What is a Quick Rise in PSA?

Posted by spaceguy @spaceguy, Jun 19 4:55pm

I've scanned through quite a few of these topics, but didn't come across any yet that seemed too similar to my situation so I wanted to describe my situation and ask the community. I plan to follow up with my PCP for medical advice when I get my retest results and will follow up with my Urologist if the retest comes back the same, just looking for thoughts and maybe pointers to good information while I wait for the results.

I am 55, I have had BPH for a number of years now, over 10 for sure. But my PSA value has never been high due to that BPH, so it would be odd for it to trigger a high value now. I was steadily 0.6 to around 0.75 for several years and then I bumped up to between 0.9 and 1.1 - varied between those two numbers for about the last 7 years. So I have probably 12+ years of PSA numbers.

I had my annual last week and my PSA was 2.5. I checked my number from last year (and my annual was almost exactly 1 year before) and it was 1.1. My doctor included a note that I should stop by the lab to repeat the test, but it was still well within normal range. A little digging told me normal range is not really below 4 anymore, but is really dependent on age and race and could be 2.5 for me. 3.5 at most. But still - I see his point that, one reading isn't reason to panic and also values can be far higher than that. Note: my PCP did not perform a DRE at my annual. So no information to help there, nor would it have impacted the results.

Then I realized I had a test from October that was also 1.1. So I realized my value went from 1.1 to 2.5 in 8 months. So while the value itself may not be particularly concerning as a single data point, in context of steady values of 1 for many years, then more than doubling in 8 months time, it may be.

I have tried to research what constitutes a sharp rise in PSA and i have come across PSA velocity, and my value is more than double the 0.75. But it is still difficult to find good information on the web about PSA values and PSA velocity and any relation to age and how they factor and when and if someone should be concerned.

Any thoughts about my increase in PSA and what it could mean? Is it fast? Is it too fast? Is 2.5 a number that could be concerning, especially when 8 months ago it was 1.1?

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

I think that your PSA is increasing enough for you to visit with a urologist who is affiliated with an excellent medical group Don’t panic but be proactive My PSA went from 3 then next year 6 then 9. It turned out that I have aggressive PC etc. Good luck!!

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I think you should visit a urologist. Mine PSA went from 4.5 to 9.7 in 6 months. I’m being treated for aggressive PC

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I was very similar. But at 67 I just started having BPH problems. Well I had been having issues but they had become inconvenient. I had my PSA checked at my yearly exam and it was 1.2. Exact same as a year earlier. I went to a urologist for the BPH. He did an exam and said nothing really in your exam. Your prostate is a little oblong. He told me lets just do a simple biopsy. twelve samples then we have no guess work. I had one out of 12 samples with cancer. So cancer with a normal PSA and a little bit of BPH. I have seen where some have said simple biopsy can spread the cancer or its not accurate. I just trusted the Dr. I caught mine very early. So your already on this site. I say your gut is telling you something. Get it checked out.

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Well, not sure why you are not scheduling (as others have said in response to your question) a consult with a urologist to discuss a DRE, then (I know, they suck(, depending on that, subsequent diagnostic tests, a TRUS biopsy (that sucks too), MRI, Decipher Test (there are other non-invasive tests working their way through clinical trials). That DRE along with the subsequent diagnostics could either confirm or rule out whether or not your PSA rise is PCa or something else.

If the former, well, you would have clinical data and time to discuss treatment, if, when, with what, for how long...if the latter, well, good news, you and your medical team can try and determine the problem and address it.

Kevin

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I'm surprised @kujhawk1978 is recommending you follow up on this, not that it would hurt. I would suspect that in the absence of other data, you would repeat the test in either 6 months or a year, whether at the behest of your primary care or a urologist. My primary care did the DRE [finger insertion to check for size and lumps] and then offered me either a referral or an mpMRI, but that was with a PSA of 10, confirmed as 8.8 on retest. Back when I was in my 40s I was followed for several years with a PSA in the 3-4 range. The higher PSA came at 65. A lot of things affect PSA, including vigorous physical activity involving the pelvis (aka biking) and sex. You may have abstained for those for several days before your PSA to ensure you got a good reading.

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Is there something else that has caused this recent spike? You want to make sure that your PSA is accurate as possible - many things can affect it —> https://www.pcf.org/c/make-sure-your-psa-is-as-accurate-as-possible

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@brianjarvis

Is there something else that has caused this recent spike? You want to make sure that your PSA is accurate as possible - many things can affect it —> https://www.pcf.org/c/make-sure-your-psa-is-as-accurate-as-possible

Jump to this post

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@spino

I'm surprised @kujhawk1978 is recommending you follow up on this, not that it would hurt. I would suspect that in the absence of other data, you would repeat the test in either 6 months or a year, whether at the behest of your primary care or a urologist. My primary care did the DRE [finger insertion to check for size and lumps] and then offered me either a referral or an mpMRI, but that was with a PSA of 10, confirmed as 8.8 on retest. Back when I was in my 40s I was followed for several years with a PSA in the 3-4 range. The higher PSA came at 65. A lot of things affect PSA, including vigorous physical activity involving the pelvis (aka biking) and sex. You may have abstained for those for several days before your PSA to ensure you got a good reading.

Jump to this post

My PSA was 2.1 when I was diagnosed accidentally.

in 2010 I had an unexplained DVT, PE and Pneumonia.

My PCP had recently completed continuing medical education where the discussion of the link between cancer and DTV and PEs was discussed. Since we had the discussion about aging, in part how lifestyle was a factor, diet, exercise , managing stress, in part seeing your doctors and having routine physicals and appropriate diagnostic testing and then, the incontrollable factor, genetic crapshoot, she had ordered a colonoscopy. That showed polyps though not cancerous, so, instead of 10 years, I was scheduled to do it again in three years. In December 2013 the gastroenterologist took the time to examine my prostate while I was under anesthesia, (he was the same one in 2010 so guess he did the same then, found nothing to alert him) In the recovery room, he recommended I see my urologist, I did, he did the DRE and said we should follow up with a biopsy. the rest is history.

My reasoning is as my PCP and I discussed, there are two factors you can control in aging, lifestyle and regular visits with your medical team. In my case, the latter is what may have saved my life, finding my PCa early enough. The recommendations of the infamous task force on PSA testing were a result of overtreating. The unintended consequences may be more men being diagnosed with advanced vice localized PCa.

I have no doubt the medical community was over treating in days past. I think today, the pendulum has shifted to more active surveillance based on clinical data, though as evidenced by various folks on this and other forums, there are still those who....

No harm, no foul, my medical team knows when I ask for diagnostic tests, I generally have a reason and as I say, you're not paying for it, so write the script, put the order in...

So, my approach is why not, either confirm or deny using medical diagnostic testing. If it's not, great, if it is, well, knowing is great too,

There are a number of factors which impact PSA testing as we generally all know. I probably should have addressed those in my comments. Your suggestions of another PSA test while accounting for "known" influencers of PSA levels is also a reasonable suggestion.

Kevin

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@kujhawk1978

My PSA was 2.1 when I was diagnosed accidentally.

in 2010 I had an unexplained DVT, PE and Pneumonia.

My PCP had recently completed continuing medical education where the discussion of the link between cancer and DTV and PEs was discussed. Since we had the discussion about aging, in part how lifestyle was a factor, diet, exercise , managing stress, in part seeing your doctors and having routine physicals and appropriate diagnostic testing and then, the incontrollable factor, genetic crapshoot, she had ordered a colonoscopy. That showed polyps though not cancerous, so, instead of 10 years, I was scheduled to do it again in three years. In December 2013 the gastroenterologist took the time to examine my prostate while I was under anesthesia, (he was the same one in 2010 so guess he did the same then, found nothing to alert him) In the recovery room, he recommended I see my urologist, I did, he did the DRE and said we should follow up with a biopsy. the rest is history.

My reasoning is as my PCP and I discussed, there are two factors you can control in aging, lifestyle and regular visits with your medical team. In my case, the latter is what may have saved my life, finding my PCa early enough. The recommendations of the infamous task force on PSA testing were a result of overtreating. The unintended consequences may be more men being diagnosed with advanced vice localized PCa.

I have no doubt the medical community was over treating in days past. I think today, the pendulum has shifted to more active surveillance based on clinical data, though as evidenced by various folks on this and other forums, there are still those who....

No harm, no foul, my medical team knows when I ask for diagnostic tests, I generally have a reason and as I say, you're not paying for it, so write the script, put the order in...

So, my approach is why not, either confirm or deny using medical diagnostic testing. If it's not, great, if it is, well, knowing is great too,

There are a number of factors which impact PSA testing as we generally all know. I probably should have addressed those in my comments. Your suggestions of another PSA test while accounting for "known" influencers of PSA levels is also a reasonable suggestion.

Kevin

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Thanks for the explanation!

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My PSA went from 3.5 to over 5.5 in 6 months I was sent to a urologist and had a biopsy and I don't have PC but I have had BPH for a number of years my previous PSA was in the 1-2 range and then this "spike". BPH can rise PSA numbers. I would go to a urologist and have a visit. If you go before PSA reaches a 3 or so they can do some imaging. If your PSA gets to 5 most urologists will immediately order a biopsy to rule out cancer. My urologist told me that if you have a PSA of 5 or above you have about a 1 in 5 chance of having PC. My dad had BPH and elevated PSA levels without PC. I'm on 2+ years of monitoring for PC and see the urologist for PSA monitoring etc. I most likely inherited this from my Dad.

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