I am 61 years olds. I have been monitoring my PSA for over a decade. Eight to twelve years ago, my PSA was in the .8 to 1.26 range. Six years ago, I had one reading of 3.19. Four to five years ago, the readings were between 1.83 to 2.65. For the past three years the readings have been 3.01 to 3.15. My last reading (two weeks ago) was 4.45. I have an appointment with a urologist tomorrow. I believe he may be inclined to recommend a biopsy (from researching his patient comments on the web). After reading up on the subject, I am not inclined to have a biopsy immendiately. My question is: What non-invasive testing, beyond additional PSA test, are available? Are there reliable MRI or other scanning alternatives?
I’m 10 years older (with appropriately higher PSA) but feeling much like you, isn’t there a better way? My reading and study on many of these forums seems to indicate that the current imaging technologies (CDU-MRI) still are not reliable enough by themselves and can indicate false positives and/or miss cancerous areas.
My thoughts go like this…there are many – many so called “Age Adjusted Normal PSA” Charts available from endless sources (Like Dr Peter Scardino’s book). In general these charts say normal PSA for me (72) is from 0 to about 6. (Mostly these charts say 0 to 4 is normal for a 61 year old.
The problem is, who can say if a specific PSA test is accurate enough? Actual tests have shown that PSA can vary by over 25% from day to day for no reason. (I have heard that officially they claim PSA readings are only 80% accurate). In any case that leaves enough wiggle room that I wouldn’t get too upset over a half-point – you could be 3.95 on re-test. (Your own experience – PSA 3.19 - 6 years ago – followed by many around 2 – should tell you how un-reliable a single test is).
Then there’s the infection thing! My PSA went to 11 this spring when I had a UT infection – 2 months later it was 6.7 and in 2 more months it was 4.3. The lesion I take from that is to be very careful about how much faith you have in any given single PSA test, it seems only the longer term average (that smoothes out the variations) helps tell us anything.
In any case to me the best advice is “don’t panic”. There is a wealth of information available on the Internet – read and learn all you can – there are many great books available – (and they become much more interesting when the subject is so important to you)..Invasion of the Prostate Snatchers is a great read! – Good Luck!
I have little to add to Jimmy's very good advice to you. He is so right that the tracking over time is much more useful than comparing any one value to age-adjusted norms. You asked about other tests. The most important one is a really well done DRE by an experienced urologist. Just take deep breaths. You can get a % free PSA test, which may or may not be useful. Soon there will be another better test called PHI (Prostate Health Index), which has been FDA-approved but the manufacturer, Beckman-Coulter, has not yet delivered the test kits in the US.
It is refreshing to hear from men like yourself that question the epidemic of routine biopsies, and the consequent overdiagnosis and overtreatment. Biopsies certainly have their place when there are indications for them (e.g., positive DRE, high or rapidly rising PSA, prostatitis and BPH ruled out, low % free PSA, bone pain).
Your PSA history is much like mine; a lot of bouncing around over the last decade and finally 4.4 in Feb 2012. I have a strong family history of Pca. After a lot of research online and dithering between active surveillance and treatment I decided to use the services of Dr. Fred Lee in Rochester Hills, MI for a color doppler ultrasound (CDU). He immediately found a .8cc tumor in my 20cc prostate. The tumor volume accounted for all the difference in PSA between what the PSA from normal prostate cells and my prostate volume should have been and the elevated PSA of 4.4. He biopsied the tumor (Gleason 3+3), the adjacent seminal vessicle and other areas of the prostate just to be sure. All biopsies away from the tumor contained normal tissue. I decided if the cancer was contained within the prostate I would go for brachytherapy. Didn't like the possibility of significant side effects associated with surgery. Seed implant was done on June 6. First PSA at 3 months from treatment was 0.8. SE's have been minimal. Some urinary urgency and frequency that is declining. The urinary stream has been slow on first arising in the morning but Flomax is helping with that. Should be off Flomax in a month or 2.
I am 73 years old. Being retired with Medicare and a good medigap policy has allowed me to seek out the experts in the field.
I never saw a urologist. Did all my own research and made all my own contacts. Fortunately I had a single localized, encapsulated tumor. That made all the difference.
I am 65 years old and like you have been monitoring my psa for the last five to ten years. I too was in the 3.5 to 3.8 range until this year when I tested at 4.7. After a six week treatment of Cipro, I was tested again and the PSA was 5.3. I did the biopsy and was found to have prostate cancer, 3+4=7, stage t1c. I won't say what to do, but don't just sit and worry. Knowledge is power. I will have davinci surgery on the 19th. Best of luck to you.
My visit with Dr. Lee was March 29, 2012. He has been at this a long time and when I saw him was accepting patients 2 days a week. Dr. Lee did the biopsy. For me it was not a big deal. I've read he is reluctant to do a biopsy unless the CDU finds vascularity indicating a growing tumor.
I had brachytherapy done by the Prostate Cancer Treatment Center in Seattle. It appears you are near the Dattoli Clinic. My brother had brachytherapy there about 10 years ago and goes back for regular followups. He has been happy with Dattoli.
The Following User Says Thank You to bharlan For This Useful Post: SiestaKeyJimmy (10-17-2012)