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Cancer: Prostate Message Board

PSA increase from 1.2 to 2.0


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Old 08-21-2017, 09:25 PM   #1
gop
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PSA increase from 1.2 to 2.0

I recently had my PSA test and shocked to find it to be 2.0. It was 1.2
8 months back.
I am a 56 year old male and have no health issues.
However I have an enlarged prostate 35cc.
I have difficulty voiding completely. My KUB ultrasound showed
residual volume of 41 cc (pre void was 150 cc).
My PCP did a DRE in Jan 2017 and said theres no cause for concern.
Should I be concerned?

Last edited by gop; 08-21-2017 at 09:34 PM.

 
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Old 08-22-2017, 12:05 PM   #2
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Re: PSA increase from 1.2 to 2.0

Hi gop,

The odds are compelling that cancer is not an issue, though in rare circumstances an extremely low-odds situation will turn out to be cancer.

A rule of thumb is that a non-cancerous prostate will produce about .1 units of cancer for every cc of cancer, in other words, one tenth. Therefore, a prostate of 35 cc would account for a PSA based on healthy cells of about 3.5, and you are well below that. Another rule of thumb uses a factor of .067 for every cc, so 35 cc X .067 = 2.3, pretty close to your value.

One of the reasons for different rules-of-thumb is that many estimates of MRI size are not that precise. Often urologists, or even PCPs, estimate the size based on their DRE. If they are highly experienced, with a lot of reality feedback from surgery or MRIs, and to a lesser extent transrectal ultrasounds, their estimates based on a DRE can be pretty close; the less experienced they are, the chancier it gets. An MRI is the most accurate way of estimating volume (lining up well with post operative prostate specimens). Transrectal ultrasound is close, but slightly underestimates the size as the transrectal probe slightly compresses the prostate.

You do have reason for concern though, due to your symptoms, but not about cancer (unless you have one of the truly rare situations). The much more likely causes for your symptoms are BPH and/or an infection. A fairly rapid rise such as you have experienced strikes my layman's eyes as more likely an infection. A urologist often is able to help with these situations.

BPH drugs finasteride and dutasteride are helpful against BPH, and also helpful against the milder version of prostate cancer. Among other benefits, they eliminate the "noise" from BPH in the PSA "signal", giving you a new, purer baseline from which increases stand out with greater clarity, making PSA a better sentinel for prostate cancer. These drugs have the same benefit for DREs.

Good luck!

 
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Old 08-22-2017, 01:34 PM   #3
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Re: PSA increase from 1.2 to 2.0

Quote:
Originally Posted by IADT3since2000 View Post
Hi gop,

The odds are compelling that cancer is not an issue, though in rare circumstances an extremely low-odds situation will turn out to be cancer.

A rule of thumb is that a non-cancerous prostate will produce about .1 units of cancer for every cc of cancer, in other words, one tenth. Therefore, a prostate of 35 cc would account for a PSA based on healthy cells of about 3.5, and you are well below that. Another rule of thumb uses a factor of .067 for every cc, so 35 cc X .067 = 2.3, pretty close to your value.

One of the reasons for different rules-of-thumb is that many estimates of MRI size are not that precise. Often urologists, or even PCPs, estimate the size based on their DRE. If they are highly experienced, with a lot of reality feedback from surgery or MRIs, and to a lesser extent transrectal ultrasounds, their estimates based on a DRE can be pretty close; the less experienced they are, the chancier it gets. An MRI is the most accurate way of estimating volume (lining up well with post operative prostate specimens). Transrectal ultrasound is close, but slightly underestimates the size as the transrectal probe slightly compresses the prostate.

You do have reason for concern though, due to your symptoms, but not about cancer (unless you have one of the truly rare situations). The much more likely causes for your symptoms are BPH and/or an infection. A fairly rapid rise such as you have experienced strikes my layman's eyes as more likely an infection. A urologist often is able to help with these situations.

BPH drugs finasteride and dutasteride are helpful against BPH, and also helpful against the milder version of prostate cancer. Among other benefits, they eliminate the "noise" from BPH in the PSA "signal", giving you a new, purer baseline from which increases stand out with greater clarity, making PSA a better sentinel for prostate cancer. These drugs have the same benefit for DREs.

Good luck!
Thanks a lot for clarification. Extremely helpful.
I had urine tested and was normal. So can I rule out infection as the cause?
I was concerned due to the symptoms - difficulty voiding, frequent urination, sense of having to urinate even after urination etc.
Since there was no blood in my urine, does it mean that it's not cancerous?

My PCP prescribed Cialis for my BPH (since I have premature ejaculation issue as well). However I haven't started due to fear of side effects.

Do you suggest getting a Ultrasound (UKB) done to see if there's an increase in my prostate size? Or do you think I should get a MRI (3 Tesla one)?

 
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Old 08-23-2017, 04:59 PM   #4
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Re: PSA increase from 1.2 to 2.0

My layman's understanding is that urine test will not rule out infection as a cause, though I think sometimes it confirms an infection. I would not testify in court to that. I do know that nailing down a urinary tract infection can be tricky. Often, doctors try one of the usual antibiotics that knock out a substantial percentage of infections. If that doesn't work, they will try another. They may also try to do a culture to figure it out.

The absence of blood in the urine does not at all rule out cancer. It can be a sign of advanced cancer, but more often it points to some other non-cancerous urinary issue.

I have never heard of Cialis being used for BPH, but again, I'm a layman. It's common use is for erectile dysfunction, and it is well established in that role. Whether it (or any drug) is worth the possible side effects is a decision we all have to make, hopefully after becoming well informed. This often isn't easy!

Whether to have an ultrasound or an MRI would be something to discuss with a urologist. My hunch is that you probably will do fine without one or the other, but that too - whether to go to a urologist - is something with which your PCP may be able to help you with.

Take care,

Jim

 
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Old 08-23-2017, 06:31 PM   #5
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Re: PSA increase from 1.2 to 2.0

Thanks again. Very informative
Are the prostrate size and infection related ?
The reason I am asking is that I have never had infection in the past
The first one was last year and the second one a few weeks back
On both occasions it lasted about 2 weeks and didn't take any medication

 
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Old 08-30-2017, 03:02 PM   #6
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Re: PSA increase from 1.2 to 2.0

I believe that prostate size and infection are generally unrelated, though I suppose infected prostate cells may become a bit bigger. I'm not sure about that.

Sometimes a chronic infection will go through a dormant phase: still there, but no symptoms. However, you might have just had two different and unrelated infections that went through a short course and then ended.

 
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