1. < Prostate Cancer

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?

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tehill | @tehill | Jun 23 1:04pm

If you have several PSA tests and know the dates along with the results.... Sloan Kettering has an excellent calculator available to see what your doubling time is. My oncologist at Mayo uses it. Although there is no set doubling time at which you should "act"; I've found there is somewhat of a consensus that you should take action when the doubling time reaches 10 months. (I am not a doctor. Just my observation)
https://nomograms.mskcc.org/Prostate/PsaDoublingTime.aspx

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1 reply
melcanada | @melcanada | 6 days ago
In reply to @proftom2 "My oncologist does all my PSA tracking. I've spent 2+ years below one after a year..." + (show)
@proftom2

My oncologist does all my PSA tracking. I've spent 2+ years below one after a year triple treatment year (Radiation, Chemo, ADT) for Advanced Stage 4. It recently started rising again. I like that my oncologist already as a plan in place including s trial. Glad you're in the tracking mode.

Jump to this post

Stage 4 in spine Xtandi for a year Now 6th injection of Xofigo Psa up from 10 to 31.4 chemo next ?

80 feel great

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spaceguy | @spaceguy | 6 days ago
In reply to @tehill "If you have several PSA tests and know the dates along with the results.... Sloan Kettering..." + (show)
@tehill

If you have several PSA tests and know the dates along with the results.... Sloan Kettering has an excellent calculator available to see what your doubling time is. My oncologist at Mayo uses it. Although there is no set doubling time at which you should "act"; I've found there is somewhat of a consensus that you should take action when the doubling time reaches 10 months. (I am not a doctor. Just my observation)
https://nomograms.mskcc.org/Prostate/PsaDoublingTime.aspx

Jump to this post

Thanks again everyone for the feedback. I finally heard back from my PCP today. His response that my second result was slightly lower/stable is good and may be my new baseline. Said I should come in to test again in 2 months. I agree with the retest part, but I replied (this is all on mychart) that I would like to discuss the results further as I am more concerned with the rise than the actual number. I have set up an appt (video) to talk to him Wednesday. I am still waiting to hear from my urologist. I mostly need to talk to him to get his thoughts and so he can refer me to another urologist. This is out of his specialty zone. Yes, as a urologist I am sure he understands most of it, but all of his time is very focused in one area. I would personally like as a minimum follow-up an actual exam by and discussion with a urologist.

I had found the Sloan Kettering tool last week. My doubling time is about 7 months and my PSA velocity is slightly over 2. (Using the 2.5 number). Before this last reading my level was pretty steady at around 1 for years.

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jc76 | @jc76 | 5 days ago

@spaceguy
Since you have not had radiation treatments you cannot discuss this is your R/O who could go over the points of rising PSA numbers. Slight fluctuation are completely normal but yours going up that much is not slight. Prior to that test did you refrain from bike riding? How about other activities that can make PSA rise in prostrate.

All those items are good topics for discussion with your urologist. Just pick a reliable one with extensive experience in prostrate cancer and treatments. I had a PSA level of 3.75. That is below normal level of 4.0. However my PCP did not like my PSA rising each time I had a PSA test. It never went back down just steadily climbing. Thus referral to urologist who did MRI found suspicious area, then biopsies and prostrate cancer diagnosis. So it is the steady rising of PSA numbers not really the actual number that is important to monitor as it indicates issues with prostrate most likely but no always prostrate cancer.

A DME can detect a noctual but cannot micorscopic detect prostrate cancer. My DME were all normal. I just had one yesterday at UFHPTI a year after my proton radiation treatments ended. My PSA at the 1 year mark was 0.44 and had steadly gone down since radiation from 3.75. I was told again to expect some flucations and most important was the degree and how much. It will go up and down I was told and already knew that from my own research.
Good luck!!

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1 reply
spaceguy | @spaceguy | 5 days ago
In reply to @jc76 "@spaceguy Since you have not had radiation treatments you cannot discuss this is your R/O who..." + (show)
@jc76

@spaceguy
Since you have not had radiation treatments you cannot discuss this is your R/O who could go over the points of rising PSA numbers. Slight fluctuation are completely normal but yours going up that much is not slight. Prior to that test did you refrain from bike riding? How about other activities that can make PSA rise in prostrate.

All those items are good topics for discussion with your urologist. Just pick a reliable one with extensive experience in prostrate cancer and treatments. I had a PSA level of 3.75. That is below normal level of 4.0. However my PCP did not like my PSA rising each time I had a PSA test. It never went back down just steadily climbing. Thus referral to urologist who did MRI found suspicious area, then biopsies and prostrate cancer diagnosis. So it is the steady rising of PSA numbers not really the actual number that is important to monitor as it indicates issues with prostrate most likely but no always prostrate cancer.

A DME can detect a noctual but cannot micorscopic detect prostrate cancer. My DME were all normal. I just had one yesterday at UFHPTI a year after my proton radiation treatments ended. My PSA at the 1 year mark was 0.44 and had steadly gone down since radiation from 3.75. I was told again to expect some flucations and most important was the degree and how much. It will go up and down I was told and already knew that from my own research.
Good luck!!

Jump to this post

Yes, I noted that above, no bike riding, no vigorous exercise, no ejaculation, no DRE before (or after for that matter), and my other bloodwork and urinalysis showed no signs of infection.

That being said, I went back and looked at old data because I have I believe 14 years worth of PSAs. At my former urologists office, he was attached to a medical college, so I always saw a resident or fellow before I saw him. They always asked me all the questions and then performed physicals before I saw the doctor. There were a couple times (confirmed in my records) where they performed DREs the same day they performed PSAs. The bloodwork was always the last thing that happened at this office after I saw the doctor. So it could be 30 to 60 minutes after the DRE. Those readings showed no difference from the one the year before or after. On one of my earliest visits they performed a DRE during the physical portion. I also had to produce a semen sample for analysis. (I do not recall which occurred first of those two) I also had a PSA test at the end of that visit. That reading was about 0.25 higher than the readings before and after. So I wouldn't expect any of that to have a 1.5 ng/ml impact.

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johnoclark | @johnoclark | 4 days ago

18 years ago my PSA went from 3 to 4 in 9 months. My PCP said get a biopsy. It was cancer Gleason 8. Got robotic surgery. Now no cancer and no prostate and everything works well. PTL!!!

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