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Old 03-21-2012, 06:13 PM   #1
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Rapid rise in PSA

Will try to keep this short but in context.

I'm 52 and my first PSA test last July came back at 5.5. My Urologist wanted to do a biopsy ASAP but I declined. After a 2-month course of antibiotics to see if it may have been an infection my second PSA in September was 12.2. Biopsy (12 samples?) was done and the word was no CA...just chronic inflammation.

Fast forward to today. I had blood drawn last Friday and saw my Urologist today. PSA is now 18.8. He wanted to do a second biopsy and I declined. He offered antibiotics and I declined those, too. Another PSA is scheduled for June.

Doc said he was worried it might be CA; my question back was "why didn't it show up in the first biopsy?" He stated that if the PSA is higher in June he'll recommend that I go to a larger medical facility and have a scatter(?) biopsy done; apparently 50 or so samples are taken.

Anyone have such a rapid rise in their PSA? Was it CA?

All questions/comments welcomed!

 
Old 03-21-2012, 11:47 PM   #2
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Re: Rapid rise in PSA

There are forms of chronic prostatitis that will not respond to antibiotics, but you can't assume that is the case with you. I assume they found no sign of hyperplasia on the biopsy, so you can rule out BPH. Inflammation may also occur as a result of cancerous lesions. As you are well aware, your PSA is high and rising quickly, so it's important to ascertain the cause.

There are a couple of blood/urine tests they can run: % free PSA and PCA3. Taken together, these biomarkers have sometimes been able to detect cancers, even when biopsies have been negative.

Biopsies are random and can easily miss the cancer, depending on where they happen to poke. Standard biopsies don't sample all over the prostate, but only in areas where prostate cancer is most likely to occur.

There have been some techniques developed for looking for suspicious lesions before they go poking at the prostate.One imaging biopsy option is a multiparametric MRI -guided biopsy. It is also not available everywhere, but these MRIs can sometimes detect lesions that are otherwise invisible. There are a couple of doctors who will do a color doppler ultrasound guided biopsy, or an ultrasound elastography guided biopsy that have also been able to find otherwise undetectable lesions. I have a friend who had two biopsies and a multiparametric MRI-guided biopsy which were all negative. Finally, they found it with a 30 core saturation biopsy. His PSA was a lot lower than yours, however. The higher the PSA, the more likely that one of those imaging options may find a suspicious lesion that may be biopsied.

- Allen

 
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Old 03-24-2012, 04:52 PM   #3
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Re: Rapid rise in PSA

Hello Lelantos
I was not aware that biopsies could determine chronic inflammation as I understood you to suggest. I can imagine that it is hard to understand why you have such a high PSA, yet the biopsy indicated no prostate cancer. The fact is though, it can happen and your high PSA post antibiotic treatment should be of maximum concern to you. It would be beneficial to know what your urologist has indicated after I assume repeated DRE's. Also, is there pc in your immediate family? I think there are new urine tests that could provide additional information. You might want to consider a color doppler ultrasound test if possible. Personally, I would be most vigilant in pursuing the cause of a relatively persistent high PSA.

 
Old 03-24-2012, 07:03 PM   #4
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Re: Rapid rise in PSA

Quote:
Originally Posted by PCaDon View Post
Hello Lelantos
Also, is there pc in your immediate family? I think there are new urine tests that could provide additional information. You might want to consider a color doppler ultrasound test if possible. Personally, I would be most vigilant in pursuing the cause of a relatively persistent high PSA.
Yes, my Dad died of bone cancer (metastatic prostate CA) in 2004. I'll be heading to the Mayo Clinic in Rochester, MN next month. They've got my records now. I'm tired of the local docs...

THANKS for your response Don!

 
Old 03-25-2012, 03:35 PM   #5
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Re: Rapid rise in PSA

Dear Lelantos,
I hope you continue your search for information and answers. The Mayo Clinic in Rochester is well known and well regarded. Personally I may be comforted with their care, I still would be vigilant about there providing you the best care. You have some form of prostate cancer and there is no better advocate for the best cure than yourself. You are obviously a smart guy - keep up the research until you get the answers you need to make the best decision for YOU. If you haven't already, please read the Prostate Cancer Decision Tool tacked at the top of this board. It will help, if in no other way, to put things into perspective.
Cheers!
Don

 
Old 03-25-2012, 08:29 PM   #6
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Re: Rapid rise in PSA

You asked if somebody had a rapidly rising PSA and was it cancer. My husband had exactly that and yes it was cancer. I only wish his urologist had suggested something beyond a stand biopsy. He had four before he finally got an MRI which showed a nodule in the anterior part of his prostate which turned out to be cancer.

You got some good advice on this thread and also from your urologist. I can't urge you strongly enough to follow through. Apparently not all prostate cancer moves as slowly as we've been led to believe.

My husband's urologist told him a PSA that bounced from 36 to 29 and then stayed at 29 was inconsistent with cancer. Apparently it wasn't because the next year the PSA went up to 50 and when cancer was finally found, he was told it had most likely metastacized (though we're seeking more opinions). I can't find anything that a PSA that high would indicate except cancer. I'm glad you are going to MN. Good luck.

 
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