My first post here - any help is appreciated. PSA 08/2005: 1.6, 08/2007, 2.2, 08/2008, 2.4. skpped a few years and now 06/2011 is 4.98. DRE reveals only slightly enlarged prostate, and very mild urinary symptoms (slighty diminsished stream) sometimes morning hesitancy. Worried about pc.
Would not hesitate to visit a Urologist who may recommend biopsy based on that PSA, although you haven't mentioned your age or if you have a family history of PCa. If I knew then what I know now I wouldn't have waited as long as I did. Can't hurt to get checked out just to be on the safe side. Good luck with your decision.
Thanks so much - I saw a urologist at NYU Medical Center last Friday. His DRE was normal (somewhat enlarged) - did a urinalysis after the DRE and I believe it may have been PSa3. Waiting for that and free vs bound PSA serum. I'm 58 years old and have no family history of PCa
Sounds like you are in good hands. I'd use this opportunity to read up on PCa. Knowledge is power. There are several good books on the subject from known experts such as Walsh, Strum, Meyers, Chodak, to name a few. I'd follow the advice of the Uro unless you are uncomfortable with him or have reason to question his judgement. Let us know how you make out. Best of luck to you.
Received some news this afternoon - 5.4 PSA and only 12% is free psa. They are looking to schedule a biopsy in July - not sooner because the doc is going on vacation. Thoughts - I am in a panic right now.
I have read your posts and the responses to date. I'll add some comments in green.
Quote:
Originally Posted by bobecus
My first post here - any help is appreciated. PSA 08/2005: 1.6, 08/2007, 2.2, 08/2008, 2.4. skpped a few years and now 06/2011 is 4.98. DRE reveals only slightly enlarged prostate, and very mild urinary symptoms (slighty diminsished stream) sometimes morning hesitancy. Worried about pc.
Urologists often want to "sell" you on biopsies and later on surgeries. Sometimes the courses they recommend can be wise, but often you are getting a biased input, even though sincere from the urologist's viewpoint. Your stats and circumstances put you in the gray zone - not clear-cut one way or the other.
For instance, that free PSA of 12%, though fairly low and near the 10% trigger for concern where there is a substantial chance of prostate cancer, is also well below the score of 25% or so that would indicate a very low likelihood of PC. I've heard a leading medical oncologist state that scores for "free PSA" in the gray area are not helpful.
You do have that clear and consistent upward trend in PSA, but that could well be do to some increase in size (benign enlargement), to a small scale infection, to a combination of both, or perhaps to cancer, or a combination of BPH, infection and cancer. Most often by far, PSAs in your range that trigger biopsies are not followed by a diagnosis of cancer. By the way, there are tools available to calculate PSA doubling time, and your time based on all four values is 42.75m (3.56 years). It actually slowed somewhat between the first two and middle two values (from 4.35 years to 5.00 years), but somewhat accelerated for just the last two readings (2.69 years). A few years ago, with a PSA doubling at that rate and a PSA above four, I'm thinking that a large majority of doctors would have sent you for a biopsy, as rcroller is indicating, and knowledge is power as he stated. However, that thinking on going quickly to a biopsy has changed for many doctors who now want to take more careful aim at the situation before deciding that a biopsy is warranted.
So, is there anything you can do? Yes! Sound tactics are to sort out such situations are very well described in a new book (August 2010) entitled "Invasion of the Prostate Snatchers -- No More Unnecessary Biopsies, Radical Treatment Or Loss of Sexual Potency," Ralph H. Blum and Dr. Mark Scholz, MD, a leading medical oncologist who specializes just in prostate cancer. Among the tactics is a relatively new test known generally as PCA3; one version of that test is the PCA3Plus. It is a urine based test, following an intensive prostate massage by a doctor for about a minute. The test is strong (specificity - basically avoiding a false alarm) where the PSA is weak, and vice versa (PCA3 being weaker on sensitivity, which is the likelihood of picking up the disease if it is there). Moreover, unlike the free PSA test that cannot tell infection from cancer (both resulting in low percentages), the PCA3 test is not thrown off by infection. There are other tactics too, but the PCA3 appears to be one of the most important.
Biopsies should not be feared, but they are not trivial either for a number of reasons, especially in these days of bacteria that are resistant to antibiotics, which, unfortunately, is a growing concern, though still rare.
Take care and good luck,
Jim
Last edited by IADT3since2000; 06-15-2011 at 12:34 PM.
Reason: Clarified specificity and sensitivity right after posting.
thank you so much Jim - I am still awaiting the PCa3 results - maybe tomorrow. What has really set off my panic on this are articles that correlate low free PSA % to aggressive forms of PC.
Bob
What I said about the free PSA still goes - your's is not low enough to trigger concern, from what I've read. I'm glad you are getting that PCA3 result.
Quote:
Originally Posted by bobecus
thank you so much Jim - I am still awaiting the PCa3 results - maybe tomorrow. What has really set off my panic on this are articles that correlate low free PSA % to aggressive forms of PC.
Bob
I did not count that last PSA of 5.4, and I treated all PSAs as if they were done mid-month, thereby allowing no more than a 15 day discrepancy. If you run the 4.98 as if it had been done on 6/1, and the 5.4 as if it had been done on 6/12, the doubling time is 3.09 months.
Bob, Take a deep breath...PCa takes a while to grow so waiting until July for a biopsy shouldn't cause you undue concern. If possible, use that time to educate yourself as much as possible. It's clear that the only way to tell if you actually have PCa is to have the biopsy, but try your best not to worry in the meantime. It won't change anything and won't help you. Don't bad case it imagining you have an aggressive form until you have the facts. Odds are 85% in your favor as only 15% of newly diagnosed PCa's are the high risk form. Someone early on told me worrying is like praying for something bad to happen and that hit home with me. I know it isn't easy, in fact I just had my first post-op PSA drawn today so I need to take my own advice at the moment. One day at a time and best of luck to you.
-Bob
Today I received the results of my PCa3 and the were encouraging. The score was 8.7 - well below the 35 threshold. this is all so confusing, especially with the low free PSA%. I'm not sure what this all means and any help is so greatly appreciated.
Bob
It looks like congratulations are in order, and I'll offer them on the theory that it's sometimes wise to eat desert first.
Congratulations!
It's not a certainty that you are free of prostate cancer, but your exceptionally low PCA3 score is a solid indicator that you do not have the disease! You wrote:
Quote:
Originally Posted by bobecus
Today I received the results of my PCa3 and the were encouraging. The score was 8.7 - well below the 35 threshold. this is all so confusing, especially with the low free PSA%. I'm not sure what this all means and any help is so greatly appreciated.
Bob
As I've mentioned, PCA3 after an earlier PSA test, unlike the free PSA test, is not fooled by infection into a score of 10% or lower that suggests a substantial (though hardly absolute) possibility of prostate cancer. The one point of uncertainty in my layman's view is that consistently rising PSA. However, that could well be do to a continuing pattern of enlargement, perhaps combined with mild infection. Free PSAs from 11% to 24% apparently are not that worthwhile - a true gray area, though it is more reassuring to be nearer to the 25% and above end of the range.
I suppose the obviouse wise course is to continue monitoring the PSA, perhaps every three months for a while, but not letting it go longer than six months.
You could also try some of the lifestyle tactics that have strong but not conclusive evidence of helping prevent, stabilize, roll back, or eliminate the disease, at least for some men. These tactics include diet/nutrition/supplements, exercise (strength and aerobic), and stress reduction. A statin drug might also be wise, as statins appear useful for lowering the risk of the lethal form of prostate cancer as well as for their well-known anti-total and LDL cholesterol impact and enhancement of cardiovascular health, which is actually a far more important threat area than prostate cancer. The mild drugs (few adverse side effects if any for most of us) finasteride and Avodart may also be helpful. I've posted about their safety from high-grade prostate cancer in the past days.
Take care,
Jim
The following user gives a hug of support to IADT3since2000: bobecus (06-20-2011)
thank you for your wisdom and support Jim - you are a wealth of unbiased information on the subject. My plan is to retest serum PSA end of July/beginning of August and take it from there. Seems like a routine course of Cipro might be reasonable in the meantime. We had a vacation planned 07/14-22 which I almost cancelled (but didn't). My urologist wanted to biopsy on 07/06, however, I will wait until after the above protocol for that. He is on vacation and is probably not aware of the Pca3 result anyway.
Bob
I believe the urologist too will want to hold off on the biopsy once he sees the PCA3 result, but I would hold off regardless of what he says. However, that is a very personal call, and I am far from being a medical professional. It would not be unreasonable to go ahead with a biopsy, but I believe it would be more reasonable not to do that in the circumstances.
Development - Urologist is putting me on course of antibiotics (Levaquin) for a while. retest PSA late July. No biopsy at this time - will wait until repeat PSA results. I hope that I'm doing the right thing here.
Development - Urologist is putting me on course of antibiotics (Levaquin) for a while. retest PSA late July. No biopsy at this time - will wait until repeat PSA results. I hope that I'm doing the right thing here.
That looks like a great approach to me. However, it is sometimes quite difficult to find the specific antibiotic that will knock out an infection - very much trial and error, hopefully trial and early success for you.
6 weeks have passed and my PSA is still 4.78 with a free psa of only 12. I took a 10 day course of Levaquin. My earlier PCa3 was only 8.7 and now don't know what to do. I saw a couple of tables online that showed the Pca probability of an fPSA of 10-15 as being 28%, however, the lab results sheet grouped 10-15 into a 50% category. Any thoughts or advice would be greatly appreciated. thanks much!
Hi Bob, You wrote:
Well, after 6 weeks, 10 days of Levaquin, PSA is about the same - slightly down to 4.78. free psa is still 12 - all of this has me worried, even in view of the PCa3 score of 8.7. I guess a biopsy is next. Any thoughts would be appreciated.
That looks like a great approach to me. However, it is sometimes quite difficult to find the specific antibiotic that will knock out an infection - very much trial and error, hopefully trial and early success for you.
I'm back with some very conflicting test results: First, the background again:
PSA 08/05: 1.6, 8/07 2.2 8/08 2.4 06/11: 4.98, 06/11 5.4 07/11: 4.7. During the 2011 tests my fpsa was only 12%. PCA3 done 06/11 was only 8.7. DRE normal but slightly enlarged; I waited a couple of months and finally had a 12 core biopsy at NYU Medical Center: No PCA, No HGPIN, No PIN, No Atypia. 4 cores showed chronic inflammation and some atrophy. TRUS show prostate size as 45(cc?)
Am going for a 6 month follow up with Urologist next week. In anticipation I had my total psa and fpsa run: now the results - Total PSA is down to 3.63, but free psa is down to 9.4. What does this mean? the lab sheet says 67.9 % probability of pc with fpsa < 10. I'm 58, no family history, some "bph type" symptoms. Any thoughts or insight would be greatly appreciated.
Unfortunately, % free PSA is not a very accurate test, especially when your total PSA is in the normal range (many false positives!). You can have a PCA3 test (a urine test after prostate massage) that improves the diagnostic accuracy of your lab tests. There are some other biomarkers that can improve accuracy but are not yet FDA approved and only available at certain institutions, notably [-2] proPSA and T2:ERG fusion.
- Allen
Sound tactics are to sort out such situations are very well described in a new book (August 2010) entitled "Invasion of the Prostate Snatchers -- No More Unnecessary Biopsies, Radical Treatment Or Loss of Sexual Potency," Ralph H. Blum and Dr. Mark Scholz, MD, a leading medical oncologist who specializes just in prostate cancer. Among the tactics is a relatively new test known generally as PCA3; one version of that test is the PCA3Plus. It is a urine based test, following an intensive prostate massage by a doctor for about a minute. The test is strong (specificity - basically avoiding a false alarm) where the PSA is weak, and vice versa (PCA3 being weaker on sensitivity, which is the likelihood of picking up the disease if it is there). Moreover, unlike the free PSA test that cannot tell infection from cancer (both resulting in low percentages), the PCA3 test is not thrown off by infection. There are other tactics too, but the PCA3 appears to be one of the most important.
Re: Worried about possible PC 
