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Old 11-06-2011, 07:34 AM   #1
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What else can be causing rising PSA?

So my PSA keeps going up - not severly, but steady - not having any symptoms and although I'm not obsessing (yet) - it is on my mind a lot trying to figure out what's going on...I had a negative biopsy in May of this year.

Here's my stats:
48 years old
Jul 2008 PSA 1.5
Sep 2009 PSA 1.9
Nov 2010 PSA 2.4
May 2011 PSA 2.9 (free PSA 3%) - Biopsy done - Negative.
Oct 2011 PSA 3.2

As you can see my PSA continues to increase with every test, my fPSA was very very low at 3%. My Doc says for me to come back again in 6 months and doesn't seem to worried. He said my DRE was normal too and in fact I have a small prostate (no jokes) - so it's not rising from enlargement.

I'm wondering if it's just my normal part of aging?

I do also keep noticing soreness in my armpits - no bumps or real pain, just sore and I seem to be losing weight - about 10 lbs. in the last 6 months - again nothing drastic and could all be explained by stress and life, I've moved to a new city in the last 6 months so that can certainly cause stress. Just seems all added up that something is up (maybe infection?) and it keeps gnawing at the back of my mind.

Thanks for any comments!

 
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Old 11-06-2011, 03:17 PM   #2
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Re: What else can be causing rising PSA?

Your recent PSA doubling time is over 2 years -- certainly no cause for immediate concern. Your low free PSA, your small prostate, and the fact that your PSA is rising slowly and steadily and is high for your age are all risk factors.

Researchers put together "nomograms" to give a feel for your statistical risk based on the experience of hundreds or thousands of men. These nomograms have varying degrees of reliability, and are right about 3/4 of the time.

I ran your data on a few of these. I assumed you are caucasian, you had no family history of PC, you have no urinary symptoms, you had no high grade PIN on your negative biopsy, and your prostate volume is 25 cc (which would equate to a PSA density of .128). No one nomogram accounts for all the risk factors. The Sunnybrook nomogram takes into account age, DRE, PSA, % free PSA, urinary score, family history and ethnicity. It predicts your probability of finding any cancer on biopsy at 60% and the probability of finding intermediate or high risk cancer on biopsy at 37%.

A nomogram developed in Parma, Italy by Luigi Benecchi et al. in 2008 takes into account DRE, % free PSA, PSA density, PSA slope (yours is .88 ng/ml/yr), and presence of high grade PIN at the first, otherwise negative, biopsy. It predicts the odds of your finding any cancer on repeat biopsy at 65%.

A third nomogram developed in by P. Finne et al. at Helsinki University in 2002 and updated in 2004 takes into account PSA, % free PSA, prostate size and DRE. It predicts the odds of finding cancer at biopsy at 68%.

All three nomograms give pretty similar results for you. If anything is there, it is growing very slowly, which is why your doctor isn't very worried. Hopefully it will turn out to be nothing, or at worst, an indolent form of PC that may be something you can monitor with Active Surveillance.

There is a very rare kind of PC that metastasizes without ever showing large increases in PSA, but it is extremely rare, so the armpit pain and lost weight are probably unrelated. When PC does metastasize, and it can take 20 years or more to do so, if ever, it typically travels to lymph nodes and bones in the pelvic area first.

- Allen

Last edited by Tall Allen; 11-06-2011 at 03:31 PM. Reason: corrected my calculation

 
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Old 11-06-2011, 11:13 PM   #3
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Re: What else can be causing rising PSA?

Get an MRI/MRI-S done as soon as your biopsy heals. Dr. Joe Busch in Chattanooga, TN does this test. He can also determine if lymph node are involved. Due to its inaccuracy, needle biopsies will be a thing of the past. There is literature out there that say needle biopsy can spread PC.

 
Old 11-06-2011, 11:21 PM   #4
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Re: What else can be causing rising PSA?

Find a Radiologist that has a 3 Tesla MRI and have a MRI-S done. Picture resolution and detection dramatic.

 
Old 11-07-2011, 08:00 AM   #5
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Re: What else can be causing rising PSA?

Allen, thanks so much for the reply and the "work up". You are right on the money in terms of demographics etc.

I do think something is going on, but probably slow growing and not major yet. I will stay on top of it. I agree, the armpit soreness (i wouldn't even say its pain, and it doesn't happen all the time, more when I'm run down or had too much alcohol) and the weight loss can both likely be from other cause - I moved and haven't worked out in 6 months, so that is more likely the cause of weight loss. I also wouldn't consider 10 lbs over 6 months as drastic.

As to the next posts about a biopsy spreading cancer, everything I rea says there really are no clinical cases reported, so I'm trying not to panic. If my PSA is up again in 6 months, likely, I could see asking for an MRI at that point, I would be surprised if my doc would go along with it at this stage. Seems a reach, certainly worth considering in the future, but it's also not like my numbers are off the charts. And I'm seeing a very reputable urologist at Northwestern in Chicago, he seemed watchful when we met but not ready to jump in to it spreading.

 
Old 11-07-2011, 09:25 AM   #6
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Re: What else can be causing rising PSA?

Jupaul,
Allen gave you some great advice. A slow and steady rise in psa is usually indicative of PC. Other things that can cause a slow rise is prostate enlargement or psa leak. You can consider taking proscar or adovart which will reduce your psa and any rise after developing a new baseline will be more likely caused by pc.
I went through the same thing you are going through for 10 years having 12 negative biopsies and a negative MRIS while watching my psa rise to over 40. A color doppler ultrasound finally indentified the tumor which was not easily biopsied by normal methods. When read by an expert I think the color doppler has some advantages over an MRIS, it's less expensive and a biopsy can be done immediately and guided to the suspicious area.

 
Old 11-07-2011, 12:24 PM   #7
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Re: What else can be causing rising PSA?

Urologists will not buy into radiology because they lose money by not doing biopsies. Follow the dollar. I have been lied to twice by a urologist. Please google MRI/MRI-S and read up on it.

 
Old 11-21-2011, 01:04 PM   #8
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Re: What else can be causing rising PSA?

So just a thought - all this time I've been thinking worse case scenario, of course, but it just dawned on me - I've yet to do any antibiotics, like Cipro, to rule out infection or prostatitis. Seems like a long shot - I have been taking propecia for years (over 10) so my prostate is small, estimate was 18ml, so it's not due to enlargement, but could I have some sort of cronic prostatitis that doesn't really cause much in the way of symptoms?

I mentioned that my righ armpit has been sore for ages, I can't really say it's pain, more just sore - seems like lymph node, but again not pain or swelling and it comes and goes. May not hurt for a few days, then may be sore for days and I'll feel it when I move a certain way. When I had the biopsy last spring, they did give me Levaquin for a week and thinking back I did notice that I felt better and didn't have the armpit soreness. So now I'm thinking there may be something to the idea that it might be an infection.

I have a Doc appt soon and will certainly ask about trying Cirpro or something, just seems like a more or less harmless option to check.

Wouldn't PSA tend to go up and down though if it were prostatitis? That's the only part that I'm not sure about - mine keeps steadily rising by about .5 to 1 per year.

Thanks guys.

 
Old 11-21-2011, 02:30 PM   #9
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Re: What else can be causing rising PSA?

The following article by Dr Strum explains how to use psa and other markers to differentiate PC from prostititis.

http://www.prostate-cancer.org/pcricms/node/119

JohnT

 
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