Could Use Some Advice on Rising PSA

Update: I found a highly recommended Urologist and I have an appointment on 9/3. I'm nervous though and it's been on my mind every day since I got my 2.838 PSA reading. I suppose I can't do anything about the worry. Anyway, I'm continuing to push forward!

There's alot of variables involved with psa, age, bph, prostatitis, vigorous exercise before test and how much it rose compared to last year. 2.83 is below the threshold of 4 which usually dictates a retest. Mine went from 3.75 to 4.9 which meant mri which lead to biopsy and now cancer diagnosis awaiting treatment.

..."My Doctor doesn't even mention it or make any note of it because it's still in the middle of the normal range (0 - 4) on the test result chart.,,,"

Well, consider telling your doctor while he (she) is not concerned, you are...there is no set cutoff point that can tell for sure if a man does or doesn’t have prostate cancer. Mine was 2.1...!

As others have said, there are many factors which may contribute to a rising PSA.

The first step may be to rule out other causes..

Before jumping to advanced testing, your doctor may look to rule out common, non-cancerous conditions that cause PSA to spike or steadily rise:

Benign Prostatic Hyperplasia (BPH): A non-cancerous enlargement of the prostate common in aging men.

Prostatitis: Inflammation or infection of the prostate gland.

Physical Irritation: Recent medical procedures (like catheterization), vigorous exercise, or recent sexual activity.

If your PSA remains elevated after a repeat blood test (usually scheduled 1 to 2 months later), your urologist may "start with the "simplest tool in their kitbag, the Digital Rectal Exam (DRE), but, is that definitive, maybe not - https://www.renalandurologynews.com/news/urology/prostate-cancer/eliminate-digital-rectal-examination-prostate-cancer-screening/

So, inquiring minds want to know:

Do I have PCa?
If so, what, where...

Don't put the cart before the horse and start poking around about treatments until you and your medical team have answered those two questions.

You can find other sources, this is from the American Cancer Society - https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/tests.html

This is from the Prostate Cancer Foundation - https://www.pcf.org/patient-support/diagnosis/how-prostate-cancer-is-diagnosed/

Take some time to read through these, jot down your notes, then discuss with your medical team exactly how you are going to definitively answer those two questions, hint, use a multi-prong diagnostic approach, not DRE followed by biopsy...

Kevin

Hi @kujhawk1978, thank you for the great information!

Question for you, it sounds like you were diagnosed with prostate cancer when your PSA was 2.1. Did you have any PSA record prior to that 2.1? I'm wondering what prompted you to get further testing to confirm prostate cancer with a relatively low PSA? Were you having other symptoms perhaps?

Thanks again!

Yeah, PSA was 2.1

My diagnosis journey was "different..."

In September 2010, I was on a work trip to San Antonio. On that Friday, I felt tightness in my chest and some difficulty in breathing. Being 54, I went through heart attack and stroke symptoms, ruled those out, so, got on the plane and started home to Kanas City.

Somewhere over Oklahoma as the pilot said they were beginning their initial descent into KC, I was struggling to breathe. But, hey, it would take just as long to turn around to Oklahoma City as it would to continue descent and landing in KC.

We landed, I called my wife while waiting for bags, told her I was experiencing shortness of breath and tightness in my chest but it "seemed" to be getting "better" and once I got my bags, I would get my car and drive home.

As you can imagine, she said, "I'll meet you at the ER....

So, got my bags, took the shuttle bus to the long term parking lot and drove to the ER, It's a this point some of you ae thinking, "why didn't you call an ambulance...!?" I digress, walked into the ER and was whisked back, I mean 54 years old, "complaining of chest tightness and shortness of breath...

Turns out I had DVTs, PE and pneumonia. When my wife asked the ER doctor how I was after they injected blood thinners, put me on oxygen...his response, "if he makes it through the night...'

I did,

When I saw my PCM, she had just completed a CEMU on the relationship between DV, PEs and cancer so she ordered a colonoscopy. That had polyps, albeit pre-cancerous. Those were removed but it meant I would do it again in three, not ten years.

Flash forward to December 2013, my doctor tells me in recovery after the colonoscopy that I should see my urologist. He doesn't say why, says he'll send a letter to my PCM. Turns out he did s DRE while I was out, found a lump...I saw my urologist, his DRE confirmed, we did s biopsy, the rest is history.

I was not experiencing any symptoms. Since otherwise I was in "excellent heath," my next PSA would have been an annual...who knows, would that have shown an increase, would it have been <4 not triggering alarm, would I have begun noticing symptoms...

We'll never know,

Kevin

@kujhawk1978 Wow, that's a quite unique diagnosis path. Good thing everyone was proactive. Thank you for sharing!

At this time, I believe your urologist will place you on active watch and even then, might be too early. Once you start exceeding 4.0 you definitely have activity for the most part (most often) especially at 3+4 or 4+3 (research). Many men live their entire lives well into their eighties and even nineties with low grade prostate cancer, but then again, being proactive is very smart. Reason, depending on the tumor (if you have any) the location of the tumor and when that time arrives, a decision should be made. Centralized tumors low grade many live with it for many years. Tumors close to the colon wall is of extreme importance (colon cancer). When the time comes (someday), definitely have a URONAV rectal biopsy overlaid with an MRI - 3d mapping and in extreme detail. At this point you are not close enough for that procedure in my opinion. Basic poke and hope biopsies, they miss often. Start researching diet changes - your best defense at this time but not a cure. BTW: there are no symptoms for prostate cancer until late stages and of course most often too late. To add insult. PET SCANS are not accurate (up to 80%, that's all and you must have a significant amount of cancer as well), very expensive, and by that time you already know because of a 3D mapping of your prostate (URONAV)

You did not mention whether a digital rectal exam was done at any point. That test and PSA monitoring is a good start in keeping an eye on things.
I reviewed Johns Hopkins age adjusted PSA index, and your results fall within the normal range. However, the PSA rise does not fall within their normal range as they cite any rise larger than .35 in any 1 year is considered abnormal. You are doing the right thing and following up on it, better safe than sorry.
Good luck

@charlesprestridge I’m right there with you in age and results and starting down the same road you began. May I ask what guided the decision for surgery vs radiation?

@ireland1964

Main reason is to have more options if I have BCR in the future.

I feel at my relatively young age, I will heal and recover OK.

I think my cancer started growing in my mid 40’s. This is based on yearly PSA tests (look back at the results) and size of lesion.

Being younger when the cancer started, has given me concern for future cancer to return.

After meeting multiple times with surgeon, I have felt this is my best choice.

For radiation, I was leaning to HDR. My radiation oncologist is very skilled with both HDR and SBRT.

Genetic tesrs did not find any BRCA concerns.

My Prostox test showed very low risk for SBRT urinary toxicity (long term).

So my options are good either with Radiation and Surgery.

I have prayed and felt surgery gives me the best flexibility for the next 20 years.

Best wishes on your decision.