lamented that he ‘had’ to refer 3 men to the urologist that very morning because their PSA’s were a tad above 4… ‘And you know what THAT means, right?’ he asked.
It was almost as if by screening them he was sentencing them to an awful fate!
And of course the famous “Invasion of the Prostate Snatchers” written in 2010 by Ralph Blum and Dr Mark Scholz made for the perfect storm of fear, confusion and hesitancy to be tested.
After this brief era, the cases of advanced PCa skyrocketed since many, many men - myself included - paused their testing. Hope that helps,
Phil
Phil