Went to my primary care doctor on Friday for a physical and he did some blood work as well. He said after the rectal exam my prostate did not seem enlarged.
Now on Tues I get a letter saying I am being referred to a urologist due to an elevated PSA result of 17.4.
Does this seem really high and how worried should I be - I'm a white male 54 years old, in otherwise good health but I have been having some discomfort in my groin area and do seem to have to urniate a lot.
Could it be a UTI causing this? Please help - thanks!
I think the referral to the urologist was the right move. If you have been having regular check ups and normal PSA's then this would be a rather large jump in a year and could be due to an infection. I wouldn't start worrying to much but like I said a visit to the urologist sounds right.
High PSA of 17.4 is not unusual in men in their 80's and 90's, but for a 54 year old is suspicious. Quick rise of PSA levels is an indication of cancer. For example, mine rose
from 1.5 to 4.1 in one year at age 63, and I was diagnosed with Prostate Cancer. During the previous 20 years, my PSA level hovered around 1.4 to 1.8. It was the quick rise withing a year - yes 1.7 PSA point rise is significant, even thought it might look minuscule to you with 17.4. Even though the cancer was microscopic and not felt
by the digital exam, my doctor was savvy enough to send me for a biopsy. One core out of 6 tested positive, and I had IMRT radiation treatment.
Since this was your first PSA, and you don't know what your PSA levels were in the previous years, I wouldn't try to guess any opinion. But -whatever the outcome with the urologist is- I recommend that from now on you should have annual checkups that
should include full blood screening - including PSA levels. Feb. 11 is ok. No reason to worry. P.S. I don't mean to scare you, but most men's PSA is below 5, and range 4-8
is considered suspect for further evaluation. But I have an 86 year old cousin in Michigan whose PSA last October was 16, but he doesn't have prostate cancer. Good luck, and let us know how things come out.
One of my friends was in a similar situation to yours with a PSA of 19. he was referred to a urologist and diagnosed with an infection. After a course of antibiotics he was back in the normal range and has stayed there.
Nevertheless a high PSA is cause for concern and follow up. even if it is Prostate cancer it is slow moving so you will have time to explore your options.
Many urologists will immediately order another PSA test, mine did. He a also said that since i was higher double digit in my PSA that the ratio of free PSA to PSa was not a reliable indicator one way or the other. In my case a needle biopsy was indicated and one was done shortly after.
In my case it was positive however having one ordered often results in negative results. I have two brother in laws who have had three biopsies each due to high PSA's and they have all returned negative.
When guys I know are going through this period of uncertainty I usually lend them one of my books dealing with prostate cancer. I think being more knowledgeable can be of benefit whether you have a positive diagnosis or not. If you do have it you come to realize that it is not necessarily a death sentence as many cases are treated very successfully. And even if the first round of treatment is not successful the disease is slow moving for most men and great strides are being made in treatment options.
Most of us go through a high period of stress while we wait for tests and results. The stress level often goes down once we know one way or the other.
Getting back to your question while there is probably no medical necessity to move your appointment up given PC slow movement, you can always ask for a quicker appointment if you think that will reduce your stress level. I assume you are talking about a Feb 11th appointment and if so that is actually pretty quick as I have heard many men who have waited much longer for there initial appointment.
BTW the books that I liked were Dr Myers Beating Prostate cancer and A Primer on Prostate Cancer: The Empowered Patient's Guide by Strum. having the knowledge often lowers the fear level if you test positive. If you test negative it improves your awareness for the future or help a friend or family member with information.
Maybe this will help: Statistically you have better than an 85-87% chance of everything being OK, i.e., not PC. Don't over worry this until it's time to. This could be nothing. But should you get a PC diagnosis, do your homework before doing anything. Read and educate yourself. You do have time on your side right now so keep a calm demeanor and don't let anyone rush you into anything. Plan for a few more consults with a variety of specialists. Remember that surgeons cut, radiologists radiate and they both think that their work is the best, but only you get to decide how you want to live. Keep in mind that the reason that there are so many options out there for early PC diagnosis is because they all get good results. Your biggest enemy is an emotional snap decision without thought.
Best of luck and I hope that you come back with good news!
Thanks Bob - today is one of those days I feel kind of 'plugged up' so maybe it's not PC but a case of Prostatitis? Could that cause a high PSA test?
Symptoms seem to be some abdominal pain that comes and go in the lower pelvic region that originally caused me to go in for the physical. It's been going on for the last few months but wasn't too bad until only recently. Standing is OK but sitting at a computer and sleeping seem to aggravate it.
My PC doctor ruled out anything like appendicitis, ucler, hernia, or H.Pylori. Said Metamucil might help - what do you think?
Hey Bob - just an update - I have been on Cipro (not Keflex) since the 11th - will be done Friday after 3 weeks on the meds. I noticed a decrease in the pain & symptoms right away and thought everything was getting better.
Sunday the 14th I had a return of the symptoms (seemed even worse than before) but they went away as well until this Sunday when all of a sudden I have problems peeing.
Seems I have to go all the time and when I do not much comes out - I am really worried about this now, thinking it might be a permament enlargment.
What do you think? I thought the Cipro was supposed to make it shrink after the infection went away...have not beem back to the Dr. yet although I did talk to her on the phone last week and she said the urinanalysis came back positive and to keep taking the Cipro.
I was hoping that meant an infection that could be cured pretty easily, although I now have my doubts about it...
A permanent enlargement would be BPH, a gradual benign increase in prostatic tissue. BPH is a condition that comes on very, very gradually symptom-wise as the extra prostate tissue puts pressure on the bladder and the urethra. It has no other symptoms than a decreasing bladder capacity and a slowing stream, which is why those urological surveys always ask you about how much you go, how often, stream strength, etc. BPH can take a very long time before it becomes an issue. Infections, on the other hand, are sudden, can be persistent and sometimes difficult to treat. You may find yourself with a couple of different courses of antibiotics, depending on how persistent the strain you have is. Sorry that you are still having problems but the fact that you have improved, then relapsed a bit is very indicative of an infection and not something else. I hope that you beat this infection soon. Good luck.
Just another update - went off the antibiotics a week ago - no real pian or anything but still having some trouble peeing - called the Doctor back to see if she wanted me to continue on the Cipro or another anti-biotic, but she said no and was real insistent to get me scheduled to come in for a cystoscopy which I am real reluctant to do.
I told her I thought we were going to wait for the next PSA test levels to determine whether to do any kind of biopsy at all.
She went ahead and put me down for the 25th but I have heard all kinds of bad results from this.
Any ideas on how I should proceed on this? Thanks again!
While the sensation of having the scope inserted is not pleasant, it's not surgery by any means. It's a very safe procedure and you should not worry about having it done. It is no worse than having a catheterization done. A local anesthetic is used, which is a lidocane gel that's squirted into the urethra to numb you down. Yes, you are going to feel the scope as it goes in, but it's probably more unsettling mentally than anything else-it's something that no guy want's to think about. But once the scope is in, that's about all there is to feel. It does provide a valuable look inside to help diagnose the problem. You'll probably have a little burning when voiding for the first one or two times because of the irritation, but that's gone quickly. I understand your reluctance to have it done, but if your doctor has scheduled it, it's for a very good reason. Granted, no one is jumping up and down to have one done, but you will find that after it's over, that your anxiety was not justified. Just put it out of your head and go and get it done.
OK - I will try but I thought they were going to do a Biopsy on the Prostate first.
Today is a really bad day for me - really having trouble going to the bathroom with some lower G.I. cramping. Just feels like I am plugged up big time - drinking some water and eating bananas - also some manual prostate massage really helps.
You think my prostate could be so enlarged it's clogging me up?
If this has come on suddenly, definitely not. Prostate tissue can't grow that fast. It sounds like something else is going on and this why your doc wants to take that look-see. I'd get that cysto scheduled pronto so that you can get on the road to recovery.
Unfortunately from an infection point of view everything is dependent on what strain you have. Different strains of bacteria are resistant to different drugs. Your doctor has scheduled a cysto, because you are not responding to the current drug course. At this point without a culture from the bacterial infection, any other drug treatment is going to be hit or miss, and the last thing that you want to do is encourage a resistant bacterial strain to become more resistant. The problem with antibiotics that most people don't realize is that failure to fully kill the strain of bacteria that you have leaves behind some of the bacteria which has survived the drug course, and when they reproduce, the are much more resistant to the same antibiotic and the infection can come roaring back, much more difficult to treat. This is why an antibiotic course lasts for several days beyond the subsidence of the symptoms and why a patient should never discontinue a course of antibiotics just because the feel better.