Rising PSA number from 5.7 at Biopsy to 6.7 in 4 months with Gleason 6

Normal caveat of "I'm no doc, or expert, just been down this road" From what I've read, you can increase your PSA that much by being slightly dehydrated, riding a bicycle or having sex. I think you would need one more PSA test at least to establish any sort of trend at all.

Not sure when your next chat with the Doc is, but, my guess would be another blood test in 3 months to see if it continues up or it was an anomaly caused by something else.

A .5 increase in a year might be concerning for someone who is younger, with no history and a normal PSA down around 1 or 1.5 as that is a 33.33% increase. Yours is considerably less as a percentage.

You certainly need to keep an eye on it, and you're going to experience the unfortunate side effect of the anxiety, it's only natural, however, it's the next test or two that will likely give you your answers.

So what to do, mitigate the anxiety as much as you can by keeping busy and enjoying life! (pretty much the only thing that works for me!)

Best of luck to you!

When my PSA increased to 6.5 my doctor referred me to an urologist which led to a biopsy (Gleason 6) and the recommendation was active surveillance. I had quarterly PSA's which showed an increasing PSA along with 3 more biopsies and a MRI. Two years after initial diagnosis my final biopsy was a Gleason 7(3+4). Monitor your PSA's and biopsies and you will know when it is time for further action, if required. All the best as you start your journey.

Nothing wrong with having some anxiety. Probably something wrong with you if you didn't. It's normal. Good advice given for continued PSA testing and continued biopsies, that's what active surveillance is! Low genomic test score is a positive as is the fact Gleason 6 does not metastasize. Don't get hung up on the PSA 10 level. Men can have high grade PC with a score below 10. Keep up with scheduled biopsies and I hope you don't see any 4's!

kugrad1975: As I understand it, your biopsy material is good for a year so you may want to have a Decipher test using the biopsy material to test aggressiveness. Maybe the Oncotype DX score can be used for prostate spread issues as well but I thought it was used more for breast cancer. My psa jumped from the earlier years of 1-4 to 6.8, then 8 then 10.2 in a one and a half year period. A prostate MRI really helped me to decide on a biopsy. I had 3+4 Gleason and was 69 when I made my decision for narrow margin radiation. I just turned 70 and have had 5 treatments of radiation finishing in February of this year. For me, I did not want to think about "it" getting worse in the short term, daily, weekly or monthly. I was looking for some sort of relief for a longer period of time with good quality of life.

Thanks for the sage advise!

I would be interested in the details of your Prostate Cancer Journey and treatment decision-making process, IF you are of a mind to share. Thanks ahead of time!

As it was explained to me, the Oncotype DX score is based off the biopsy slides, and tends to indicate the level of aggressiveness and likelihood of metastasis. Based on the information I was provided my score of 17 was deemed low risk for metastasis. A score above 50 was deemed to be high risk for metastasis, but they had data that claimed any one with a score below 25 had a zero to negligible risk of metastasis at 10 years. That claim may have to be taken with a grain of salt!

You're no doubt learning prostate cancer management is not "one size fits all". The calculus is unique for each individual. Age, health status/life expectancy, tolerance of potential treatments including side effects (bowel, bladder, sex), family history of PC, other life goals, etc all factor into decisions. One other thing to throw in the mix is the time from your next PSA to biopsy, then potential treatment. In my case, with me pushing for speed, it took 4 months after the PSA came back until I underwent surgery; often it's six months or more!

Kugrad1975: I am happy to share though I anpologize for the length but I summarized below the best I could so that you could understand my decision process.

After the mri and the biopsy, which they put me out for, I had the Decipher test done. My urologist had suggested either prostate removal or radiation knowing my cancer was contained within the prostate.

I decided the risks of side effects for me were too great with prostate removal. Besides my online research, including Mayo connect, I had a friend who had had one of the first robotic surgeries, and he ended up having a closed system pump inserted because he needed that to have sex. I know there are people that have had successful robotic surgeries and their prostate removed but I wasn’t willing to take that risk and I read that 20 to 30% have biological reoccurrence. It obviously has worked for others, but it just did not make sense for my risk level. I understood that if I had radiation and wanted my prostate removed later on, that I could run into difficulties in finding someone skilled enough to remove my prostate after I had had radiation.

I researched the different types of radiation machines that were available in the market. I narrowed it down to Proton Therapy and the MRIDian Viewray machine. My goal with radiation was to have the least amount of healthy tissue impacted. The proton beam seemed a little more accurate but the mapping process and other process items struck me as being like any other radiation machine. I decided on the Mridian because it was the only machine with 2 mm margins (vs 4-6mm), a built-in MRI, so one could see in real time what was happening, automated gating, so that the machine turned off if the body/organs moved and the radiation started to go outside the mapped area, 5 treatments and it also had dynamic mapping if it was needed. Additionally, the Proton Therapy machines required two people while the Mridian required three and I liked the idea of three people watching over me as they radiated me.

In addition to going on the Mayo web site, nccn.org, Dr Walsh’s book, pcri.org videos and listening to the comments made by patients on there, I spoke with five Radiation Oncologists who’s Cancer Center‘s had the Mridian machine. In the case of Cornell Weill and a radiologist there, I was able to speak to three patients as part of their patient volunteer group who had used the machine for their prostate cancer. That gave me additional insight into both the Mridian machine, the experience on the machine, and the support from the various team members that treated them.

I also spoke with spaceor and their technical department. Again, with protecting the healthy tissue in mind, it gave an extra half an inch protection between my prostate and rectum. I was lucky enough to have a spaceor technician from the company in the operating room as well.

I spoke with the makers of the Decipher test. I was told by a couple of Radiation Oncologists that because the sample size was larger for the Decipher test that it was better than the Prolaris Test, which, by the way, I actually took first. Both had similar results.

I also took a myrisk test to identify male or female genes that might affect my son or daughter, because the Braca gene could affect my daughter if I had it, but I was OK in that direction.

I discovered and read that many of these doctors, even though they have devoted themselves to helping people who are sick with cancer, provided solutions in some cases that were based on their success experience even though there might be better choices around them. That is why back up opinions and back up tests were important to me as part of the process.

It is certainly not a black-and-white decision, but obviously other than PSA, I will not know for a while what my results will be. If I can get four or five years without cancer coming back, maybe by that time, the imaging, the radiation and other choices will be even better.

Sorry about the length and that’s the summary version. Good luck with your decision.

Thanks for your post - I learned a lot (I'm a newly dx'd prostate cancer patient - doing lots of reading to find my best course)