My father is in his early 60s and his PSA level rose from 8 to 12 within 6 months. His prostate has also grown bigger. I am concerned that he may have some kind of aggressive cancer. What are the chances that it's not the case? If it is indeed cancer, what are the chances of getting successful treatment? What would be the average life expectancy?
Hello Rising and welcome to the board! I am now a ten year veteran of a challenging case of PC, and I've learned a lot about the disease (but have had no enrolled medical education). I'll insert some comments in green.
Originally Posted by RisingPSA
My father is in his early 60s and his PSA level rose from 8 to 12 within 6 months. His prostate has also grown bigger. I am concerned that he may have some kind of aggressive cancer. What are the chances that it's not the case?
Your concern is valid, as a doubling time of one year (projected from moving form 8 to 12 within 6 months), if due solely to prostate cancer, is one sign of aggressive prostate cancer. However, even then it is not a conclusive sign, and there are other explanations that have a fairly strong likelihood for explaining some or all of that increase.
First, benign growth could explain a lot of the PSA of 8 and perhaps some of the increase. The rule of thumb, based on research, is that each cubic centimeter (cc) of healthy prostate produces 0.066 units of PSA. A very large prostate of 100 cc would therefore be expected to produce about 6.6 units. However, it would take a healthy prostate of 121 cc to produce a PSA of 8 (8/.066=121), and 121 cc would be an exceptionally large prostate; even more to the point, it would take a healthy prostate of 181 cc to account for a PSA of 12, and I've never heard of a healthy prostate that big. Therefore, it's likely something other than benign growth is responsible for some of the PSA level and velocity in the past six months.
The other most likely culprit (and it is a fairly likely culprit in your dad's case), orther than prostate cancer, is an infection or inflammation of the prostate. That could easily account for a high PSA and a rapid rise. In fact, it's possible that your dad's PSA soared much higher and is now on the way down when the snapshot was taken that showed a 12. One key clue to figuring out what's happening is to have another PSA test fairly shortly. If the PSA continues to rise, and if the pattern fits previous PSA results in what the doctors (and mathematicians) call an exponential trend, that would suggest but not prove there is cancer. Another clue would be to see how your dad responds to antibiotics that are appropriate for prostate infections. It's often hard to pin point what is causing an infection, but often an antibiotic in a trial-and-error approach will knock the PSA down, which is a strong indicator that infection is playing at least some role in causing the elevated and previously rising PSA scores.
Does your dad know the dates and scores from previous PSA tests? Does he know the size estimates of his prostate? Those are valuable pieces of the puzzle.
If it is indeed cancer, what are the chances of getting successful treatment?
They are outstanding! Modern medicine has an arsenal of approaches that often work. No guarantees, but the odds are good.
What would be the average life expectancy?
Prostate cancer is not one of the quick killers like aggressive pancreatic cancer, or lung cancer. Therefore, your question is virtually impossible to answer if a prostate patient gets good care. Partly that's because we have some excellent medical approaches now. Partly it's because prostate cancer medicine is constantly improving. The survival situation is kind of like the situation for testicular cancer about the time Lance Armstrong was diagnosed; testicular cancer was considered a death sentence only a short time before his diagnosis, but he was in the early wave of patients getting a modern approach that has made testicular cancer highly curable. He went on to win all those bike races. My original PSA was 113.6 from a test I got ten years ago yesterday, and my biopsy was quite unfavorable. Two respected doctors estimated my survival at five years, including three good years, based on the best medicine they knew about. Well, I'm doing just fine at ten years and am going strong.
Let's assume that your dad has cancer - which has not been established yet, and that he has a case that is closer to the most challenging end of the range of risk. A fairly new pamphlet from the Prostate Cancer Research Institute (PCRI, a non-profit organization for educating patients) entitled "What's Your Type?" says this: "Good news: Even with High-Risk Prostate Cancer, Survival is Excellent Compared to other cancers, prostate cancer has an excellent 10-year survival rate. With High-Risk prostate cancer, 95 out of 100 men are still alive in 10 years. [The basis is a 2008 May Clinic study.] Remarkably, men with Low or Intermediate-Risk disease are not at any increased risk for dying of prostate cancer within the first 10 years after diagnosis."
The thing for your dad to do is to work with the doctors to find out what is going on. I hope it turns out to be something other than cancer, but even if it is, there's a lot that can be done, and that should leave him room for a lot of joy in life!
I also hope you will get other responses, and feel free to followup with more questions.
Thank you so much for the detailed explanation. As far as I know his prostate size is 2". He does not have any signs associated with cancer or infection such as difficulty urinating or discomfort but I've booked an appointment with an urologist for further tests. The waiting period is hard to get by but your statistics and your own experience are comforting to hear. Also, congratulations on doing well and hope you go on doing fine for a long time .
Well, he had his first PSA test in April when it was 8.8, the second one was in August when it climed to 11.8 and the most recent one in November is 12.8. So it rose pretty steeply in a very short amount of time...