Quote:
Originally Posted by doug71
I'm a 71 year old male. Recent PSA tested at 8.5. Up from .8 approx. 1 year ago. G.P. thought reading was a test error. DRE indicated enlarged prostate.
Retested PSA 3 weeks later at 3.9. Is there reason for concern in the rise- even if the lower reading is correct? Should I have a biopsy?
doug71
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Hi Doug,
I have read Able5 and daff's replies, but I would like to offer a different view, though what they said certainly has a good sound basis. That increase from .8 to 3.9 in about a year, assuming the 3.9 is valid, is a concern. In fact a rise of more than 2.0 in the year prior to diagnosis is in effect an additional risk factor (per the D'Amico team's fairly recent research, since replicated by others) to the traditional PSA, stage, and Gleason Score, with number and percent of cores positive, percent of core that is positive, and location trailing behind but also important. So what is the basis for hesitating before jumping to a biopsy?
First, something caused your PSA to jump all the way from .8 to 8.5, and then fall to 3.9 three weeks later. It could have been a test error as the doctor suspected. I have had a multitude of PSA tests in the past eight years to track my case, and one was erroneously high (about 20 instead of about 8), basically throwing a serious scare into my wife and me.
My doctor ran another PSA the next day with a fresh blood draw, but he also had an unused remainder of the first sample run through the test again. Both came out around 8, which in the particular circumstances was good news.
It's possible your doctor could have a remainder of that first sample rechecked. Test errors are not common but do happen occasionally.
But it might not have been a test error, but still not cancer. You could have had or still have an infection or inflammation of the prostate. Either can jack the PSA way up. If it was an infection that is going away, the 3.9 might be just a snapshot of the PSA on its way down. Another PSA several weeks after that one would be an important clue. Another often used approach is for you to take an antibiotic aimed at likely causes of infection and then have another PSA after the drug has had time to do its work. A limitation of this tactic is that it's not that easy to guess which drug would do the trick, so you could still have an infection influencing PSA even after using an antibiotic and finding little change in the PSA.
You mentioned that the doctor did notice an enlarged prostate. There is research suggesting that healthy prostate tissue produces roughly .066 ng/ml of PSA for each cubic centimeter of the prostate gland as a rule of thumb. Normal size for most of us is in the 20 to 30 range, I believe, which would account for 1.34 to 2.01 PSA units. However, it would take a prostate of about 59 cc to account for a PSA of 3.9. Prostates certainly can be that large and much larger, but it is not typical for a younger person. While your earlier .8 suggests a prostate that has not been gradually growing as prostates usually do for someone about 70, the normal upper healthy limit PSA for someone 70 and up is up to 6.5 for a caucasian man (up to 6.0 for an African American). (Of course, you would like your PSA to be below the median (average), which indicates very low risk, rather than below the upper limit, though the majority of scores above the upper limit will still not be due to cancer.) Possibly your prostate just started growing late.
Urologists usually can get a pretty fair estimate of size when they do DREs. If you've only had a DRE from a GP, I suggest you have a urologist do one as they are much more familiar with what prostates feel like than are GPs. (But good for the GP for doing one at all and for giving you PSA tests!
) You could ask the urologist for a size estimate; many urologists will keep such detail in their case notes. You could have a combination of slight infection plus size that accounts for the 3.9 Of course, cancer could also be contributing.
There are certain flaws in preparing for a PSA that can have an effect. A DRE shortly before the blood draw can raise the PSA for a time, as can ejaculation within 24 hours, and perhaps bicycle, motorcycle or horseback riding.
There are also some fairly new tests out that can help determine if a man with a suspicious PSA has prostate cancer. One of them, now available commercially, is the PCA3 Plus test, now available from at least two labs. You can learn about it by searching the internet with a string like: " "PCA3 Plus" "prostate cancer" ". This particular test is much more informative than the PSA test and can provide significant help in deciding whether a biopsy is needed. It's a urine test following an intensive DRE; it can be done anywhere and then shipped to the lab. Another older test is the "free PSA" test, and you can also learn about that on the web. You could have both done.
Finally, after doing what you can to tie down what is happening, you might want to try a new tactic: the drug finasteride, formerly known as Proscar before it went generic nearly a year and a half ago. Finasteride has been proven to reduce the incidence of prostate cancer by 25%, and it has been virtually cleared of a possible role in stimulating high-grade disease. (It turns out it is just easier to detect high-grade disease in men on finasteride.) After about six months on the drug, your PSA should have dropped by at least half if you do not have cancer; if it does not, it's not a sure sign of cancer, but it warrants extra surveillance and attention. Also, research indicates it makes DREs more accurate and clarifies PSA trend lines (velocity) after the starting point is reset. At least that's what some leading docs are saying who have paid close attention to the drug. (I'm an eight year survivor with no enrolled medical education, by the way.) The drug
Avodart would probably serve the same purpose and appears to be even substantially more effective, but not as much has been proven about it. Both drugs help reverse and control benign enlargement of the prostate, so you get a triple proven benefit with finasteride and likely benefit with
Avodart: enlargement control, prevention help, and additional diagnostic clues.
I fully agree with Able5 and daff that you need to follow-through on this, perhaps not with a biopsy now, but enough to determine what is going on, which might require a biopsy.
Take care, good luck, and keep in touch,
Jim
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