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  • Rapid PSA rise to 4.5 at age 49

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    Old 01-23-2018, 10:58 AM   #1
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    Rapid PSA rise to 4.5 at age 49

    I have not been diagnosed with prostate cancer.

    The background:
    Just turned 49 a few weeks ago
    No known prostate issues in men on my mother's side, no information on men from father's side
    Off and on TRT for last 13 years, mostly off more recently (skipped 3 out of 4 prescribed weekly injections for at least the last 3 months, no injections in the 4 weeks preceding most recent PSA test)
    Active and pretty healthy at 6', 200 lbs...have dropped 45 lbs in the last year by eating better and exercising regularly.

    Recent PSA results:
    6 Jan 16 - 1.04
    6 Sep 16 - 1.33
    8 Aug 17 - 1.84 (Endo expressed concern about rising trend, despite low values)
    19 Jan 18 - 4.46

    The "good" news, if Google is to be believed, is the fact that I've had urinary symptoms for at least the last several months, including difficulty starting, reduced flow, feeling that I'm not completely emptying my bladder, frequent trips to the restroom, and occasional night trips. If I understand correctly, urinary symptoms + elevated PSA = lower risk of PCa. However I'm not finding anything about rapid onset BPH, but plenty on high PSAV.

    So, my endo is concerned and wants me to have it investigated by a urologist. My primary is submitting referral paperwork to my insurance, which will take about a week, then I'll likely be looking at a couple month waiting list to see a local urologist. I'm assuming he'll want to do a DRE and perhaps order a round of antibiotics followed by another PSA test if DRE is normal, but it's possible he'll want to do some imaging, or maybe a biopsy. Does that sounds about right? The infection possibility seems unlikely, as there's no pain and I've been through a couple rounds of antibiotics for ortho surgeries in last few months (shoulder replacement on 9/5 and cervical disc replacement on 12/29).

    I usually travel out of town for specialized medical care (last 5 ortho surgeries, I'm becoming a cyborg with 5 artificial joints already), but at least for now, I'm leaning toward tolerating a longer waiting list to stay local unless/until a diagnosis suggests I need someone better. Does this seem like a reasonable approach for my relatively low risk factors? What questions should I bring to my initial consultation with the urologist? What concerns should I have now, or should give me pause when discussing with him?

    Thanks in advance for any thoughts or advice.

    Last edited by Administrator; 01-23-2018 at 10:18 PM. Reason: Missed words

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    Old 03-19-2018, 10:27 AM   #2
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    Re: Rapid PSA rise to 4.5 at age 49

    Follow-up. After a couple month wait, I finally got into see a urologist this morning and was scheduled for a biopsy after another couple month queue. He did tell me to get another total PSA test done, with the option to cancel the biopsy if it's back down around 2 or below. I asked him if we could do the bigger set of analyses this time, with %free, but he declined on the basis that his desire to do the biopsy would be unaffected by the percent free PSA result, be it 5 or 30. That's a little frustrating as I'm a scientist and l take comfort in data. I wish I could tell the lab to test for percent free in addition to total and just pay cash for the extra analysis. I know its results aren't definitive, but they do provide some additional context and help frame a more/less likely opinion.

    Last edited by afg; 03-20-2018 at 05:51 AM.

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    Old 03-23-2018, 01:53 PM   #3
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    Re: Rapid PSA rise to 4.5 at age 49

    Hi afg,

    Welcome to the board, and Iím sorry no one responded earlier.

    The urologistís plan looks sound to me, especially dumping the biopsy if the PSA pattern signals that an infection is driving the PSA. That kind of pattern could be benign growth, especially with TRT in the background, up to that January result of 4.46 .

    Both your urinary symptoms and that rapid jump in PSA suggest an infection; infections breeze right through antibiotics that are not the ones needed for the bacterium that is causing the infection. Infections will often result in an up and down pattern of PSA results as the infection waxes and wanes; sometimes the changes will be rapid and large. That is not the pattern for BPH, and the rapid rising part isnít the pattern for cancer either unless it is one of the quite aggressive but uncommon types of prostate cancer. If cancer IS driving this, you will see a substantial increase in PSA in the next test (but infection might cause that too). Also, infections, like cancer, affect free PSA scores, so itís understandable that the urologist's decision would be unaffected by the free PSA level in the context of a likely infection.

    I can empathize with your frustration as a scientist. In 2012 I had had two highly advanced scans for bone and soft tissue metastases. But both were negative, so there was no explanation for underlying aggressive cancer except a simple CT scan, at the time of placing fiducials for radiation in 2013, that had revealed an enlarged area within the prostate itself. I really wanted a multiparametric MRI to characterize what was going on in my prostate. Like your urologist, my radiation oncologist was reluctant as it would not have altered his planning. I did appreciate his point, but I still kind of wanted to know, though I knew he was right; when you are used to analyzing things, it's hard to forego getting data. (All has turned out well.)

    Hereís to a good PSA result!

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