First PSA test at 47

[Bill1321]

Having not been to a Dr. in a million years I took the advice of a nurse friend and went in and had some blood work. It was my first PSA test and it came back at 4.4. I went to a urologist who asked if I had any symptoms (I didn't). He gave me a DRE and said everything felt normal. He scheduled me for a biopsy. Being the chicken I am, I began reading all I could to avoid such test. My research told me that it wasn't that high and that for a first reading I shouldn't rush into such an invasive procedure. I was treated with an antibiotic for two weeks and re-tested 4 wks after that. The Dr. called today and said my number had dropped to 4.2 but was still above "normal." He recommended I go forward with the biopsy. I'm only 47 and the thought of surgery, with all the side effects, is pretty frightening. Is there such a thing as "watchful waiting" before a biopsy? Would I be crazy to monitor my PSA level every few months to look for a jump before letting them "dive in?" Any advice or personal experiences would be greatly appreciated.

Bill

[daff]

We're sometimes helpful in providing our own experiences and recommending alternative treatments to look into, but I'd say this is a
tough call for non-medical people that we are. While you could certainly
wait 3 months and test again, in my opinion, it wouldn't be so bad to get a
biopsy. (Some people have difficulty with it-- I had it in my urologist's office with some mild sedation and numbing medication and had no problems whatsover.)

You certainly don't need to jump to any conclusions about what the results might show and to immediately be thinking of surgery. The most likely result is that everything's ok-- but if it's not, wouldn't you like to deal with it
in its earliest stage? And there are plenty of non-surgical options out there if it does become necessary to choose a treatment-- just ask us and you'll
learn of many (I did proton beam therapy last fall and was happy with that choice for me).

Others may weigh in with other ideas. One other thing-- was there a free PSA reading too? That can also help in the predictions, but it's really only the biopsy that will tell for sure, and even then, it doesn't always pick it up (the first time...).

Also, for your information, if you had a DRE just prior to the blood being taken for a PSA test or if you had an ejaculation 3 or 4 days prior, these can have an impact of the PSA readings. Doctors don't always mention this, but I've read it in enough places to believe there's truth to this.

It's never to soon to educate yourself. There are some good books on this subject, including a recent one by Patrick Walsh.

[Kemahsabe]

Bill,

Sorry to hear from you under these circumstances. I'll give you my PC tale and you can add it to what you've learned. My first PSA 10 years ago came in at 4.5. I waited a year for a retest (4.7) and was biopsied (the first of three). Six months later my PSA was 5.0 and six months after that it was 5.3 so I had another negative biopsy.

My PSA then declined into the 4.* range where it stayed for 4 years. My urologist attributed the elevated PSA to BPH which was starting to be a problem. I later learned that I had changed labs and that different assay methods give different results, and that was probably what caused the reduction. But, whatever the number was it wasn't rising!

In 2004 I changed labs again (but still didn't realize it was an issue) and my PSA shot up from 4.9 to 9.0 in one year! The retest was 9.4 but the DRE was normal. I was dealing with an enlarged prostate and doing alot of traveling so I decided to decline the biopsy. In June of last year my PSA hit 10.1 and finally agreed to another biopsy which was positive in less than 5% of the cores. I had a robotic-assisted RP 7/30/07 and so far everything is going well.

OK, so now you're thinking I'm nuts for not getting the biopsy sooner, and maybe I was. But I had been researching PC for many years and was getting regular PSAs which leveled off below 9.0 after that big jump. It was a form of 'watchful waiting'. Also, some people just produce more PSA than others and I assumed, with the cautious blessing of my urologist, than I was one of those people. In other words, my 9.0 was equivalent to a 5.0 in a 'normal' person.

In 1998 it was assumed that PSA's below 4.0 were not due to cancer, and that those from 4.1 to 7.0 were in a gray area. That's why I wasn't rushed into a biopsy after my first test. Anymore, probably due to fear of malpractice, urologists push biopsies on men with PSAs in the 2.* range.

Take the above for what it's worth to you. My only suggestion is to find out if they tested Free PSA, which might help you understand better where you're at. (My free PSA was 11%. My current PSA is .004 )

Best of luck to you!

[IADT3since2000]

Originally Posted by Bill1321

Having not been to a Dr. in a million years I took the advice of a nurse friend and went in and had some blood work. It was my first PSA test and it came back at 4.4. I went to a urologist who asked if I had any symptoms (I didn't). He gave me a DRE and said everything felt normal. He scheduled me for a biopsy. Being the chicken I am, I began reading all I could to avoid such test. My research told me that it wasn't that high and that for a first reading I shouldn't rush into such an invasive procedure. I was treated with an antibiotic for two weeks and re-tested 4 wks after that. The Dr. called today and said my number had dropped to 4.2 but was still above "normal." He recommended I go forward with the biopsy. I'm only 47 and the thought of surgery, with all the side effects, is pretty frightening. Is there such a thing as "watchful waiting" before a biopsy? Would I be crazy to monitor my PSA level every few months to look for a jump before letting them "dive in?" Any advice or personal experiences would be greatly appreciated.

Bill

Hi Bill,

daff and Kemahsabe gave some good advice, and I would like to emphasize that surgery is not the only or even necessarily the best option. At least one leading doctor is comfortable with active surveillance for low-risk cases for men your age, and from the details re PSA and DRE that you have so far, you appear to be in that category.

I have only two suggestions to add: you could have a PCA3Plus test done, and you could try some tactics involving nutrition, lifestyle and mild medication. One of us just had the PCA3 test and initiated a thread called PCA3 Results with some first hand information. The PCA3 test is strong where the PSA is weak, and vice versa, so using both is helpful and provides information in addition and independent of the information you get just from the PSA and free PSA.

It's good that your PSA went down, and it might have been due to the antibiotic, but on the other hand, PSA varies by up to 15% day-to-day as I recall. Antibiotics are tried because infections can boost PSA from a little to a lot, but it's a crap shoot trying to find the right one to control an infection unless the doctor does a culture and figures it out ahead of time, and even figuring out how to do the culture is chancy. In other words, your PSA could still be due to an infection that the particular antibiotic was not designed to target. Also, the size of the prostate makes a big difference. A healthy prostate will produce about .066 ng/ml of PSA for every cc of prostate tissue. At age 47 your prostate would usually not be large, but it could happen. A healthy prostate of 63 grams, a bit more than double the normal size for your age I believe, would generate a PSA of 4.2 using the rule-of-thumb (based on research). If your prostate were large, you would probably want some treatment for BPH, but not for cancer.

You could also try some of the nutritional and lifestyle tactics and see what effect they have on your PSA. A recent thread gives an overview and leads to resources.

You could also try finasteride (formerly Proscar) for six months and see if your PSA falls by 50% or more. If not, that is an additional clue for the presence of prostate cancer, meriting careful monitoring and perhaps a biopsy, but if it does fall by 50% or more, that's an additional clue for the absence of cancer. (I'm not a doctor and have had no enrolled medical education. I'm getting this from the September 2006 issue of the Journal of the National Cancer Institute, based on comments from some leading doctors, such as Dr. Eric Klein of the Cleveland Clinic.) Finasteride is also useful for reducing BPH. It's a mild drug, but there are some occasional side effects, including growing hair in the male pattern baldness areas, a side effect I have gratefully lived with. Avodart might even be more effective, but it has not been as thoroughly studied regarding cancer impact.

By the way, my first ever PSA, also when I was unaware of any symptoms, came back 113.6 in December 1999, so don't feel too bad! Congratulations on getting it done!

Good luck,

Jim

[able5]

Originally Posted by Bill1321

Having not been to a Dr. in a million years I took the advice of a nurse friend and went in and had some blood work. It was my first PSA test and it came back at 4.4. I went to a urologist who asked if I had any symptoms (I didn't). He gave me a DRE and said everything felt normal. He scheduled me for a biopsy. Being the chicken I am, I began reading all I could to avoid such test. My research told me that it wasn't that high and that for a first reading I shouldn't rush into such an invasive procedure. I was treated with an antibiotic for two weeks and re-tested 4 wks after that. The Dr. called today and said my number had dropped to 4.2 but was still above "normal." He recommended I go forward with the biopsy. I'm only 47 and the thought of surgery, with all the side effects, is pretty frightening. Is there such a thing as "watchful waiting" before a biopsy? Would I be crazy to monitor my PSA level every few months to look for a jump before letting them "dive in?" Any advice or personal experiences would be greatly appreciated.



Bill

My opinion...

Get the biopsy!

I was dx'd at age 58 and, like you, I initially went into shock, denial and avoidance. The thoughts of surgery and the after effects scared the heck out of me! Knowing what I know now, if I were age 47 with a PSA above 4, I'd muster up some courage and go get this test done. For me, it took some courage to face facts and face reality and realize that my chosen urologist, the professional that I fully researched and finally placed my trust in, is suggesting that I get a biopsy. That was enough for me. I say, if you have every reason to trust your urologist, and no reason to mistrust him, then you need to follow his advice. Some on this forum will pretend that they know more than their doctor does. In my view, that's a very big mistake and may result in a delay which may allow further growth and spread of the cancer. Bottom line, you either trust you doctor's advice, or you don't! If you don't, then you need to find a doctor that you trust and follow his advice.

A biopsy is no big deal and, when added to your PSA numbers and DRE, the biopsy is the next logical step in the process and it will be the reinforcement your need to either confirm or dismiss your fears. You mention "watchful waiting". I am personally not a big fan. Especially at age 47. If you were 20 years older, then I'd say it would be more appropriate. That being said, it is still a treatment to be considered when applied to a specific situation. Of course, any PCa treatment can not be started without "all" of the staging data. It seems to me that you are at the midway point of collecting your staging data. It's much too soon to choose a treatment option. Even "watchful waiting". In my mind, you still need (at minimum) a biopsy, a CT scan and a bone scan for any doctor to commence with a treatment.

One word of caution. Since you are so close to NYC and to the absolute best possible state-of-the-art medical care, I suggest that you get your biopsy done at an outpatient surgery center where they are fully staffed and fully equipped to make this procedure comfortable and safe. I had my biopsy done at this type of center. My biopsy was very much like getting a colonoscopy. They put you to sleep and the next thing you know you are waking up in the recovery room.

Just to ease your mind a bit...

For what it's worth, my robotic LRP surgery was a cake walk! I worried much about nothing. All my side effects are virtually gone.

Best wishes!