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Old 09-04-2009, 04:09 PM   #1
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Fast-rising Psa, scared

My husband's psa has been steadily rising for the past 4 years or so. He has had 3 -12 sample biopsies and one 6 sample biopsy after a finding of HGPIN. His last 4 psa tests the past two years are as follows: 4.2, 6.2. 4.6 and his most recent, an 8.2! His free psa has now dropped from 17 to 13. I am terrified at the sudden large jump in PSA. He saw his urologist today and he said my husband does not have an infection because the exam would have hurt, so he wouldn't give him any antibiotics. He does not have any symptoms of an infection either. The urologist also mentioned that other than slight enlargement, his prostate felt normal. He is scheduled to get, yet again, another biopsy next Friday. I am so scared that he now has aggressive cancer.
I have been reading that a jump of more than 2 points in psa in one year usually leads to a bad outcome. I am scared and confused and don't know what to think. Thanks for reading.

 
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Old 09-05-2009, 09:03 AM   #2
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Re: Fast-rising Psa, scared

I am new to this test but know the feeling of anxiety and not knowing. My husband has just had his first PSA & CEA. They told me it could be upi to 3 weeks before he gets his results back. His problem is that his CT scan was abnormal. He is having severe pain in his abdomen. They say his Large intestine, spleen and Liver are all swollen and enlarged. Also there is a shadow around his large intestine which showed in a previous Scan in 2006, but is more prominent now. They are unable to do a biopsy because its too big of a health risk for him as he also has Hep C and recently diagnosed with Lyme disease. I am sorry I don't have any real answers for you. Just wanted you to know your not alone. Ive found lots of info on the net in different places. The GI doc told me to arm myself with as much info as possible. So this is what I am doing & printing out info I find to ask about and other possible test to perform. Good luck to you & your husband. GOD BLESS!

 
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Old 09-05-2009, 10:16 AM   #3
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Re: Fast-rising Psa, scared

Hi Looney,

Welcome to the board!

That's a scary ride that you and your husband have been on these last two years. You are certainly getting more than your money's worth of anxiety. I'll insert some thoughts in green. Jim


Quote:
Originally Posted by Looney1 View Post
My husband's psa has been steadily rising for the past 4 years or so. He has had 3 -12 sample biopsies and one 6 sample biopsy after a finding of HGPIN. His last 4 psa tests the past two years are as follows: 4.2, 6.2. 4.6 and his most recent, an 8.2!

Actually, there are some important clues in that pattern, and if you think about it, your husband has not experienced a steady rise, and that could be important: after increasing by 2.0 from 4.2 to 6.2, it dropped by almost the same amount before the recent increase. One of the reasons that's important is because cancer, all by itself - uninfluenced by benign enlargement, infection or inflammation - results in a steady increase; cancer alone does not cause a PSA to go up and down, nor does benign enlargement. For cancer alone, 1,000 cells become 2,000; 2,000 split into 4,000; 4,000 divide into 8,000, and so on, with each doubling taking about the same amount of time, though that "PSA doubling time" is particular to each man's case. If you are into mathematics, that is an "exponential" pattern of increase. Benign enlargement causes, by itself, a gruadual increase in PSA, but not an exponential doubling. However, infection and/or inflammation often causes an up and down pattern in PSA as the disease waxes and wanes. The bottom line: just based on the PSA, your husband's pattern sure looks like infection or inflammation rather than the other two. (But keep in mind that, like most of us, I've spent a lot of time in the School of Hard Knocks for prostate cancer, but have had no enrolled medical education.)


His free psa has now dropped from 17 to 13.

Of course, that is a concern, both the drop and the level. However, unfortunately for free PSA as a test, it is not as selective for cancer as we would like; in fact, infection often causes free PSA to drop. Therefore, in light of your husband's see-saw PSA pattern that is typical of infection, you could probably notch down your worry level a bit - not all the way, but down a little.

I am terrified at the sudden large jump in PSA.

The PSA test dates are important here. While a sudden large jump - short period of time - could indicate a very aggressive cancer, that is quite unusual in this era of regular PSA screening. On the other hand, an on-and-off chronic infection could easily account for a big jump. My hunch is that a jump from a PSA from 4.6 to 8.2 in a short (how short?) period is more likely to be due to an infection, especially in view of the history of a previous substantial jump, followed by a decline.

He saw his urologist today and he said my husband does not have an infection because the exam would have hurt, so he wouldn't give him any antibiotics. He does not have any symptoms of an infection either.

This is where I wish I knew more about diagnosing prostatitis (infection or inflammation of the prostate gland). My impression is that some infections do act like what your husband is experiencing: no symptoms, and not painful on examination, but I'm not that sure. I do know that urology experts concur that some cases of prostatitis are very hard and sometimes impossible to diagnose, and that challenging the condition or tissue culture with various medications is a common tactic. Maybe one of our other board participants knows more about diagnosing prostatitis, especially in the absence of pain during an exam.

The urologist also mentioned that other than slight enlargement, his prostate felt normal. He is scheduled to get, yet again, another biopsy next Friday.

There is a fairly new test that can help rule prostate cancer pretty much in or out in conjunction with PSA tests, and unlike the PSA and free PSA tests, it is not thrown off by prostatitis. The latest version is known as the PCA3Plus test; it is based on a urine sample, collected shortly after an "attentive" DRE that causes some prostate cells to be shed into the urine. It is strong (specificity) where the PSA test is weaker, and to some extent vice versa (weaker on sensitivity - it takes a stronger "signal" to indicate prostate cancer). Bostwick Laboratories, run by one of the world leaders in prostate cancer pathology, is one of the labs that can do this test, with samples shipped in from anywhere.

If it were me, after four negative biopsies, I would want to give this test a try before having a fifth biopsy, but that is a highly individual call to make. Many doctors do not yet know about this test (used to be known as the uPM3 test), or have not used it, but the number is growing. It has been discussed on this board.

Also, rather than going down the same biopsy road again, if the PCA3Plus test resulted in a substantial likelihood of prostate cancer, your husband could consider either a color Doppler ultrasound (CDU) guided biopsy or a saturation biopsy, even the "3D mapping" type of saturation biopsy favored by Dr. Gary Onik of Celebration, Florida. There are, unfortunately, only a handful of sites with the expertise to do a good CDU biopsy, but I think it would be worth it to get the added precision and information that biopsy affords. It's big advantage is that it can determine and display where new blood vessels are growing in the prostate, and the resulting sites ar where there is likely to be prostate cancer.


I am so scared that he now has aggressive cancer.
I have been reading that a jump of more than 2 points in psa in one year usually leads to a bad outcome.

That's true, and it's good that you are aware of it, but, if the increase is due a little to BPH and a lot to infection, it seems quite possible that none of it is attributable to prostate cancer.

I am scared and confused and don't know what to think. Thanks for reading.
You're welcome. Please followup if you have additional questions. I hope you can keep your spirits up during this scarry time.

Take care,

Jim

 
Old 09-05-2009, 03:19 PM   #4
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Re: Fast-rising Psa, scared

Hi again Looney1,

I'm adding a postscript to my response to your first post regarding the "bad outcome" you have learned about when the PSA rises more than 2.0 in the year before diagnosis. That's a very important point, only appreciated in the past few years, but the research is really about more aggressive cases than bad outcomes, as explained below.


Quote:
Originally Posted by Looney1 View Post
... I am so scared that he now has aggressive cancer. I have been reading that a jump of more than 2 points in psa in one year usually leads to a bad outcome. I am scared and confused and don't know what to think. Thanks for reading.
There's a better way to put that information about a velocity of more than 2.0 points in PSA in the year before diagnosis: research showed that it raised the risk of a bad outcome in the cases studied. There's a very important characteristic of those cases that is not true for men facing prostate cancer today: those men were all treated well in the past. That often makes a huge difference in outcomes. For one thing, doctors treating those men did not have the benefit of this important clue about a PSA velocity of greater than 2.0 making a difference. That information was first published in 2004, just a few years ago. Before that, docs did not know they needed to be extra vigilant, and probably extra aggressive in treating those cases.

For the record, the D'Amico teams that first published this finding published about surgery patients in 2004, and then about radiation patients in 2005. The 1,804 patients in the surgery study were at least mostly Dr. William Catalona's patients and were treated between January 1989 and June 1, 2002, for stage T1c or T2 prostate cancer; basically, they were treated in the 1990s, so most of them were treated more than a decade ago. The radiation study involved 480 men treated in a hospital associated with Harvard Medical School, and these men were treated between January 1, 1989 and December 1, 2002, again, basically in the 1990s. Therefore, again, most would have been treated more than a decade ago.

There have been numerous important advances in prostate cancer technology since then, including cure/recurrence monitoring, primary treatments, how and when to use treatments, and followup treatments. We also now know that lifestyle tactics and certain mild drugs have a good chance of helping us.

As just one concrete instance of a major treatment advance in this decade, regarding radiation, the minimum extrenal beam radiation dose to the prostate was 70.35 Gy in the radiation study, and, while that would not mean much to you at this point, it is now known that that the extrenal beam radiation dose to the prostate should be in the neighborhood of 80 Gy, generally plus or minus 2 Gy. (This assumes a conventional dosing schedule, but that's another story that does not affect the point here.) The lower dose was inadequate to kill some prostate cancers in the prostate, whereas the higher dose is highly effective at killing such cancer, and it is now known how to deliver that kind of dose safely.

If you want more information about the research on the significance of a velocity above 2.0, I started a thread about it on 12/13/2007, "PSA velocity >2.0 and assessing seriousness of prostate cancer." (I'm quite familiar with the research; in fact, as a patient representative, I heard Dr. D'Amico give a preview to his expert peers at an FDA workshop. I've kept fairly good track of followup developments.)

The bottom line here is that the past can help us figure out what is going on in the present, but what happened in the past is not a good guide to our current destinies.

Also, your husband may not have prostate cancer. Sorry, we can't let you in our club until he is diagnosed. I know you are disappointed about that, but you and he can be associate members in good standing.

Finally, this is coming from a guy with a baseline PSA of 113.6, and it's a sure bet that my PSA was rising at a rate well above 2.0 per year. I am now doing quite well (knocking on wood and praying while I write this), with a good quality of life and cancer apparently under great control, as I near the end of my tenth year as a prostate cancer survivor.

Take care,

Jim

 
Old 09-05-2009, 04:20 PM   #5
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Re: Fast-rising Psa, scared

Hi ladybugjen3,

I'm sorry that you too have found a need to check this board , but I hope you will find some useful information. Please feel free to start a thread of your own if the PSA comes back and concerns you and your husband. I'll add a few thoughts in green to an excerpt of your post. By the way, my wife and I are graduates of Wake Forest, and we are fond of North Carolina.


Quote:
Originally Posted by ladybugjen3 View Post
... My husband has just had his first PSA & CEA. They told me it could be upi to 3 weeks before he gets his results back.

That's a long time for PSA results. I suggest you become a squeaky wheel, perhaps by mentioning that you've learned that most labs report results within a few days (true), and asking if there is a special problem with the lab your husband's doctor uses, and if so, if the results could be expedited. Maybe that's too abrasive an approach, but I don't think the doc and his staff are paying you and your husband the attention you deserve.

His problem is that his CT scan was abnormal. He is having severe pain in his abdomen. They say his Large intestine, spleen and Liver are all swollen and enlarged. Also there is a shadow around his large intestine which showed in a previous Scan in 2006, but is more prominent now. They are unable to do a biopsy because its too big of a health risk for him as he also has Hep C and recently diagnosed with Lyme disease.

There is a fairly new prostate cancer test available that is based on a urine sample following an "attentive" (meaning longer than usual, about a minute, DRE - not exactly a "finger wave"). Together with a PSA result, it can go a long way toward indicating whether there is prostate cancer, though a biopsy is the only sure way. Bostwick Laboratories is one of the labs that does this test; they were the lab that pioneered this test in this country. The test is known as PCA3Plus. A simple blood test, the "free PSA test", could also be useful.

Take care and hang in there,

Jim


...

 
Old 09-06-2009, 08:41 AM   #6
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Re: Fast-rising Psa, scared

Hey Jim,
Thanks for the info. Any responses durring this waiting game are greatly appreciated. What I didn't mention in this post, but on another board & post of my own.....My husband also has Hep C wich didn't respond to treatment, Cirrhosis, recently diagnosed with Chronic Lyme disease. He has been battling the Hep C for over 8 years, and at this point we are begining to think possibly the Lyme also undiagnosed for almost as long. Both disease have alot of the same symptoms. So I am concerned we are going to be facing some tough weeks ahead.
I am gald you love NC. We live north of Winston Salem, and only 12 miles from the VA border.
Also my husband is a veteran. Thats where he contracted the Hep, and also who is doing the testing. Thats probably why they said the wait would be so long. Maybe that sheds more light on this situation. Thanks again for you input. It means alot. Jen in NC

 
Old 09-06-2009, 08:19 PM   #7
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Re: Fast-rising Psa, scared

Quote:
Originally Posted by IADT3since2000 View Post
Hi Looney,

Welcome to the board!

That's a scary ride that you and your husband have been on these last two years. You are certainly getting more than your money's worth of anxiety. I'll insert some thoughts in green. Jim




You're welcome. Please followup if you have additional questions. I hope you can keep your spirits up during this scarry time.

Take care,

Jim
Thank you so much for your thoughtful and informative post. I really want you to know how much I appreciate the time and effort you put into it to help a terrified complete stranger. I can't thank you enough. Your post has given me some hope to cling too, especially after reading about the outcome you have had with your battle. It really gives me hope to hear that even if he does indeed have cancer, even an aggressive form, that there is always hope of a positive outcome. I will definitely have him look into the PCA3Plus test, that is great advice. Thanks again.

 
Old 09-06-2009, 08:24 PM   #8
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Re: Fast-rising Psa, scared

Quote:
Originally Posted by ladybugjen3 View Post
I am new to this test but know the feeling of anxiety and not knowing. My husband has just had his first PSA & CEA. They told me it could be upi to 3 weeks before he gets his results back. His problem is that his CT scan was abnormal. He is having severe pain in his abdomen. They say his Large intestine, spleen and Liver are all swollen and enlarged. Also there is a shadow around his large intestine which showed in a previous Scan in 2006, but is more prominent now. They are unable to do a biopsy because its too big of a health risk for him as he also has Hep C and recently diagnosed with Lyme disease. I am sorry I don't have any real answers for you. Just wanted you to know your not alone. Ive found lots of info on the net in different places. The GI doc told me to arm myself with as much info as possible. So this is what I am doing & printing out info I find to ask about and other possible test to perform. Good luck to you & your husband. GOD BLESS!
I hope that everything works out for you and your husband. It sounds like you have been through some scary and trying times, and I hope and pray that everything will go well for you both.

 
Old 10-13-2009, 01:07 PM   #9
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Re: Fast-rising Psa, scared

try to settle yourself down a bit. my dr. assured me that of all the cancers, prostate cancer is the slowest developing. most important is that he ios bering monitored by a pro. easy for me to say "settle down" but try to get a perspective for your husbands sake. positive attitude is most important. be well. g

 
Old 10-14-2009, 10:53 AM   #10
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Re: Fast-rising Psa, scared

Update: My husband went to our family doctor and he put him on a sulfa drug for 30 days. We hoped that would lower his psa, but that is not the case. My husband got his psa retaken, and unfortunately, it was still 8.2. I am really disappointed, I thought for sure he had an infection, but it seems it is not the case. He has an appointment with a new urologist tomorrow, who I assume will want to do yet another biopsy. It is very frightening thinking he may have cancer and have a nearly 4 point rise in his psa in a year, which may mean it is very aggressive.

 
Old 10-14-2009, 05:33 PM   #11
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Re: Fast-rising Psa, scared

Hi Lonney - good to see you back!

I'll insert some thoughts in green. Jim


Quote:
Originally Posted by Looney1 View Post
Update: My husband went to our family doctor and he put him on a sulfa drug for 30 days. We hoped that would lower his psa, but that is not the case. My husband got his psa retaken, and unfortunately, it was still 8.2. I am really disappointed, I thought for sure he had an infection, but it seems it is not the case.

It is much too early to conclude there is no infection based solely on a stabilized PSA after one month of sulfa. Prostatitis can be caused by a number of disease agents, and sulfa may simply be the wrong drug! Prostatitis is also slippery; sometimes the cause is never found; doctors often use a trial and error approach, trying a number of drugs until hopefully they find one that eliminates the infection.

I just searched www.pubmed.gov, a source we can use on this board because it is Government sponsored, for " prostatitis AND sulfa ", which yielded three hits. The second seemed most relevant, and here's a key quote from the abstract: "Prostatic tissues are best penetrated by drugs with a high pKa and high lipid solubility, such as quinolones, macrolides, tetracyclines, and sulfa drugs. Ciprofloxacin has been shown to be effective in the treatment of chronic bacterial prostatitis caused by Escherichia coli. The older quinolones demonstrate superiority against chronic bacterial prostatitis caused by gram-negative pathogens; the newer quinolones may be more effective against gram-positive pathogens and anaerobes." I'm pretty shaky on some of these details, often the way it is when we check PubMed, but I can see clearly that different causes of prostatitis are involved and that each is best treated by certain drugs and not others.

Here's another "glass half full" (vice "glass half empty") kind of point: your husband's PSA over the past month has been stable. Now the time is quite short for saying that his PSA is not increasing; for instance, his PSA may be increasing so slowly that you cannot see a change in just a month. On the other hand, his PSA may truly have stabilized, and that would not be characteristic of prostate cancer! If his PSA is increasing due to cancer, it appears the increase may be happening quite slowly, suggesting a slow-growing cancer.


He has an appointment with a new urologist tomorrow, who I assume will want to do yet another biopsy.

I wouldn't be surprised if the doctor instead wanted to try another drug agent to again try to smoke out an infection, instead of going for the biopsy.

It is very frightening thinking he may have cancer and have a nearly 4 point rise in his psa in a year, which may mean it is very aggressive.

Consider this: if your husband's PSA velocity is 4 points per year, that suggests, roughly, an average increase of .33 per month (and actually the increase would be "exponential" so at this point the monthly increase would be somewhat greater than .33 - that's why I wrote "roughly"). That would mean your husband's PSA should have been 8.2 + at least .3 = at least 8.5 after a month, but it was not! That clue is certainly not the whole ball game, but it is encouraging.

It's possible your husband may have an infection and also cancer, with both boosting the PSA, but my hunch is that he just has an infection.

Does all this make sense to you?

Please keep the board posted.

Good luck to you both and hang in there,

Jim


PS - I realize that you and your husband are eager to join our exclusive club, and just having prostatitis is not good enough to qualify. However, if you really want to get in the clubhouse, knock three times on the door and tell them that Jim sent you!

Last edited by IADT3since2000; 10-14-2009 at 05:57 PM. Reason: Added tip on joining our club.

 
Old 10-14-2009, 06:27 PM   #12
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Re: Fast-rising Psa, scared

Thank you so much for again responding to my post. Your extensive knowledge is most welcome. I am so frightened right now, that I am thinking out of fear instead of with my head. It was a nice reprieve for the past month putting it all out of my mind, but it seems we have to deal with it head on again. I should quit complaining though, there are many, many people that certainly have it a lot worse. I will post again tomorrow when I find out what the uro says. Thanks again.

 
Old 10-17-2009, 11:14 AM   #13
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Re: Fast-rising Psa, scared

Quote:
Originally Posted by Looney1 View Post
My husband's psa has been steadily rising for the past 4 years or so. He has had 3 -12 sample biopsies and one 6 sample biopsy after a finding of HGPIN. His last 4 psa tests the past two years are as follows: 4.2, 6.2. 4.6 and his most recent, an 8.2! His free psa has now dropped from 17 to 13. I am terrified at the sudden large jump in PSA. He saw his urologist today and he said my husband does not have an infection because the exam would have hurt, so he wouldn't give him any antibiotics. He does not have any symptoms of an infection either. The urologist also mentioned that other than slight enlargement, his prostate felt normal. He is scheduled to get, yet again, another biopsy next Friday. I am so scared that he now has aggressive cancer.
I have been reading that a jump of more than 2 points in psa in one year usually leads to a bad outcome. I am scared and confused and don't know what to think. Thanks for reading.
Not always is there a bad out come. My PSA jumped more
than 2 pts. in a year. I had a biopsy, found early cancer, had RPS at U.W. Madison Hosp., Madison, WI and am now fine. Last PSA was zero. Hope all goes well.

Last edited by ldskier; 10-17-2009 at 11:16 AM.

 
Old 10-18-2009, 08:38 AM   #14
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Re: Fast-rising Psa, scared

Quote:
Originally Posted by ldskier View Post
Not always is there a bad out come. My PSA jumped more
than 2 pts. in a year. I had a biopsy, found early cancer, had RPS at U.W. Madison Hosp., Madison, WI and am now fine. Last PSA was zero. Hope all goes well.
Thanks so much for your reply. It helps a lot to hear about other people's good outcomes.

My husband visited a new uro a few days ago. He thinks he has an infection of some kind and we are waiting for the results of a urine culture. If that is negative, they will do more tests. While I was thrilled that the uro thinks my husband has an infection, I am sort of alarmed that he did find a "small bump", however, that could be from an infection too. I guess we will just hurry up and wait.

I hope you continue to have low psa readings, and thanks again for the encouraging reply.

 
Old 11-13-2009, 06:44 PM   #15
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Re: Fast-rising Psa, scared

I hope your husband's rising PSA is something other than prostate cancer...have there been any further developments?

In 1998, my husband PSA rose steadily and finally reached 12. He was put on antibiotics from the beginning and that brought the levels down a bit but not enough. When the PSA reached 12, he had a biopsy and ultrasound and it showed Benign Prostatic Hyperplasia...that was a relief! Then in 2003, while in surgery for rectal cancer, it was found that his prostate was very large and almost a year after the cancer surgery, he had a TURP operation to reduce the size of the prostate. That surgery was very successful, there was no malignancy and the PSA came down to, I think, around 1. For the next couple of years, the PSA remained low until six weeks ago when he had his annual test and it was 8 and now is 9. He is to see the urologist on the 24th and we are of course concerned. I am of course hoping it is just a return of the BPH but the numbers seem to be going up so quickly.

Alison

 
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