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Cancer: Prostate Message Board
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Old 02-16-2011, 04:31 PM   #1
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Fluctuating PSA Readings - Long Story

Hello - This is my first post to this board and would greatly appreciate some thoughts on my situation. I am 61 years old but look and feel 20 years younger. I have always been in good health with frequent doctor check ups, etc. My PSA number has always been in the 2.7 - 2.8 range ever since I started getting it checked. My current issue started in March 08 when a routine blood test indicated a PSA of 6.1. I was sent to see a urologist who did a DRE and said my prostate was enlarged ( approx 58 cc) and did a 12 core biopsy which was negative. I will list below what else has occured since that time:

March 2008 PSA 6.1 12 core biopsy - All Benign

March 2009 PSA 14.6 12 core biopsy - All Benign - but some cores showed focal atrophy (whatever that is) and one showed mild chronic inflamation. Since I am allergic to Cipro, he put me on Bactrim for 2 weeks.

May 2009 PSA 20.0 At this time, I passed a 10mm stone at home which my urologist had tested. It was a uric acid bladder stone. My urologist looked in my bladder with a scope and there were numerous stones in my bladder. Since that time up until now, I have passed over 100 of them ranging in size from grains of sand to close to 1/8 of an inch in diameter.

Aug 2009 PSA 22.7 He had a CAT scan done which said the following; "Study shows moderate bilateral perinephric stranding without evidence of hydronephrosis or nephrolithiasis. The abdominal organs appear grossly benign. There is high denisity material in the dependent urinary bladder. The prostate gland is heterogeneouslly prominent bulging into the base of the bladder measuring 5.8cm transverse x 4.6 cm AP. There are no pelvic masses or adenopathy.

Sep 2009 Urologist performed a "Cooled Thermotherapy Microwave procedure " where an antenae of some type is inserted into the prostate with the goal of shrinking the prostate over time.

Jan 2010 PSA 17.4 Urologist said lets watch it

April 2010 PSA 18.2 Urologist said lets watch it

July 2010 PSA 21.8 ( This was from my family dr physical blood panel. )

Aug 2010 PSA 17.3 Urologist said lets watch it.

Nov 2010 PSA 14.6 Urologist said lets watch it.

Feb 2011 PSA 24.1 Urologist now has me scheduled for another look in the bladder and wants to do a 24 core biopsy. He thinks the bladder stones could be irritating the prostate resulting in these see-sawing PSA numbers.

Does anyone have any thoughts on this. Would appreciate any replies.

Sorry for the long story.

Frank

 
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Old 02-16-2011, 06:01 PM   #2
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Re: Fluctuating PSA Readings - Long Story

I suspect your Uro is right. I'm sure the RF thermo-ablation is causing much of your PSA rise. The urethra and bladder can also put out copious amounts of PSA when irritated, as by your bladder stones. At least you don't have kidney stones as well. Do you have high levels of uric acid in your blood as well? They would probably have given you colchicine if you did. It sounds like a genetic abnormality.

24 core biopsy can irritate things even more. Have they taken your Free PSA? If it is less than 10%, it may indicate PC, although it isn't a very accurate test. It might be worth a try though before undergoing yet another procedure.

- Allen

 
Old 02-16-2011, 06:33 PM   #3
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Re: Fluctuating PSA Readings - Long Story

Quote:
Originally Posted by Tall Allen View Post
I suspect your Uro is right. I'm sure the RF thermo-ablation is causing much of your PSA rise. The urethra and bladder can also put out copious amounts of PSA when irritated, as by your bladder stones. At least you don't have kidney stones as well. Do you have high levels of uric acid in your blood as well? They would probably have given you colchicine if you did. It sounds like a genetic abnormality.

24 core biopsy can irritate things even more. Have they taken your Free PSA? If it is less than 10%, it may indicate PC, although it isn't a very accurate test. It might be worth a try though before undergoing yet another procedure.

- Allen
Allen

Thanks very much for your quick reply. Surprised to hear that the Microwave procedure I had done could result in higher PSA numbers. I`ve just looked over some of my last general blood test results and I do not see any result for uric acid so it probably was never checked. The last time I asked my Uro about a Free PSA test he said it would not work because my PSA levels were too high. Does that make sense to you ?? I am very leary about undergoing the 24 core biopsy - I think I will hit him up again for the Free PSA test and see what he says.

Frank

 
Old 02-16-2011, 06:55 PM   #4
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Re: Fluctuating PSA Readings - Long Story

Here's a quote from the National Cancer Institute:
Quote:
Free versus attached PSA: PSA circulates in the blood in two forms: Free or attached to a protein molecule. The free PSA test is more often used for men who have higher PSA values. Free PSA may help tell what kind of prostate problem a man has. With benign prostate conditions (such as BPH), there is more free PSA, while cancer produces more of the attached form. If a manís attached PSA level is high but his free PSA level is not, the presence of cancer is more likely. In this case, more testing, such as a prostate biopsy, may be done. Researchers are exploring additional ways of measuring PSA and comparing these measurements to determine whether cancer is present.
http://www.cancer.gov/cancertopics/factsheet/detection/PSA

According to that, "the free PSA test is more often used for me who have higher PSA values."

Prostate-Specific Antigen (PSA) is released from prostate cells, and some other cells as well, when they are irritated in any way, and you have a lot of irritation going on. In light of two recent negative biopsies in the last few years, I think you are wise in your decision to consider other options first.

- Allen

 
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Old 02-17-2011, 10:52 AM   #5
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Re: Fluctuating PSA Readings - Long Story

If you don't want to get a 24 core biopsy then I would suggest a color doppler ultrasound and a biopsy can be done on only the areas that are suspicious, between 3 and 6 samples. The CDU should be able to identify any cancer. You can also take a PCA3 test in addition to a psa.

JohnT

 
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Old 02-17-2011, 11:45 AM   #6
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Re: Fluctuating PSA Readings - Long Story

Thank you JohnT for this information. I will ask my Uro about these options.

Frank

 
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