I had a routine blood test last year in 2009 and my PSA was 1.8. On 10/25/2010 i had my routine uro exam. He did a blood test and my PSA came back 2.8. He also did a rectal exam which he said was smooth and no hard areas and the right size for my age (51). He wants to do a biopsy to rule out anything ( due to the rise of my psa). I'm worried and have read all over the web to wait another 3 months and get another blood test to see if the PSA went down or stayed the same. Please help, i worried sick. Thanks
Your PSA is within normal limits for a man your age, and with a negative DRE, if it were me, I would not be rushing to a biopsy. You might try a round of antibiotics and/or some finasteride to bring it down, if you are concerned. There are some medications/supplements that seem to have a good effect. Among them are statins, COX-2 inhibitors (e.g., celebrex or ibuprofen), curcumin (turmeric extract) , soy isoflavones, quercetin, EGCG (green tea extract) and melatonin. An option is to see whether you can reduce your PSA with some or all of them and get retested in 6 months.
My PSA jumped around between 3 and 5 for years. Ten years ago, I got a needless biopsy under advice from my doctor when it was around 4 -- it was negative. Last year it started to increase steadily, so I got another biopsy and it was positive. Doctors will always advise biopsies to cover their asses.
Hi,nightwatchman, I see T.A. gave you lots of information that should reduce the anxiety. Unfortunately (in my opinion), we need some better tests that insurance will readily cover. With this vacuum, excessive weight seems to be given to PSA level...and the velocity of any increase. Insurance companies are unhappy about the false positives that lead to unnecessary biopsies. However, doctors worry if they are casual and fail to detect a problem early. They prefer to err on the side of doing too much versus doing too little. Your doctor is to be commended for including a PSA in tests for such a young patient. Do you have prostate cancer in the family (brother or father)? Were these the only two PSAs? Keeping track along with your doctor will facilitate your not being overwhelmed. Did the recent or previous blood tests include a PSA-f? Your doctor must have used that in his deciding it was prudent to recommend a biopsy? You can get some idea reading the literature of the worrisome ranges. Did your doctor discuss this? Above 50% suggests a rise in PSA is more likely to be from benign causes. Your PSA-free may have been below 10% ...and that, combined, with a bit of a rise in the PSA in a year...is significant. With a rise of a point in PSA in a year and a low PSA-free, one could make the case that your doctor wants to make sure you don't have an aggressive cancer in the prostate. The PSA/DRE are just guesses...cancer is detected by a pathologist examining tissue. So ...what would I do? I would get a list of all my previous PSAs and PSA-free...and ask the doctor to explain why a biopsy rather than repeating the PSA & PSA-Free in a couple months.
That's good news. ...about your good health...and no family history of prostate cancer...and no problems found by the finger exam...I would wonder if anything was suspicious besides the rise in the PSA (as you know, benign things can cause a rise in the PSA and I wonder how vigorously the doctor explored that possibility). You did not what he said about the PSA-Free results. I would have presumed he did. Your not mentioning it makes me wonder if it was done. That is a piece of information easily obtained...in regard to a very important decision (go a biopsy) resting on so few pieces of information. Maybe you are comfortable trusting the doctor's hunch and his desire to be certain your prostate is okay.
There are lots of false positives and false negatives with Free PSA. The way my doctor put it was that it was so unreliable that a decision should not be based on it. Many doctors don't do them. Ten years ago my Free PSA was 10% (=positive) so I decided to undergo what turned out to be a needless biopsy. It turned out to be a false positive. I'm glad that I had ten years with none of the side effects of treatment.
Hi, nightwatchman, I don't have a dispute with Tall A. I hope I did not give the impression that the PSA-Free is more reliable than the PSA. As a layman at the mercy of my doctors using a few pieces of information to make estimates, I would like for them to use three or four available sometimes unreliable tests ...than one or two. Your doctor seems to be worried enough to recommend a biopsy. I was just wondering, with a normal DRE, the basis of his rationale.
I am also a layman with a view based just on my personal experience's.
I think the value of a biopsy is that it takes the guess work out of it, when the pathology comes back you know exactly where you stand. To me, even though the pathology was positive, I found it cathartic as I could begin to solve the problem rather than being in limbo.
From my understanding the normal PSA level for a man of 50 years of age unaffected by prostate issues is 0.9.
I was in a similiar situation at 51 with a PSA of 2.8 and a Free PSA of 14.3 and a normal DRE(2yrs earlier it was 2.4 and Free PSA of 27). My feelings were at the time that I was very lucky to have this warning that I may have a prostate issue. I waited 3 months to confirm this with similiar results, 2.76 and 14.5.
I think you are very fortunate that your doctor is encouraging you to have a biopsy as my doctors were doing the opposite and were wrong in their GUESS based on my results. The key with PC is to get it early, you as I see it are in the very lucky situation to be either cleared of PC or to find it early.
Best of luck,
Last edited by letsgetgoing; 09-09-2010 at 09:46 PM.
Reason: normal DRE added
The American Society of Clinical Oncology established the following cutoffs: The age-specific cut-offs which maximised sensitivity and specificity were 2.0 ng/ml, 3.0 ng/ml, 4.0 ng/ml and 7.0 ng/ml for age categories <50, 50-59, 60-69 and >70 respectively. There are lots of false negatives, and even more false positives. You can read about it at: http://www.cancer.gov/cancertopics/factsheet/Detection/PSA (see section 4)
Prostate cancers are usually slow growing. You have to make the decision to seek biopsy or not, and possibly to seek treatment or not, based on your own assessment of risks and benefits.