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tonesie 02-12-2011 03:21 PM

Rising PSA but no prostate enlargement
 
My PSA is measured every year .
In the last 4 years it has gone from less than one to ten (confirmed with repeat test).
The ultra sound of my prostate shows a size of 16 cc and the comment that it is "unremarkable".
I have no prostate type symptoms .
This leaves me puzzled as to what conclusion to draw from the PSA reading increase.
Your thoughts are invited.

IADT3since2000 02-12-2011 04:29 PM

Re: Rising PSA but no prostate enlargement
 
Hi tonesie,

Welcome to the Board, but I hope you won't have the results that would cause you to become a frequent participant. :)

A PSA increase is almost always due to one of three causes: benign growth, infection or inflammation, and prostate cancer, with prostate cancer as the least likely cause. In your case, as I think you are aware already, benign growth has been ruled out. There are several rules-of-thumb, based on research, for how much PSA should be expected from healthy prostate tissue (no infection, no cancer), and one rule is to multiply the prostate volume in cc by 0.066, or 16 X 0.066 = 1.056 in your case; another rule is to multiply the gland size by .1, which equals a PSA of 1.6 for you. Obviously, benign growth does not account for much of the PSA.

Your current PSA of 10 puts you in the area where prostate cancer is a possibility :confused:, but the rise from 1 over the past four years also could be due to an infection, chronic or temporary. Infections can drive PSA really high, with 50 being quite possible and as high as 200 in rare instances.

The pattern of increase is often a valuable clue. Prostate cancer is usually distinguished by a constant time period for the PSA to double. In other words, it goes from, say, 1,000,000 cancer cells, which divide, into 2,000,000; then the 2,000,000 split into 4,000,000; the 4,000,000 into 8,000,000, and so on. This creates what is known mathematically as an exponential pattern of increase. If you graph it with enough points, it will look like a curve with a steadily accelerating rise. Sometimes the pattern is murkier because of PSA increasing at the same time due to benign growth, or affected by infection. In your case, benign growth would not mess up the curve much, so you are left with infection or prostate cancer. Increases due to infection are only exponential by chance; normally they will be uneven, often forming a see-saw up and down pattern. What does your pattern look like?

The absence of symptoms is good, but you can still have an ongoing infection or cancer.

A new test has been available for several years now that is not influenced by infection or benign growth. It is known by several names, but one name is the PCA3 test, or PCA3Plus test. It is a urine test; a sample is collected shortly after an intensive massage of the prostate for about a minute by the doctor. A low value on the test is a good but not perfect indicator that there is no cancer.

The "free PSA test" has been around for years, but, unfortunately, it can be fooled by infection and report a low value; then you aren't sure whether the result is due to infection or cancer. On the other hand, if you get a high value, say 25% or higher for strong confidence, it's likely you do not have cancer.

There's a new prostate cancer book from August of last year that is outstanding on many aspects of the disease, but it is especially good for patients and doctors trying to figure out whether the patient has cancer. Here's the title: "Invasion of the Prostate Snatchers -- No More Unnecessary Biopsies, Radical Treatment, or Loss of Sexual Potency", by Ralph H. Blum and Mark Scholz, MD. (The word "unnecessary" deserves emphasis; the authors are strongly in favor of treatment when it [I]is[/I] necessary.

I hope this helps.

Take care,

Jim :wave:

Tall Allen 02-12-2011 04:32 PM

Re: Rising PSA but no prostate enlargement
 
Three things cause one's PSA to climb: BPH, prostatitis and prostate cancer. BPH is unlikely with a prostate that small, but finasteride can reduce it if it's BPH. You can take an antibiotic like Cipro to see if the PSA goes down due to prostatitis. You have to get a biopsy to determine if it's prostate cancer. PSA of 10, increasing quickly, and small prostate volume (high PSA density) are indicators, so I would schedule a biopsy very soon -- didn't your Urologist suggest it?
- Allen

Baptista 02-13-2011 04:10 AM

Re: Rising PSA but no prostate enlargement
 
I agree with Allen, the high PSA is a "raised flag", a biopsy will give you the answer and peace of mind.

Wishing you the best.
Baptista

tonesie 02-13-2011 05:16 PM

Re: Rising PSA but no prostate enlargement
 
Thank you for the input it has been helpful.
It appears that the most probable cause is some low grade infection which has caused the high PSA reading.
At this stage I intend to try the anti biotic ciprofloxacin and see what happens .
I have had two or three instances of lower abdominal pain which I had not previously related to the prostate.
My advice is that biopsy is not the first preference due to the possibility of problems caused by the biopsy proceedure.

Baptista 02-14-2011 01:58 AM

Re: Rising PSA but no prostate enlargement
 
[QUOTE=tonesie;4683855]Thank you for the input it has been helpful.
It appears that the most probable cause is some low grade infection which has caused the high PSA reading.
At this stage I intend to try the anti biotic ciprofloxacin and see what happens .
I have had two or three instances of lower abdominal pain which I had not previously related to the prostate.
My advice is that biopsy is not the first preference due to the possibility of problems caused by the biopsy proceedure.[/QUOTE]

You are doing well to try arresting PSA down with antibiotics. That will tell you if the rise of 10 is suspicious, however, a biopsy should not be delayed in case ciprofloxacin fails. There are aggressive cancers typical of fast PSA rises which require fast action.
Hopefully your antibiotics due the job and you return your “membership” to this board for good.
Wishing you the best.
Baptista ;)

harpman 03-05-2011 01:13 PM

Re: Rising PSA but no prostate enlargement
 
tonesie,

My Urologist told me that I might have an enlarged prostate or a high PSA coupled with a small prostate before he performed a digital exam at our first appointment. I had a high PSA and a small prostate so he immediately scheduled a biopsy which confirmed cancer. A renowned doctor that I visited told me that you should always have a biopsy at PSA 2.5.

I would suggest that you get a biopsy as soon as possible. It is basically a painless minor outpatient procedure, a slight discomfort for a couple of minutes. As it was explained to me taking a prostate biopsy was like taking a drop of water from a lake. It is such a small amount from such a large volume that there is no guarantee that they will find cancer even if it is there. Some people end up having several biopsies before they are diagnosed with cancer.

Don't delay as you want to have all options available if you are unfortunately diagnosed with prostate cancer and you want to achieve a cure.

Good Luck,

Bob

tonesie 03-06-2011 06:58 AM

Re: Rising PSA but no prostate enlargement
 
Thank you for the input .
If I have cancer then it has to be the slowest growing variety ever known with a prostate volume of 16 cc as opposed to an average size of 20 - 30.
Remember I am 68 this month .
Accordingly I am not considering biopsy or even DRE .
I am currently taking 500 Cipro 2 tabs per day ;1 in the morning and 1 at night for 10 days and then I am seeing a specialist urologist to get his input .
Options I will be considering are MRI scan and boosting my testostrone levels my testostorone has gone down as my PSA level has gone up ,left field is an AMAS test.
Fortunately thanks to the internet we all have a wide spread of options in deciding how to tackle problems.
Options I am not willing to consider are surgery in any form ,biopsy or DRE they all look bad risks to me.

harpman 03-10-2011 12:32 PM

Re: Rising PSA but no prostate enlargement
 
tonsie
A DRE is nothing. It takes about thirty seconds and the physician feels the back of your prostate for lumps or changes in texture from smooth and soft. It's only about an inch inside your butt. A biopsy is a minor out patient procedure that is basically painless with slight discomfort for a couple of minutes. Takes about 5 or 10 minutes. These are certainly small prices to pay to avoid a truly miserable death.

Tall Allen 03-14-2011 12:19 AM

Re: Rising PSA but no prostate enlargement
 
Hey Tonesie,

I hope the Cipro clears it all up.

I just wanted to correct a possible misapprehension that a small prostate size implies no prostate cancer. Actually the reverse may be true. One of the indicators of prostate cancer is a measure called "PSA Density" which equals PSA divided by prostate volume. So, for a given amount of PSA, a SMALLER prostate means that there is a HIGHER PSA density which INCREASES the likelihood of cancer. PC doesn't take up a lot of room like BPH does. In early stages, the prostate cells simply become less differentiated (i.e., cancerous) with little change in volume.

I agree with Bob that a DRE is nothing. Painless, takes seconds, no side effects. Why would you avoid it?

- Allen

IADT3since2000 03-22-2011 01:36 PM

Re: Rising PSA but no prostate enlargement
 
[COLOR="DarkGreen"]Hi tonesie,

I gave my thoughts earlier, but I do want to write something about your notion of testosterone supplementation. You wrote in part: [/COLOR]

[QUOTE=tonesie;4700081]...
Options I will be considering are MRI scan and boosting my testostrone levels my testostorone has gone down as my PSA level has gone up....[/QUOTE]

[COLOR="darkgreen"]Some men benefit a lot from testosterone supplementation, but, as you probably know by now, if you have prostate cancer, testosterone will almost always serve as a potent fuel for the cancer. (The rare exceptions are nasty cases where the cancer does not need testosterone to thrive.) If you do try testosterone supplementation, be sure to have your PSA, testosterone and DHT levels monitored regularly, especially before and early after starting the supplement.

Take care,

Jim :wave:[/COLOR]


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