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Old 12-11-2007, 02:10 PM   #1
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PSA Levels Went Down On Second Test. Should I Still Get A Biopsy?

My PSA tests were always in the 2.6 range. It's been about two years since I had one. I went two months ago and it was 5.1. Doctor gave me the finger examine and said my prostate was nice and small and felt perfectly normal. But he wanted to do a biopsy right away. I mentioned to him I had had sex the night before the test. He said it doesn't matter, despite what I read on all these medical sites on the web that it does. The doctor also told me that anything over a 2.5 in a man over 50 should get a biopsy. Again, in reading the medical web sites, they say 1 to 4 is normal. I thought he was a little to quick with the biopsy and I suggested I do a follow up test. Well my new PSA reading is 4.4. So I'm not sure if I should wait and get a third PSA test in another two months? The lab where I go to the tech said she sees men coming in all the time getting these tests. Men with cancer and men without and views their PSA test results all the time. She claims 4.4 is pretty normal for a 56 year old man.

 
Old 12-11-2007, 03:25 PM   #2
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Re: PSA Levels Went Down On Second Test. Should I Still Get A Biopsy?

There is no such thing as a "pretty normal" PSA figure: many things affect PSA numbers, including infection, inflamation, and prostate size (which is not possible to accurately measure by DRE). The larger a prostate is, the more PSA is produced, so size needs to be taken into account for a PSA number to have real meaning. These are the reasons majority of PSAs in the gray area between 4 and 10 relate to benign causes.

One isolated PSA reading is not all important. What's important is the trend and doubling time. That's difficult for you to gauge right now in the absence of previous regular tests, although it's obviously good that the recent test didn't show a rise.
When discussing the question of biopsy, you could also ask about a "free PSA" test which indicates the probability of PC.

 
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Old 12-11-2007, 07:41 PM   #3
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Re: PSA Levels Went Down On Second Test. Should I Still Get A Biopsy?

Quote:
Originally Posted by rstarre View Post
My PSA tests were always in the 2.6 range..... Well my new PSA reading is 4.4. So I'm not sure if I should wait and get a third PSA test in another two months?
Are you seeing an internist or a urologist? I don't get a lot of confidence in reading your comments on his recommendations and lack of willingness to consider what may or may not give cause to a higher than normal PSA reading. I had been in the 2.5 range (in my early 60s) and when it increased to 3.9 I waited three months and got another that was 4.2. That's when I had a 12-core biopsy and learned that one core was cancerous.

Given my free PSA and other indications, the odds were 70% that it would not have turned out that way, but I was glad to have caught it.

Odds are that you're probably ok, but wanting another PSA (and free PSA) can't be a bad idea for two months from now, and then make the call for a biopsy. Or just go for the biopsy- if they use a little numbing medication it's not so terrible to go through this procedure- for some peace of mind if nothing else. The more cores the better, but they probably won't want to do more than 12 the first time.

What do others think?

 
Old 12-11-2007, 07:47 PM   #4
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Re: PSA Levels Went Down On Second Test. Should I Still Get A Biopsy?

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Originally Posted by daff View Post
Are you seeing an internist or a urologist? I don't get a lot of confidence in reading your comments on his recommendations and lack of willingness to consider what may or may not give cause to a higher than normal PSA reading. I had been in the 2.5 range (in my early 60s) and when it increased to 3.9 I waited three months and got another that was 4.2. That's when I had a 12-core biopsy and learned that one core was cancerous.

Given my free PSA and other indications, the odds were 70% that it would not have turned out that way, but I was glad to have caught it.

Odds are that you're probably ok, but wanting another PSA (and free PSA) can't be a bad idea for two months from now, and then make the call for a biopsy. Or just go for the biopsy- if they use a little numbing medication it's not so terrible to go through this procedure- for some peace of mind if nothing else. The more cores the better, but they probably won't want to do more than 12 the first time.

Yes I was at a Urologist. I have a hard time taking his finger let alone 10 minutes of a needle in there. But if I have to I have to. I was going to try and find someone to give me the twilight shot instead. I had it for Colon and Esophagus scope check and it put me out. I woke up an it was over. Not sure they will do that for a prostate biopsy.

What do others think?

 
Old 12-11-2007, 08:51 PM   #5
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Re: PSA Levels Went Down On Second Test. Should I Still Get A Biopsy?

Quote:
Originally Posted by rstarre View Post
My PSA tests were always in the 2.6 range. It's been about two years since I had one. I went two months ago and it was 5.1. Doctor gave me the finger examine and said my prostate was nice and small and felt perfectly normal. But he wanted to do a biopsy right away. I mentioned to him I had had sex the night before the test. He said it doesn't matter, despite what I read on all these medical sites on the web that it does. The doctor also told me that anything over a 2.5 in a man over 50 should get a biopsy. Again, in reading the medical web sites, they say 1 to 4 is normal. I thought he was a little to quick with the biopsy and I suggested I do a follow up test. Well my new PSA reading is 4.4. So I'm not sure if I should wait and get a third PSA test in another two months? The lab where I go to the tech said she sees men coming in all the time getting these tests. Men with cancer and men without and views their PSA test results all the time. She claims 4.4 is pretty normal for a 56 year old man.
Hi Rstarre,

There is no normal PSA number or range. What is important is the velocity of change. And, a doubling of 2.5 is 5. So, whether 4.4 or 5.1, both are suspicious.

Not to scare you, it could be nothing, but it is not something to fool around with. If something were wrong, god forbid, the earlier it is found, the better.

My husbands prostate felt normal. He is 49. His PSA did not rise as much, % wise, and he unfortunately did have PC

A friend of mine, her husband's PSA was 1, yes 1, and he had cancer. He is very grateful that he was urged to proceed because the cancer happened to be along the outside wall, so it could have penetrated the wall quickly and early. They were shocked.

Others have a PSA of 12 that have no cancer. So, as you see, PSA is a test to determine a further look, with a biopsy. PSA does not determine cancer. A biopsy can.

So, as others have said, see a urologist or get another opinion. I wouldn't ignore this.

Best wishes!
Debbie

 
Old 12-12-2007, 12:04 PM   #6
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Re: PSA Levels Went Down On Second Test. Should I Still Get A Biopsy?

When I was 48 my PSA was 4.5. My DRE's found nothing suspicious. On re-test it was 4.6 and free PSA was 17%. I had a biopsy and my prostate was about 60-65 cc's. My uro thought I'd just be a guy with a high PSA due to a large prostate but I had cancer (2 of 12 positive cores) and had a RRP within 3 months.

I'd say have the biopsy....it's not a horrible thing to go through. It made me what I am today - a 51-year old 2.5 year survivor.
__________________
I'm not a doctor, just a guy who used to have a cancerous prostate....but I got over it...

Last edited by james_wv; 12-12-2007 at 12:07 PM.

 
Old 12-12-2007, 05:59 PM   #7
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Re: PSA Levels Went Down On Second Test. Should I Still Get A Biopsy?

there are lots of postings here on this topic. for me, the idea was was sure, get the biopsy. [sure glad i did. the rest is history] though it is no walk in the park, the procedure is not all that unpleasant and it is over very quickly. you can -- as i did -- get the doc to prescribe a sedative to take before you go in. in retrospect, i wouldn't have needed it, but, hey, why not. the anticipation in the days before the procedure are the hard part; the procedure is very quick, 15 minutes or less from pants off to pants back on.

as for should you have the procedure or not: the wisdom i got was this -- if the course of action you take depends on the results of a test, then have the test. my doc said to me something to the effect of "if it is worrying you, have the biopsy." talk with your doc, get his advice, and so on. you've heard all this, i'm sure.

good luck; keep posting.

 
Old 12-12-2007, 06:10 PM   #8
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Re: PSA Levels Went Down On Second Test. Should I Still Get A Biopsy?

This issue is very confusing. In reading Web MD and other sites like it, I read where having a small prostate with an elevated PSA is cause for concern. Then I read that if there is cancer present, PSA levels never go down. They stay the same or gradually go up. I do have a cyst above my testicle that has been hurting quite often. Urologist said it was nothing to worry about. He gave me anti inflammatories and the pain went away. He didn't think that is what caused the PSA levels to rise. He did give me antibiotics though. Can that be the reason my PSA levels dropped?

 
Old 12-12-2007, 08:03 PM   #9
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Re: PSA Levels Went Down On Second Test. Should I Still Get A Biopsy?

In addition to the free PSA test and the other thoughts already mentioned, there are now a couple of related new tests in use: the uPM3 and its more recent offspring, the PCA3Plus. You can learn details by searching the web, but here is the gist of the PCA3Plus:

If you don't care for the DRE, you will care for this even less, as it involves a longer DRE of about a minute, with the idea that a mild massage causes some cells to be shed into urine, which is collected shortly after the DRE. The sample is sent to one of at least two labs that can do the test. However, the test appears to be more useful than the "free PSA" in providing a key indicator whether prostate cancer is present, and can help patients and doctors decide whether a biopsy is warranted.

This test is very strong where the PSA is weak, and vice versa, so the two together complement each other. Here is a table from the site of one of the labs that runs the test:

.....................................Sensitivity*................Specificity**

PCA3Plus >= 35......................57%............. ...........75%

PSA >=4...............................83%... ......................17%

*Sensitivity means the likelihood that a test can correctly identify the presence of a disease: if the disease is there, the test is likely to find it.

**Specificity means the likelihood that a test can correctly identify the absence of a disease: if the disease is not there, the test is likely to say it is not there.

The ideal is a test that is both highly sensitive and highly specific, but often tests that are high in one are low in the other.

The PSA test fits this description. If prostate cancer is present, the PSA test, which is highly sensitive when the result is 4.0 or higher, is highly likely to show an elevated result. Unfortunately, since the PSA test is not very specific, other causes will lead to an elevated result in many instances, in fact a strong majority of instances.

On the other hand, the PCA3Plus, when the test result is >= 35, meaning greater than or equal to 35, has mediocre sensitivity. However, it is highly specific, in fact four times more specific than the PSA test. Therefore, if the result is negative, meaning less than 35, indicating prostate cancer is not there, it is quite unlikely that the patient has cancer. But, since the sensitivity of the test is mediocre, you would not want to use it alone, as I understand it.

This test is not yet FDA approved, but it has been validated by academic studies and at least one leading commercial laboratory. The leader of this leading laboratory at a talk I heard said that insurance coverage has been excellent.

Has anyone reading this had either the uPM3 or the PCA3Plus?

Jim

Quote:
Originally Posted by rstarre View Post
My PSA tests were always in the 2.6 range. It's been about two years since I had one. I went two months ago and it was 5.1. Doctor gave me the finger examine and said my prostate was nice and small and felt perfectly normal. But he wanted to do a biopsy right away. I mentioned to him I had had sex the night before the test. He said it doesn't matter, despite what I read on all these medical sites on the web that it does. The doctor also told me that anything over a 2.5 in a man over 50 should get a biopsy. Again, in reading the medical web sites, they say 1 to 4 is normal. I thought he was a little to quick with the biopsy and I suggested I do a follow up test. Well my new PSA reading is 4.4. So I'm not sure if I should wait and get a third PSA test in another two months? The lab where I go to the tech said she sees men coming in all the time getting these tests. Men with cancer and men without and views their PSA test results all the time. She claims 4.4 is pretty normal for a 56 year old man.

 
Old 12-18-2007, 01:55 PM   #10
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Re: PSA Levels Went Down On Second Test. Should I Still Get A Biopsy?

Quote:
This issue is very confusing. In reading Web MD and other sites like it, I read where having a small prostate with an elevated PSA is cause for concern. Then I read that if there is cancer present, PSA levels never go down.
My husband was declined for life insurance at age 49 due to a 4.4 PSA and 18% freePSA. His prostate was small. Urologist thought it might be a silent infection and gave a long course of antibiotics. It did come down at first, but was back up 3 months later. They tried a second round of antibiotics, but it continued to climb.

When I obtained his previous PSA's from the GP, I saw the trend over the past few years was a steady climb, 1's, 2's, 3.9 etc. When I mentioned this being a 'red flag' to the nurse, she acted like I didn't know what I was talking about because they were still "Normal." (ugh)

His freePSA kept dropping...18%, 11%, 5%. The doc finally agreed it was time to do a biopsy, and it did show cancer. He had a RRP 2 months later.

I feel safest with the "When in doubt, check it out" motto. Best wishes to you & good luck with your decisions.

L&L

 
Old 12-19-2007, 12:11 PM   #11
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Re: PSA Levels Went Down On Second Test. Should I Still Get A Biopsy?

Quote:
Originally Posted by rstarre View Post
This issue is very confusing. In reading Web MD and other sites like it, I read where having a small prostate with an elevated PSA is cause for concern. Then I read that if there is cancer present, PSA levels never go down. They stay the same or gradually go up. I do have a cyst above my testicle that has been hurting quite often. Urologist said it was nothing to worry about. He gave me anti inflammatories and the pain went away. He didn't think that is what caused the PSA levels to rise. He did give me antibiotics though. Can that be the reason my PSA levels dropped?
I must have overlooked your post until Lilacs and Lillies quoted part of it. Here are several points to consider.

About size of the prostate and PSA - Since normal prostate cells release some PSA into the blood, prostates that are larger due to non-cancerous BPH will produce more PSA than a normally sized prostate. On the other hand, you can see why a smaller than normal prostate that is producing a normal amount of PSA or more would be a concern, though not necessarily a case of prostate cancer. The rule-of-thumb is that prostates produce about .066 ng/ml of PSA for every cc of prostate (from "A Primer on Prostate Cancer - The Empowered Patient's Guide," p. F4). Unfortunately, though doctors can make a rough estimate of prostate volume from a DRE, it takes an ultrasound exam or biopsy to get an accurate size. One of the best known prostate cancer doctors and PSA researchers, Dr. Stamey of Stanford U, turned against screening several years ago basically because he felt there was so much BPH around that many men were getting unnecessary biopsies. (Many of us, including me, think his position is profoundly faulty, though we agree that going off half-cocked on the basis of a single PSA test without considering the trend usually makes little sense.)

You wrote: "Then I read that if there is cancer present, PSA levels never go down." I hope you did not read that in *****, because the statement is flat out wrong, and I would hope the editors of ***** would know better! We have a man in our support group following an Active Surveillance strategy (for about 3-4 years now and doing very well) whose PSA goes up and down a bit, and he has biopsy-proven cancer. Also, a patient can easily get around a 15% variation in PSA just from his own day-to-day personal variation. A man may have mild prostate cancer but also an infection or inflammation, and if the latter two recede or go away, the PSA is likely to decline. Hormonal blockade drugs will obviously make the PSA drop except in rare instances, but even mild drugs like finasteride (aka Proscar) and Avodart will usually drop the PSA by 50% or more. In fact, if a man does have prostate cancer but does not know it yet, failure to achieve at least a 50% drop with finasteride is a strong (but not conclusive) indicator of prostate cancer, according to what I have read and heard.

Regarding antibiotics, if the doctor picks the right one, which is often chancy, they can knock out an infection and that will eliminate the PSA that was associated with the infection. That can amount to a large PSA reduction.

Take care,

Jim

 
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