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Could Use Some Advice on Rising PSA

Posted by mikeg73 @mikeg73, Aug 16 6:58pm

Hello, I'm a 53 yr old male that just returned from my wellness visit with my Primary Doctor and I have my blood work results.

My PSA result is 2.838. Last year (almost to the exact day) it was 2.004. Two years ago in 2023 it was 1.4. So it essentially doubled in 3 years from 1.4 to 2.8.

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.

I'm more concerned because I have a cousin that was diagnosed with prostate cancer at 57 years old in 2023, which is what prompted me to get mine checked at that time. The indicator for him was escalating PSA (over 5 when they diagnosed him). My grandfather also had prostate cancer but it was diagnosed in his late 60 or early 70s.

I brought my concern with my doctor in an email exchange and he said we will continue to track it and if it goes higher than 4.0 he would schedule an MRI.

I don't have any symptoms other than pee a lot at night, but I drink a lot of fluids before bed (40oz or more). I don't have any blood in urine, semen, or any trouble with flow.

I only get my PSA test done yearly as part of my annual physical, and I don't want to wait another year given the rise.

My plan is to schedule another test in 6 months and if it's any higher I will schedule an appointment with a Urologist.

Does my plan sound reasonable? Am I over-worrying?

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Profile picture for fritzo
fritzo | @fritzo | 20 hours ago

mikeg73 @mikeg73

Lots of really solid advice from a bunch of guys who know way more than me. I'll share a little of my decision process below.

First up is my PSA journey; I went from 1.72 eight years ago up to 4.3 last October and now post surgery, I am below <.064 , which is a huge relief.

• 4/22/18 1.72
• 11/5/21 2.43
• 2/26/25 2.96
• 5/20/25 3.07
• 10/17/25 4.3
• 5/18/2026: <0.064

Last October, I was in denial, but with my increasing PSA trend, my PCP sent me to a urologist. The urologist said they could keep on doing PSAs every six months since my PSA wasn't that high or do a MRI. I was like, do the MRI!. My thought was that I could just eliminate the whole issue and not have to worry about it.

Turns out , post MRI , then biopsy and a follow-up PSMA-PET SCAN, I was 3+4=7 prostate cancer.

I explored surgery and radiation. I took a Decipher test (typically done by the radiologist if you are considering radiation), which showed my cancer was moderately aggressive, which meant he recommended hormone therapy on top of the radiation for six months I really did NOT want hormone therapy as a first course of action.

I went with the surgery and the results look to be very good. The tumor was contained to the prostate and the surgical margins (edges of the tissue that they take out) were negative for cancer. My doc said this is as good as it gets.

But, let me explain my thought process on treatment.

First, this is cancer. Recurrence is a very real possibility. I choose the option that gives me the most options for recurrence treatment. I chose surgery because it leaves open more options for follow-up treatment if you need it down the road.

This is simplified:
• If you have surgery first, if there is recurrence you can get radiation/hormone therapy (plus more) later.
• If you have radiation first, surgical removal of the prostate is rarely possible because radiation causes the prostate to shrivel and bind to the rectum/bladder walls. If they try to surgically remove the prostate post radiation, it would likely cause major rectal/incontinence issues as they pry it away from those tissues.

Now, mind you, the doctors may tell you to base your the decision process on the side effects of each procedure based on which set of side effects are the least disagreeable to you. I get it. Both have lousy side effects. Both cause incontinence and ED problems.

Surgery side effects are immediate, but most likely wane over time. Radiation side effects are delayed, but are likely to get worse in time. Surgery incontinence tends to be stress (leakage). I'm told that radiation incontinence is more likely urge (sudden urge to go that is hard to control). Now, I did have some urge issues as well with surgery, and I'll tell you that for me, the urge incontinence was a big problem. The stress (leakage) incontinence is much more manageable. This is just me. Everyone is different.

In my case based on my testing, both the surgeon and radiation oncologist said that either treatment would have a similar positive 10-year outlook for my condition. I chose based on which treatment would best stop my cancer from progressing. I chose not based on side effects, but which treatment left me more options down the road if the cancer came back.

Caveats: Everyone's tumor location and aggressiveness of the cancer is different. Everyone's side effects profiles are very different. So, getting lots of testing done before decision making is key. And know, there isn't one right decision. Ultimately, the choice is yours and you just have to own it. You're doing all the right homework.

Lots of people on the forums are dealing really tough situations. I think they caught my early and my surgical outcome looks to be good. Four months post surgery, my incontinence is getting better every week. It was never dramatic, but is showing good improvement. I actually go less often than my buddies (who still have their prostates, but are likely enlarged). My ED is showing promising signs early (which is rare).

But even though I've got it better than some, it's still no cakewalk. Treatment takes a lot out of you and it takes time to recover.

If considering radiation, definitely get the Prostox test, which can predict how toxic a radiation protocol will be based on your biopsy sample. It might steer you to one type of radiation over another.

Keep asking questions here and make sure you go to a center of excellence!

REPLY
1 reply
Profile picture for mikeg73
mikeg73 | @mikeg73 | 18 hours ago
In reply to @fritzo "mikeg73 @mikeg73 Lots of really solid advice from a bunch of guys who know way more..." + (show)
Profile picture for fritzo @fritzo

mikeg73 @mikeg73

Lots of really solid advice from a bunch of guys who know way more than me. I'll share a little of my decision process below.

First up is my PSA journey; I went from 1.72 eight years ago up to 4.3 last October and now post surgery, I am below <.064 , which is a huge relief.

• 4/22/18 1.72
• 11/5/21 2.43
• 2/26/25 2.96
• 5/20/25 3.07
• 10/17/25 4.3
• 5/18/2026: <0.064

Last October, I was in denial, but with my increasing PSA trend, my PCP sent me to a urologist. The urologist said they could keep on doing PSAs every six months since my PSA wasn't that high or do a MRI. I was like, do the MRI!. My thought was that I could just eliminate the whole issue and not have to worry about it.

Turns out , post MRI , then biopsy and a follow-up PSMA-PET SCAN, I was 3+4=7 prostate cancer.

I explored surgery and radiation. I took a Decipher test (typically done by the radiologist if you are considering radiation), which showed my cancer was moderately aggressive, which meant he recommended hormone therapy on top of the radiation for six months I really did NOT want hormone therapy as a first course of action.

I went with the surgery and the results look to be very good. The tumor was contained to the prostate and the surgical margins (edges of the tissue that they take out) were negative for cancer. My doc said this is as good as it gets.

But, let me explain my thought process on treatment.

First, this is cancer. Recurrence is a very real possibility. I choose the option that gives me the most options for recurrence treatment. I chose surgery because it leaves open more options for follow-up treatment if you need it down the road.

This is simplified:
• If you have surgery first, if there is recurrence you can get radiation/hormone therapy (plus more) later.
• If you have radiation first, surgical removal of the prostate is rarely possible because radiation causes the prostate to shrivel and bind to the rectum/bladder walls. If they try to surgically remove the prostate post radiation, it would likely cause major rectal/incontinence issues as they pry it away from those tissues.

Now, mind you, the doctors may tell you to base your the decision process on the side effects of each procedure based on which set of side effects are the least disagreeable to you. I get it. Both have lousy side effects. Both cause incontinence and ED problems.

Surgery side effects are immediate, but most likely wane over time. Radiation side effects are delayed, but are likely to get worse in time. Surgery incontinence tends to be stress (leakage). I'm told that radiation incontinence is more likely urge (sudden urge to go that is hard to control). Now, I did have some urge issues as well with surgery, and I'll tell you that for me, the urge incontinence was a big problem. The stress (leakage) incontinence is much more manageable. This is just me. Everyone is different.

In my case based on my testing, both the surgeon and radiation oncologist said that either treatment would have a similar positive 10-year outlook for my condition. I chose based on which treatment would best stop my cancer from progressing. I chose not based on side effects, but which treatment left me more options down the road if the cancer came back.

Caveats: Everyone's tumor location and aggressiveness of the cancer is different. Everyone's side effects profiles are very different. So, getting lots of testing done before decision making is key. And know, there isn't one right decision. Ultimately, the choice is yours and you just have to own it. You're doing all the right homework.

Lots of people on the forums are dealing really tough situations. I think they caught my early and my surgical outcome looks to be good. Four months post surgery, my incontinence is getting better every week. It was never dramatic, but is showing good improvement. I actually go less often than my buddies (who still have their prostates, but are likely enlarged). My ED is showing promising signs early (which is rare).

But even though I've got it better than some, it's still no cakewalk. Treatment takes a lot out of you and it takes time to recover.

If considering radiation, definitely get the Prostox test, which can predict how toxic a radiation protocol will be based on your biopsy sample. It might steer you to one type of radiation over another.

Keep asking questions here and make sure you go to a center of excellence!

Jump to this post

@fritzo @gem1128

A lot of great advice, thank you all so much!

I made a slight adjustment to my next steps. I had an appointment with a popular Urologist on 9/3 but I canceled that appointment. I was able to get an appointment with a doctor (family doc & Urologist) at the University of Michigan Hospital at the end of September. I REALLY wanted to be seen by University of Michigan as they are a well recognized center of excellence, so that's my reason for the slight date change. I think that will be especially important if I need further follow-ups and/or more medical procedures.

I'm only 53 years old and I've not had a DRE at this point, just 3 PSA tests so far taken over the last 4 years with results:

8/16/2023: PSA = 1.4
(2024 was skipped)
8/11/2025: PSA = 2.004
8/16/2026: PSA = 2.838

So it essentially doubled in 4 years. No symptoms of any kind except frequent urination at night (5+ times a night) which has been the case for years since 50+. Of course, I drink a lot before bed and that doesn't help.

I'm going to try not to worry too much. I think I'm making the best decisions I can right now, and all of the great advice I get from you all is educating me more on what can be involved.

I really appreciate all of the time you all have spent with sending me your comments. I believe it has guided me into action and now onto a center of excellence for the best care.

Thank you!

REPLY
4 replies
Profile picture for ireland1964
ireland1964 | @ireland1964 | 8 hours ago
In reply to @mikeg73 "@fritzo @gem1128 A lot of great advice, thank you all so much! I made a slight..." + (show)
Profile picture for mikeg73 @mikeg73

@fritzo @gem1128

A lot of great advice, thank you all so much!

I made a slight adjustment to my next steps. I had an appointment with a popular Urologist on 9/3 but I canceled that appointment. I was able to get an appointment with a doctor (family doc & Urologist) at the University of Michigan Hospital at the end of September. I REALLY wanted to be seen by University of Michigan as they are a well recognized center of excellence, so that's my reason for the slight date change. I think that will be especially important if I need further follow-ups and/or more medical procedures.

I'm only 53 years old and I've not had a DRE at this point, just 3 PSA tests so far taken over the last 4 years with results:

8/16/2023: PSA = 1.4
(2024 was skipped)
8/11/2025: PSA = 2.004
8/16/2026: PSA = 2.838

So it essentially doubled in 4 years. No symptoms of any kind except frequent urination at night (5+ times a night) which has been the case for years since 50+. Of course, I drink a lot before bed and that doesn't help.

I'm going to try not to worry too much. I think I'm making the best decisions I can right now, and all of the great advice I get from you all is educating me more on what can be involved.

I really appreciate all of the time you all have spent with sending me your comments. I believe it has guided me into action and now onto a center of excellence for the best care.

Thank you!

Jump to this post

@mikeg73 I’m starting down this road myself and wasn’t aware UM was a COE . I actually have an appt with Karmonas GU department in Detroit next week.
Do you have any input to the difference between UM vs Karmonas?
Thanks for sharing

REPLY
1 reply
Profile picture for gem1128
gem1128 | @gem1128 | 8 hours ago
In reply to @mikeg73 "@fritzo @gem1128 A lot of great advice, thank you all so much! I made a slight..." + (show)
Profile picture for mikeg73 @mikeg73

@fritzo @gem1128

A lot of great advice, thank you all so much!

I made a slight adjustment to my next steps. I had an appointment with a popular Urologist on 9/3 but I canceled that appointment. I was able to get an appointment with a doctor (family doc & Urologist) at the University of Michigan Hospital at the end of September. I REALLY wanted to be seen by University of Michigan as they are a well recognized center of excellence, so that's my reason for the slight date change. I think that will be especially important if I need further follow-ups and/or more medical procedures.

I'm only 53 years old and I've not had a DRE at this point, just 3 PSA tests so far taken over the last 4 years with results:

8/16/2023: PSA = 1.4
(2024 was skipped)
8/11/2025: PSA = 2.004
8/16/2026: PSA = 2.838

So it essentially doubled in 4 years. No symptoms of any kind except frequent urination at night (5+ times a night) which has been the case for years since 50+. Of course, I drink a lot before bed and that doesn't help.

I'm going to try not to worry too much. I think I'm making the best decisions I can right now, and all of the great advice I get from you all is educating me more on what can be involved.

I really appreciate all of the time you all have spent with sending me your comments. I believe it has guided me into action and now onto a center of excellence for the best care.

Thank you!

Jump to this post

@mikeg73

Well if it eases your mind a little more, the Johns Hopkins .35 normal/abnormal point of increase is just about what you have. So, their age adjusted measure has you in the normal range for PSA, and the rate of increase is also normal as your use of 4 decimals can be rounded appropriately to 1.4.
There are so many variables that can account for PSA fluctuations. Since you are on this page, I'm sure you've read them all.
Keep an eye on things. You have a plan. You can't do anything more at this time, so go out and live your life.

REPLY
Profile picture for fritzo
fritzo | @fritzo | 7 hours ago
In reply to @mikeg73 "@fritzo @gem1128 A lot of great advice, thank you all so much! I made a slight..." + (show)
Profile picture for mikeg73 @mikeg73

@fritzo @gem1128

A lot of great advice, thank you all so much!

I made a slight adjustment to my next steps. I had an appointment with a popular Urologist on 9/3 but I canceled that appointment. I was able to get an appointment with a doctor (family doc & Urologist) at the University of Michigan Hospital at the end of September. I REALLY wanted to be seen by University of Michigan as they are a well recognized center of excellence, so that's my reason for the slight date change. I think that will be especially important if I need further follow-ups and/or more medical procedures.

I'm only 53 years old and I've not had a DRE at this point, just 3 PSA tests so far taken over the last 4 years with results:

8/16/2023: PSA = 1.4
(2024 was skipped)
8/11/2025: PSA = 2.004
8/16/2026: PSA = 2.838

So it essentially doubled in 4 years. No symptoms of any kind except frequent urination at night (5+ times a night) which has been the case for years since 50+. Of course, I drink a lot before bed and that doesn't help.

I'm going to try not to worry too much. I think I'm making the best decisions I can right now, and all of the great advice I get from you all is educating me more on what can be involved.

I really appreciate all of the time you all have spent with sending me your comments. I believe it has guided me into action and now onto a center of excellence for the best care.

Thank you!

Jump to this post

@mikeg73 You've got the right frame of mind. It's early and you are ahead of the game and well informed. Get the docs advice, test when the time is right for more info and just enjoy life.

Side note: DRE never showed anything for me (4 different docs never felt a thing). It all depends on the location of the tumor. Also, PSAs are just a warning light, not an indicator that the engine is going to blow. You're listening to the warning light and doing a great job.

Moving to a center of excellence is the best move. Still, make sure to be your own advocate even in these settings.

Glad we all could help in some small way. You're in a good place!

REPLY
Profile picture for Jeff Marchi
Jeff Marchi | @jeffmarc | 6 hours ago
In reply to @mikeg73 "@fritzo @gem1128 A lot of great advice, thank you all so much! I made a slight..." + (show)
Profile picture for mikeg73 @mikeg73

@fritzo @gem1128

A lot of great advice, thank you all so much!

I made a slight adjustment to my next steps. I had an appointment with a popular Urologist on 9/3 but I canceled that appointment. I was able to get an appointment with a doctor (family doc & Urologist) at the University of Michigan Hospital at the end of September. I REALLY wanted to be seen by University of Michigan as they are a well recognized center of excellence, so that's my reason for the slight date change. I think that will be especially important if I need further follow-ups and/or more medical procedures.

I'm only 53 years old and I've not had a DRE at this point, just 3 PSA tests so far taken over the last 4 years with results:

8/16/2023: PSA = 1.4
(2024 was skipped)
8/11/2025: PSA = 2.004
8/16/2026: PSA = 2.838

So it essentially doubled in 4 years. No symptoms of any kind except frequent urination at night (5+ times a night) which has been the case for years since 50+. Of course, I drink a lot before bed and that doesn't help.

I'm going to try not to worry too much. I think I'm making the best decisions I can right now, and all of the great advice I get from you all is educating me more on what can be involved.

I really appreciate all of the time you all have spent with sending me your comments. I believe it has guided me into action and now onto a center of excellence for the best care.

Thank you!

Jump to this post

@mikeg73
Here is a good doc at University of Michigan

University of Michigan health rogel cancer center
Dr. Ulka Vaishampayan MBBS Medical Oncology top notch Doctor

This is a doctor you want to talk to if you have an advanced case but you have to see the urologist first and see what’s going on.

Your PSA is quite low, in the normal range. Yes, it has gone up, but that could be due to something you did in a couple of days before having a test. Doubling in four years is really not normally relevant at all, since age also raises your PSA.

REPLY
Profile picture for mikeg73
mikeg73 | @mikeg73 | 2 hours ago
In reply to @ireland1964 "@mikeg73 I’m starting down this road myself and wasn’t aware UM was a COE . I..." + (show)
Profile picture for ireland1964 @ireland1964

@mikeg73 I’m starting down this road myself and wasn’t aware UM was a COE . I actually have an appt with Karmonas GU department in Detroit next week.
Do you have any input to the difference between UM vs Karmonas?
Thanks for sharing

Jump to this post

@ireland1964 Hello, to be honest, I wasn't aware of Karmanos but I looked them up after reading your comment. It looks like a top Michigan cancer center as well.

I'm mainly looking at the "Best Hospitals for Cancer in Michigan" site at: https://health.usnews.com/best-hospitals/rankings/cancer/michigan

I also have had others recommend me to UofM and I know several people that have had great personal experiences there. Plus, I'm also a graduate of the school (Computer Science though) so perhaps I'm a little biased. 🙂

However, I don't want to guide anyone wrong so I'll be very honest that I don't really have any other knowledge of which hospital is better over another. I'm a guy that's done his best to steer clear of any doctor visits for the first 53 years of my life. I suppose I'm a bit of a wimp; scared of needles, finger pokes, DREs, etc!

However, I now realize at 53 that I need to change my ways. I want to live as long as possible. My son is only 20, and I need at least 20 more years with him. I need to catch up on embarrassing him as much as possible before I ultimately kick the can. lol

Best of luck on your journey! Please feel free to reach out to me if you ever need anyone to talk. I think we're both at our starting points.

REPLY
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