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  • 48 yrs old, 8.6 PSA, 8.4 percent free PSA

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    Old 08-01-2018, 01:36 PM   #1
    flyted's Avatar
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    48 yrs old, 8.6 PSA, 8.4 percent free PSA

    Hello this is my first post here after getting a standard PSA of 8.6 and having a free PSA came back pretty low (not good) at 8.4%. I'm 48 years old. My father died of prostate cancer at 60 and I mention this any time I see a doctor. I have a very healthy diet and exercise often. I have an appointment with a good urologist in about 10 days.

    Here is my sort of "resume". I'll try to keep it as brief as possible.

    1999 / 29 years old - I was having problems with frequent urination for a while. There were also 2 things that both seemed to make the frequent urination even worse - frequent masturbation and alcohol consumption. I went to a urologist. We wound up doing a cystoscopy and everything looked completely normal. Looking back the cystoscopy was probably overkill but it wasn't painful. The urologist then suggested prostatitis and then put me on a course of ciprofloxacin antibiotics. That seemed to do the trick as I recall just forgetting about the problem for a while after that.

    2000 - 2016 - In subsequent years the frequent urination would flare up again from time to time. I was in my 30s and early 40s so I didn't get too concerned and chalked it up to more prostatitis. In my 40s I started getting digital rectal exams. It was always the same result. Normal size and smooth.

    Late 2015 - As part of a mid-life crisis, I wound up having several sexual relationships with different female partners. About half the time I did not use protection. Yes I realize that was very dumb. I regret it and have learned from it.

    2016 / 46 years old - I had my first PSA test and the result was 3.28. My general doctor said that was a little high for my age but nothing to get too alarmed by. He said come back for another PSA in 6 months. I got busy, life got in the way and I didn't have another PSA until last month, July 2018.

    2018 / 48 years old - For a few months I had been having a rise in frequent urination and also a feeling that I can best describe as inflammation in the prostate area. There has also been some dribbling. For the prior 2 years I had been noticing an increase in frequent urination but not as much as in these few months. Last month (July), I had my second and third PSA tests as well as a PSA Free test. As I mentioned the results were:
    Second PSA on 7/13: 8.4 ng/mL
    Third PSA on 7/31: 8.6 ng/mL
    PSA Free on 7/31: 8.4% (lower % means better chance of cancer)
    Digital rectal exam: normal size and smooth.

    I will see the urologist and then soon know more but in the meantime I was wondering what other's make of this or if anyone has been on a similar path. I realize one of the criticisms of the PSA test is that it can lead to unfounded cancer fears, so I am not panicked. But I sure am wondering if this is more prostatitis (based on my history) or prostate cancer (based on my father and my test results). Lastly I should add that I have had a few STD tests since that promiscuous period late 2015 / early 2016 and they have all been negative. My last STD test was April 2018.

    I feel like I am probably headed towards a biopsy. I'm not opposed to that although I rather not do it unnecessarily. I will defer to the urologist's expertise though. I am also going to ask the urologist if it makes sense to first go back to another round of prostate-focused antibiotics like cipro and then see how things feel and do another PSA.

    Thanks for reading this.

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    Old 08-02-2018, 01:08 PM   #2
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    Re: 48 yrs old, 8.6 PSA, 8.4 percent free PSA

    Hi flyted and welcome to the Board!

    It’s easy to see where that rise in PSA in the light of your family history would grab your attention! I hope you “just” have prostatitis again, which I think is fairly likely but by no means excluding the chance that there is prostate cancer.

    That PSA pattern could represent infection/inflammation alone, or in combination with BPH and/or prostate cancer. While that “free PSA” result is in the range that suggests cancer, free PSA, like PSA, is heavily affected by infection/inflammation; in other words, it is not reliable when the patient has a prostate infection. Given your personal history, another round of Cipro seems a no brainer to me; if the PSA plunges, then the chance for prostate cancer drops a lot. If your PSA does not go down, then there could still be infection/inflammation, just with a cause that does not respond to Cipro, as is often the case.

    My father also died of prostate cancer, though he was in his 80s. While having a “first degree” relative – a father or brother – who had prostate cancer, especially one who died of it at a young age increases your risk quite a bit, prostate cancer is by no means in 2018 your father’s brand of prostate cancer. Survival has improved greatly, and treatments with related management technology are vastly better. These days survival at 10 years from diagnosis, averaged for men with all degrees of seriousness, is virtually 100% - the best of any major cancer, with the few unfortunate men diagnosed with widely spread disease about the only ones at substantial risk of death from prostate cancer in the near term. (And even their situation appears to be improving.) Even at 15 years, survival compared to age-matched peers is about 95%! (I appear to be in fairly good health at age 75 and with 18 years as a survivor of a once life-threatening case unde my belt.) This modern survival snapshot contrasts to the 1970s when about a third of all diagnosed prostate cancer patients didn’t make it to even the five year point.

    One of the many improvements is genetic testing, which has made its way to the clinic in the past few years, though its use is still not widespread and it is steadily becoming more useful. With your family history, a genetic test panel would probably be wise; results can aid in therapy selection, though mostly for folllow-up therapies, if needed, rather than primary radiation or surgery. There is no doubt that we will see substantial advances in the usefulness of genetic results in the coming years.

    If your results are still troubling after another course of Cipro, the next step might be a multiparametric MRI instead of a biopsy. This is becoming popular. I just posted about that on another thread on this Board. If it were me, I would not jump to a biopsy just yet; on the other hand, that is not unreasonable if it will give you peace of mind.

    Good luck!

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    Old 08-04-2018, 09:11 PM   #3
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    Re: 48 yrs old, 8.6 PSA, 8.4 percent free PSA

    Thanks for your very insightful reply IADT3since2000. Due to an insurance complication I am not seeing a urologist now until early September. I did however get my primary doctor to give me a prescription for Cipro, which is good as at least I am starting to do something now. He wants me to take the Cipro for 28 days - 500 mg twice a day for the first 7 days, and then 500 mg once a day for the final 21 days. Then we will do one more PSA to see if their is a change before I go the urologist. I am really crossing my fingers the Cipro does have an effect.

    By genetic testing do you mean something like 23andMe (with the health option included) or something more clinical? I haven't done 23andMe yet but I am planning on doing it soon.

    I do agree if the PSA doesn't drop on the next test, that doing a multiparametric MRI would be the best next step. I read your other thread and the PROMIS study is very encouraging. I'm just not sure my health insurance will go for that over a biopsy. I'm actually working very hard on changing my insurance to something better at the moment.

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