Could Use Some Advice on Rising PSA

@jeffmarc Hello Jeff,

My grandfather that died of prostate cancer was on my mother's side, and my cousin who was diagnosed with prostate cancer at 56 was my mother's sister's son. So it appears to be on my mother side.

Interestingly, my father had battled high PSAs all of his life from 65 and beyond. I remember having the conversation with him. His remember him saying his PSA was an 8, then 11. He went and seen a Urologist and got DRE and biopsies and nothing was ever found. Then after a while he just never went back. I don't know the final answer on that, or if he was asked to do more follow-ups. He did pass away due to cancer 13 years later and I asked the doctor if this could have started in his prostate but the doctor told me he died of a "smokers cancer" type. My father smoked for 43 years. The cancer my father had that killed him at 78 gave him no warning. He was 77 and moving furniture out of the basement by himself - very strong with no symptoms. He dies in literally 7 months of diagnosis. Never had any pain, even at the end.

My father's also had 2 other son's with a different mother than mine, but neither of them had prostate cancer and they're in their 70s now.

I made an appointment with my PCP for tomorrow to order a PSE test. I'll happily pay for it. then wait to see those results. If it comes back indicating I likely do have cancer, I'll immediately get an appointment at our UoM Urology clinic. If it comes back that I likely don't have cancer, I'll opt to monitor every 6 months through my PCP.

Does that plan sound reasonable at this point?

@mikeg73
The PSE test is a good way to find out whether or not a biopsy is needed.

The grandfather, passing down the prostate cancer risk your cousins passed it down to you just the same. It would’ve been interesting to see what a biopsy of your father’s prostate would’ve shown when he died. That rising PSA is not normal though it could be BPH or a very large prostate.

People definitely get prostate cancer in the lung. Was just reading an article where they were removing that part of the lung that had it in order to resolve the problem long-term.

@mikeg73 Yes, sounds like a plan. Still have the PSE test submitted to insurance and appeal if denied. A lot of commercial insurance is denied just because most do not appeal. I had 5 denials reversed on appeal from prostate cancer diagnosis through treatment usually when it went to external review.

I have an appointment tomorrow with my primary doctor to schedule a PSE test. If the results of that are good, I'll just continue to monitor PSA every 6 months. If bad, I'll schedule an appointment with a Urologist.

Thanks for all the comments.

What you need at this point - is to get more information (since your primary care physician isn’t being proactive):

> With your grandfather (& cousin) having been diagnosed with prostate cancer, have you had a genetic (germline) test to see if you inherited any gene mutations related to prostate cancer? If not, then there need not be much concern there.

> At your next Total PSA test, have them also test your “Free PSA.” PSA exists in two forms - attached to certain blood proteins and also unattached (i.e., “free”). % Free PSA is the ratio of unattached PSA to Total PSA in the blood. A higher % (above 25%) suggests more benign conditions like BPH, while a lower percentage (under 15%) indicates increased risk of prostate cancer.

What you’ll find is that unlike most illnesses, diseases, and injuries, prostate cancer is one of self-advocacy and shared decision-making. You can’t just wait for the doctor to do something.

Next steps:
> express to your doctor that given your family history of prostate cancer (& any other solid tumor cancers that males or females in your family have had), that you’d like to track Total PSA every 6 (or 3) months instead of annually.

> also have them include a “Free PSA” test. (They’ll likely do the % Free PSA calculation for you; if not, you can calculate it yourself.)

> given your family history of prostate cancer, ask for a genetic (germline) test.

Urinating a lot at night may simply be an overactive (or enlarged) bladder…or maybe not. By collecting more information while still tracking your PSA, you’ll have enough information to move to an MRI if needed.

Prostate cancer is usually asymptomatic in its early stages so, the fact that there’s no blood or other serious issues is good, but it isn’t a factor in early detection.

In what country are you located?

It’s not over-worrying. Lack of information is the worst thing. Once you have more information - one way or the other - you’ll have better proactive about your medical care and that often brings mental relief.

Hi,
Similar case, my PSA kept climbing over several years and when it got over 4 my doctor referred me to a Urologist. MRI and biopsy confirmed cancer. Sounds like you are on the right path. When you get to the MRI stage your Urologist can confirm “suspicious areas” and also measure the size of your Prostate. Your increase could be due to an enlarged Prostate(BPH) which is usually non cancerous but does elevate your PSA readings. PSE test might not be a bad idea either.

Dave 3+4

Well, no good result after my visit with my primary doctor again. I went in expecting to order a PSE test but he didn't want to do it. Instead, he said let's do the PSA test again in 6 months and if it goes up again we'll do more testing. I reiterated that it went from 1.4 in 2023, 2.0 last year to 2.8 this year but he didn't seem concerned.

@mikeg73

Make an appointment straight with a Urologist, in the next few months. May take 4-8 weeks to get an appointment. Have them order the PSE test.

Best wishes.