Seeking an opinion

Posted by stew80 @stew80, May 30 1:19pm

I had a PSA test in March. It was 12.3. Two weeks later it was 8.6. Three months after that (yesterday) it was 9.5. The free PSA is 1.10. The free percentage is 12%. Recent DRE found no irregularities although the prostate is moderately enlarged. Symptoms are slow to start and a weak stream. Slight burning sensation but urine test is fine. I had a TURP 10 years ago. I have a Urologist appointment next week and I'm wondering what the next steps might be. I am concerned. Could this be benign or is it probable cancer? I'm 83 years old.

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

It is important that all of the blood test are done at the same lab in order to compare the results
Good luck young man!

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Only your medical team can give you genuinely-useful advice, but as a layperson, I'll say that PSA around 10 in your 80s doesn't sound all that bad. A small percentage of prostate cancers (like mine) hit in your late 40s to early 60s and are very aggressive and fast-moving. The rest develop very slowly, and as I understand it, the odds are that you can live on to a good, old age even if you do have an early-stage, low-grade prostate cancer left untreated at age 83.

So the main thing to do is to find out from your medical team (through tests) if you have prostate cancer and if so, if it is the aggressive type. Even if you have a low-grade cancer, it would be entirely reasonable, after discussing with them, to choose (if you wish) to live out your next 15–20+ years without the sometimes-harsh side-effects that cancer treatment can cause.

FWIW, my PSA was 67 at age 56. It had already spread to my spine.

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Thank you for your comments. So comforting to be part of this forum and hear back from those who have treatment history. I wish you well with your journey.

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Stew80, prostate enlargement, the digital exam, infection, age can cause a rise in PSA. If the urology visit doesn't reveal cause, the next step would be an MRI. I hope it's something minor and you get rid of the slight burn.
Best wishes.

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Stew80:I agree with @gently. An MRI would be the next step. At least then you and your doctor can get an indication of whether something is there. If you end up getting a fusion biopsy under a twilight drug, you might want to get a Decipher test to evaluate treatment modes and aggressiveness. Maybe then you and your doctor can decide what treatments may get rid of the cancer, if you have it (vs an infection), in a way that also protects your quality of life. You certainly will see plenty of treatment discussions and experiences on this web site. Get multiple opinions where you can (telehealth consultations) at centers of excellence. Come back and let us know how things are going.

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I will keep you posted. Thank you.

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No kidding. My mind works like this. 3.5 Years on this Advanced Prostate Cancer journey. My take is the Prostate Warranty seems to expire for most men in their 60s. Mine did at 67. My buddies just expired at 80. For 50+ Decades I didn't know what a prostate was. I understood it had something to do with that exam, the Bend-Over exam. After I joined the Advanced Prostate Cancer club I sound the PSA alarm freely without worry. PSA Results posted on "My-Chart" give me and my oncologist plenty to talk about. Mine had been stable for years, now they're rising again for the first time in years. My PSA exams have gone from quarterly to monthly. Good Oncology.

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Just a few minor addition. My prostate cancer was diagnosed at age 69 after about a 1.0 increase in my PSA annually. DRE was ‘normal’. Also prior had some kind of genetic test suggesting I was not genetically inclined towards prostate cancer. Also was on finasteride for ~10 years -finasteride suppresses PSA numbers by ~50% (didn’t know this and my urologist didn’t ‘catch’ this done to sloppy office procedure (prescribed by my PCP)
-get a multi-parametric MRI (new to my hospital in 2019). MY mpMRI showed a tumor in the front of my prostate. Anterior tumors are not typically detectable by DRE.
-consider getting a transperitoneal fusion biopsy (translation= biopsy thru’ the peritoneum not the rectum, fusion=uses MRI data with ultrasound to guide the biopsy.) My not-so-wonderful urologist wanted to do a rectal ultrasound guided biopsy with only 9 cores. I opted into a fusion biopsy at Mayo Rochester with 23 cores.
-I’ll reiterate getting PSA numbers from the the same lab; I had one test at a different lab which was higher - I followed that with another test via Mayo’s lab which showed no change.

-and lastly an unfortunate caution. Because of the profit focus of most US medicine remember that doctors (for example your urologist) make no money when they refer you to a different specialty or facility.

Look at the many good video’s at the Prostate Cancer Research Institute (pcri.org) Also search out “Active Surveillance”

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I was 73 with a PSA of 2.9 and a Gleason of 4 -3 and 3 -4 with a very large prostate (120gms). I elected 5 radiation treatments at Mayo Phoenix. Two weeks after my treatment a study out of England came out with results that said if you did nothing, had radiation, or a proctectomy your life expectancy was 15 years with any choice. You are 83 add in 15 years puts you at 98. How long are you planning to live?

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@mikewo

I was 73 with a PSA of 2.9 and a Gleason of 4 -3 and 3 -4 with a very large prostate (120gms). I elected 5 radiation treatments at Mayo Phoenix. Two weeks after my treatment a study out of England came out with results that said if you did nothing, had radiation, or a proctectomy your life expectancy was 15 years with any choice. You are 83 add in 15 years puts you at 98. How long are you planning to live?

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Respectfully, the 15 year life expectancy numbers are not a one size fits all deal for everyone with prostate cancer. The study out of England does not take into account high risk / aggressive cancer and/or Gleason 8/9 scores. If I did nothing my odds of living 5 more years at age 69 would only be 50%.

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