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    Old 11-17-2021, 04:46 AM   #1
    sniper2357
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    Fluctuating PSA

    Hi

    First post, psa for years at 1 or lower. Then in May of 2021 went to 2.7 in August 2.3 then in November 1.69, only seen and discussed with PCP. Now making appointment with urologist, but wondering why it went back to a level which I've read which is not or should not be concerning at this time. My father had Prostate Cancer at my same age 73, he is 99 now.

     
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    Old 11-17-2021, 10:50 AM   #2
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    Re: Fluctuating PSA

    Hi sniper2357 and welcome to the Board! And thanks for your service!

    Kudos to you for carefully tracking your PSA and knowing your results!

    This is where that pays off: it is very likely, according to what doctors advise, that an infection/inflammation is causing that fluctuation in your PSA results. Infection/inflammation typically exhibits a fluctuating PSA pattern as the infection/inflammation waxes and wanes. Sometimes the increases can be dramatic - in the tens, twenties, thirties, etc., echoed by dramatic decreases, and back to a normal level if the right antibiotic is found to eliminate the cause, which is not always easy to do.

    In sharp contrast, BPH that is unchecked causes a usually fairly steady, usually gradual increase in PSA, while prostate cancer causes PSA to double in a period of time that is usually the same for an individual patient, which results from one cancer cell dividing into two, two into four, four into eight, etc. Elevated PSA does not decrease, as yours has, if the elevation is caused purely by cancer or BPH.

    On the other hand, some of us have a combination of infection/inflammation, BPH and/or cancer going on at the same time, and that can cloud discovery of exactly what is happening. At your now fairly low level of PSA, my layman's feeling is that cancer is quite unlikely to be involved. My hunch is that the small elevation you are seeing, compared to your history, is likely due to some lingering infection.

    I'm hoping you find a good urologist who will not rush you to a biopsy that is very likely not appropriate in your situation. What would be appropriate is some lab testing to try to sort out a cause of infection, as well as, perhaps, some safety-belt blood or urine tests to eliminate cancer as a cause. In the unlikely event that tests open the possibility of cancer, what is called a "multiparametric MRI" (mpMRI) is becoming a filtering step to determine whether a biopsy would be wise. mpMRIs usually measure anatomy, blood flow, and water flow to get a combination of clues as to whether cancer is or is not likely. Biopsies are not a huge deal, usually, but it is smart to avoid unnecessary biopsies as there are some small but not zero risks.

    Also, about your father: prostate cancer is no longer your father's disease - enormous progress has been made and continues to be made. That means greatly improved chances of survival (really high for almost all of us), a shot at avoiding treatments for those of us with mild cases, and more effective treatments with lower burdens of side effects.

    Good luck!

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA, for some reason based on a less sensitive test on 7/20/2021 was <0.05, still apparently cured in my ninth year since radiation (PSA as of 12/2/2020 was <0.01). (T 93 as of 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. I have also had 225 undergraduate classroom hours just in statistics and experimental design, plus more in graduate school, which dwarfs what most doctors have, and that has made my “hard knocks” experience more meaningful. What I experienced is not a guarantee for all but shows what is possible.

     
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    sniper2357 (11-21-2021)
    Old 11-17-2021, 01:02 PM   #3
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    Re: Fluctuating PSA

    Continue to track your PSA. Early detection early treatment is the mantra for treatable cancers. Prostate cancer is a treatable cancer. With your father's history, you are at a higher risk.

    In general, a persistent PSA at or above 4.0 calls for a biopsy. This general rule is subject to modifications for ethnicity and age. Spiking and fluctuations are common for a variety of stated causes and none of them rule out the possibility of cancer if the levels do not return to normal and they continue to rise despite some volatility. BPH makes this much more difficult to track.

    Stay on top of it. Due to your family history, it is a good idea to turn the tracking and annual visits for testing, DRE and urinary symptoms over to a urologist to track with you.

    Put together your father's signature information if it is available. As much specific info you can gather about your father's disease will help you in tracking yours.

    Do not attempt to manipulate your PSA thinking you are impacting your risk of cancer with diets or supplements. It may temporarily alter your PSA, but it also adulterates it use to you as an effective way to monitor the possibility of cancer. Your PSA is now your best friend.

    Physical sitimulation of the prostate can temporarily raise PSA levels including sexual stimulation, DRE's (should be performed after the blood test), bicycle riding and heavy physical exertion are some others. Abstain from them several days before the test.

    Beware the use of antibiotics as a screening tool for prostate cancer. Many think a course of anitbiotics will resolve the inflammation causing the PSA spike to reverse proving the PSA rise was a result of inflamation from the infection. This practise contributres to developing resistant organisms, and studies have shown random fluctuations in PSA, unrelated to infections, behave in the same manner. It can not be used to determine cancer or infection as the cause.

    At this time, the only method for diagnosing prostate cancer for treatment is a positive biopsy.
    __________________
    Born 1953; family w/PCa-grandfather, 3 brothers
    7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2
    3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3
    5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, upgraded to G3+4, Tumor vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months
    7-9-21 PSA less than 0.02; zero club 5yrs

     
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    Old 11-17-2021, 02:40 PM   #4
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    Re: Fluctuating PSA

    Hi again sniper.

    Regarding workups after fluctuating PSAs, use of lab cultures to try to identify bacteria that may be responsible for PSA elevation is pretty much routine and widely accepted by urologists. I went through a similar experience myself a few months ago. I was experiencing "gross hematuria," a polite, technical medical term for blood in the urine; I'll fully agree with the term "gross", and it was a scary experience, including great discomfort and some pain, plus concern that something really threatening could be the cause. I'll bet my PSA would have been elevated if it had been tested at that time. I got an emergency appointment with my PCP, who took blood and urine samples. Based on the odds and symptoms, he immediately prescribed levaquin, an antibiotic, without waiting for the test results. I was feeling great, amazing relief within an hour, and by evening all signs of the infection were gone. A few days later the test results were in, showing that I had had an e-coli infection. As Prostatefree noted, use of antibiotics can result in growth of resistant bacteria, but that happens when the patient (or other patients) ceases the medication too early, allowing a few bacteria that have not yet been eliminated to mutate and sometimes become resistant. I took the full course of medications, I believe over ten days.

    For me, my trip to the doctor was not a screening tool for prostate cancer. Instead, it was an effective way of dealing with a common human occurrence, a urinary tract infection.

    To me, the PSA test is a multipurpose sentry that works effectively for three important men's health issues: of course cancer, the most serious by far, but also and far more commonly infection/inflammation and BPH, both of which can cause a lot of discomfort, pain and a reduced quality of life. I get really frustrated with doctors and others who criticize PSA because it is not highly sensitive and specific just to prostate cancer. As I see it, we should be grateful that it can signal trouble in three important areas, and good doctors have a pretty good shot at figuring out which is which.

    To paraphrase the previous post, many think a course of antibiotics that resolves inflammation behind an elevation of PSA is an important clue that infection was likely the cause of the elevation. I certainly agree. I also agree with the previous post that it is not absolute proof; that said, it is often enough proof to get on with our lives, hopefully keeping a watchful eye on PSA results.

    It is true that there are minor, random, day-to-day, lab-to-lab, test-version- to-test version fluctuations in PSA, but my impression is that urologists can sort these out easily from fluctuations due to infection. If anyone can cite studies to the contrary, I would welcome citations so that those of us interested can review those studies and change our understanding if the studies are sound and convincing. I am unaware of any such studies.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA, for some reason based on a less sensitive test on 7/20/2021 was <0.05, still apparently cured in my ninth year since radiation (PSA as of 12/2/2020 was <0.01). (T 93 as of 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. I have also had 225 undergraduate classroom hours just in statistics and experimental design, plus more in graduate school, which dwarfs what most doctors have, and that has made my “hard knocks” experience more meaningful. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 11-18-2021, 01:25 AM   #5
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    Re: Fluctuating PSA

    Just Google it. Antibiotic use has no impact on prostate cancer or it's risk.

    It's overuse in generating resistant bacteria is increasingly well documented as is the increased risk of drug resistant infection from it's overuse in men who may one day require a TRUS biopsy or surgery. And, the class of antibiotic drugs used today for these type infections can have very serious side effects that are not often disclosed in the casual attitude we have developed towards their use.

    At best, the use of antibiotics as a cancer screening tool for PCa can be used to avoid biopsies. But again, it has no impact on the risk of cancer, and avoiding biopsies in men consistently exceeding recommended PSA thresholds for biopsy is risky business. Especially those with family history of the disease.

    There are now biopsy procedures that greatly reduce the risk of biopsy infection if there is a concern, i.e. transperineal prostate biopsy.

    By all means, if you have a proven infection treat it with antibiotics. But, use of antibiotics for asymptomatic men trying to avoid a biopsy or confirm prostatitis or BPH is bad medicine.

    The OP's PSA numbers alone do not call for a biopsy at this time. Nor is there any concern or symptoms shared indicating he may have prostatitis or BPH. His PSA numbers are low and his fluctuations are not uncommon.

     
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    Old 11-20-2021, 12:19 PM   #6
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    Re: Fluctuating PSA

    Hi again sniper and Prostatefree. Sniper, your original concern has generated a discussion of some important points that include ongoing controversy, not just on this board but in and between the urologic and oncologist medical communities. I hope you already have the information you need, but in case you haven't, and because many others will be viewing this discussion, here are some thoughts to carry the discussion forward.

    Prostatefree - you posted the following in response to my request for specific citations of studies that you believe exist that show there are significant random fluctuations in PSA, unrelated to infections or inflammation. This is in the context of well-accepted awareness that there are minor day-to-day, lab-to-lab, etc. variations in PSA, incuding variations due to ejaculation and other causes you mentioned, variations that are below the threshold of this fluctuating pattern of PSA; these minor variations are not the issue here:

    Quote:
    Originally Posted by Prostatefree View Post
    Just Google it. Antibiotic use has no impact on prostate cancer or it's risk."
    Regarding "just google it", whenever I see such a response, I automatically react with the feeling that the person making the claim believes what they have said but actually lack any credible support for it. Perhaps, I'm wrong here, but the ball is still in your court. I am unaware of any such study. It's up to you to find at least one credible study that supports your claim. Frankly, based on what I've heard from expert doctors over the years, I believe you won't find even one. If you do cite a study, I commit that I will will look at it. If you find more than one, please tell me the one you would like me to look at.

    Regarding antibiotic use and prostate cancer risk, it seems that you and I are paying attention to different doctors. That's a benefit for all of us, as we all get exposed to different perspectives. I sense that you pay more attention to urologists, while I am more attentive to medical oncologists with practices dedicated to prostate cancer patients. Here's what the doctors I follow recommend: seeing if a rise in PSA that has a pattern and perhaps symptom set resembling infection by a work up, involving "antibiotic challenge" when appropriate; if the elevated PSA drops back to normal, then they do not keep looking for other causes, such as BPH or cancer. If the elevation cannot be explained, they continue to look, not just for cancer or BPH, but for infection and inflammation that may have been overlooked, as well as rare causes (e.g., infarction). (This is not the same thing as routinely trying antibiotics on all men with PSA elevations, which they DO NOT advocate!) Sometimes these docs say they decide to just wait and observe more test results to see if that reveals more clues and a clearer picture of what is going on. I'm not a health professional and never have been one - no enrolled medical education, but that approach makes good sense to me. Even if lab cultures, etc, turn out negative, these doctors also recognize that infection/inflammation can still be the cause, as infection is sometimes impossible to pin down, and prostatitis can have a non-bacterial cause and therefore will be unaffected by antibiotics.

    You raised another point about antibiotics as follows, but I'm not sure whether you are addressing a particular class of antibiotics, such as those often used for transrectal biopsies for prostate cancer, or antibiotics generally:
    Quote:
    Originally Posted by Prostatefree View Post
    It's overuse in generating resistant bacteria is increasingly well documented as is the increased risk of drug resistant infection from it's overuse in men who may one day require a TRUS biopsy or surgery. And, the class of antibiotic drugs used today for these type infections can have very serious side effects that are not often disclosed in the casual attitude we have developed towards their use.
    That's kind of the way I see it too, but with more of a balance that includes benefits on the other side of the scale. When my PCP was prescribing levaquin for me for that UTI I experienced (described earlier in this thread), he mentioned the risk of drug resistance but emphasized that he saw that risk as quite low in my particular case. And about "very serious side effects," yes: I read the flier that came with the container of pills, and a few of those possible side effects were serious and worrisome; I was a bit on my guard for signs of those effects throughout the ten days and even afterwards, as some of them may show up months later - still not completely out of the woods, but I now am fully confident.

    My impression is that's the way it is with much of modern medicine - a balance of likely benefits against unlikely but still real, serious risks - sort of like the ads for medications that we hear so often on TV which often include speedl-talking through an array of scary risks, typically including a line similar to "If you take it and it kills you, stop taking it". For instance, that benefit/risk balance is definitely the case with surgery for prostate cancer: for appropriate patients surgery is curative in a substantial majority of cases - the benefit, but surgery also involves a substantial likelihood of somewhat burdensome side effects, such as a degree of incontinence, usually quite tolerable, plus a small chance of some life-altering, really bothersome side effects. Moreover, if the surgeon is an inexperienced, low-volume doctor, a risk of death due to the operation for about 1 in every 200 patients treated. And yes - patients are often not specifically informed about those risks of treatment, such as for prostatectomy. That neglect to inform is on the doctors, but also we patients often do not do enough fact gathering and thinking, which is on us.

    Quote:
    Originally Posted by Prostatefree View Post
    At best, the use of antibiotics as a cancer screening tool for PCa can be used to avoid biopsies.
    I think you are implying that some doctors are routinely giving antibiotics to their patients who experience PSA elevations, regardless of whether the circumstances suggest that infection/inflammation is a likely cause. I have not heard that such use of antibiotics is at all common, but perhaps some researcher has looked into this and can answer the question for us. To me, it seems poor medical practice to put a patient through a course of antibiotics without having a good reason, such as suspicion of bacterial infection. It strikes me as offering a low likelihood of benefit while opening up the risks you have mentioned. If that is what you are essentially concerned about, then we are both seeing this the same way. Such medical practice is not at all the same thing as looking for an infection when an infection is likely, especially when there is a significantly fluctuating pattern of PSA results.


    Quote:
    Originally Posted by Prostatefree View Post
    But again, it has no impact on the risk of cancer, and avoiding biopsies in men consistently exceeding recommended PSA thresholds for biopsy is risky business. Especially those with family history of the disease.
    Maybe I'm seeing this differently because I've been at it a long time, since 1999, including a period of many years when a very large and vocal proportion of PCPs was arguing that PSA tests were more harmful than good because they were steering so many men toward unnecessary biopsies and unneeded treatment, especially prostatectomies, too often resulting in bothersome consequences, especially serious incontinence, which they were seeing in their practices. Bottom line: they were telling many patients that they should not have PSA tests. (My PCP at the time was in that group, and if I had not had misgivings about his advice, I'm convinced I would have been long dead.) We are still suffering needless deaths because of earlier guidance from the US Preventive Services Task Force, basically a PCP operation with scant expertise in oncology, a group that overdrove their headlights and persuaded many doctors and many in the media and public that PSA tests were not worth it. A PhD (NOT MD!!!!!) named Richard Ablin even wrote a book which strongly discouraged PSA testing; the book - "The Great Prostate Hoax" - is profoundly flawed and dangerous, but unfortunately it has been influential, and I am convinced has caused many needless deaths and much suffering.

    So for me, it is really important to consider infection and BPH as likely causes of an elevated PSA; this is important in order to avoid needless biopsies. Proper smart screening with PSA testing, with consideration of infections and BPH, achieves what we really need: catching significant prostate cancer, but avoiding needless biopsies and fruitless treatments where a patient with a mild case but aggressive doctor is spooked into something he does not need.

    Doesn't that make sense?

    Quote:
    Originally Posted by Prostatefree View Post
    There are now biopsy procedures that greatly reduce the risk of biopsy infection if there is a concern, i.e. transperineal prostate biopsy.

    By all means, if you have a proven infection treat it with antibiotics. ...

    The OP's PSA numbers alone do not call for a biopsy at this time.
    Sniper, you are seeing different opinions here, but I'm thinking all of us would agree with these statements.


    Quote:
    Originally Posted by Prostatefree View Post
    ... But, use of antibiotics for asymptomatic men trying to avoid a biopsy or confirm prostatitis or BPH is bad medicine.... Nor is there any concern or symptoms shared indicating he may have prostatitis or BPH. His PSA numbers are low and his fluctuations are not uncommon.
    Well, I'd really like to hear a good urologist comment on these statements, but our board is not for medical professionals. Infections, prostatitis and inflammation often have no symptoms at the time that a pattern of PSA results suggests that something is going on, very possibly an infection. I have heard well-regarded urologists and oncologists state that a fluctuating PSA pattern is a fairly reliable sign of an ongoing or previous infection.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA, for some reason based on a less sensitive test on 7/20/2021 was <0.05, still apparently cured in my ninth year since radiation (PSA as of 12/2/2020 was <0.01). (T 93 as of 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. I have also had 225 undergraduate classroom hours just in statistics and experimental design, plus more in graduate school, which dwarfs what most doctors have, and that has made my “hard knocks” experience more meaningful. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 11-21-2021, 04:01 AM   #7
    sniper2357
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    Re: Fluctuating PSA

    ALL:

    Thank you for your posts. I apologize for not responding, but lost my sign in credentials and obviously found them. I also want to again than you all for your thoughtful and indepth response to my short post. It's comforting to know that people such as yourselves care enough to share your experiences and knowldege.

    In addtion to the recent, 2021, PSA results my new to us PCP did a DRE at my insistance and found it to be soft and small. Upon further consideration her reluctance and the fact that prior to taking over the practice of our long time PCP who retired due to the pandemic she is a "Family" doctor and I have become somewhat concerned at the number of DREs she has done etc.

    I have no symptons at all other than an occasional slight pain when urinating at the tip, but I also have kideny stones. In September of 2020, without seeing our PCP he treated my symptoms as an infection and prescribed Cipro for 10 days. Gave relief and a reaction in the groin area that required a trip to a dermotologist, who cleared it up in a short time with a cream. Other than the occasional urinating pain I've never had a "failure" etc. On a CT scan in September of 2020 they noted two more stones of less than 4mm as well as "Center Calcification of the Prostate". When I saw via video this October my new PCP I told her I wanted a new CT to see what was going on with the stones as I had new back pain. She reluctantly agreed, I had it and this time they see one stone of under 2mm, she has no explanation other than I passed the other two and this is a new one. Other than slight pain at the tip during urination a few times I never felt anything if in fact they have passed. Also, on this CT they noted nother remarkable down in the area except the "center calcification of the prostate". Our PCP upon this and the new 1.69 PSA says we will simply monitor at next annual physical in June. I am not one to wait around so the Urologist is scheduled and fortunately under our Medicare plan I do not need any referrals for in network Doctor appointments.

    So, I have an appointment this coming Wednesday the 24th with a Urologist at a major teaching hospital where we live. She, is a new Urologist who was hired and working under the department head who is a surgeon only. The department head's assistant recommended this urologist I have an appointment with as the 18 others in the department are all booked out until late December or January, so I figured this would be a start.

    I am looking forward to talking with the Urologist as I've never been to one and want to hear her assesment of the fluctuating PSA numbers and what she recommends as a next step. I have no intention at this point of a biopsy, but would if she does a "Free PSA" blood test and it comes back below 25%.

    I will make sure to post what she says and what steps she recommends as the next step. I am also, without names etc going to show her the comments from this board. As noted she is a new urologist to this team, but her credentials are substantial and she treats only Prostate Cancer, Infections of the Prostate, Kidney and Bladder as well as Kideny Stones.

    Again I appreciate you all.

    Bud

     
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    Old 11-22-2021, 12:44 PM   #8
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    Re: Fluctuating PSA

    Hi again Bud (sniper),

    You're welcome, and I hope your upcoming consultation gives you peace of mind.

    I'm looking forward to your review of the urologist's impressions. As she is new to the field but has obviously gone through all the hard work and education needed to become a specialist in urology, her advice to you should reflect the state-of-the-art in the urologic community, informed by recent findings from research. Sometimes older doctors, while having a big advantage in knowledge gained from long practice, have a disadvantage if they have not kept up with research, or if they have become committed to approaches that are now obsolete. I suspect those influences are typical of all of us, no matter what our occupation. We're human.

    Here's one more thought. You wrote:
    Quote:
    Originally Posted by sniper2357 View Post
    ... I have no intention at this point of a biopsy, but would if she does a "Free PSA" blood test and it comes back below 25%.
    "Free PSA" is often a useful clue, but it is not that specific to prostate cancer. Unfortunately, the percentage can also be reduced, as it is with cancer, if the patient has an infection. For that reason, some of the other more modern tests that include free PSA as one of their constituents can also mislead if infection is present.

    Also, while a result of 25% or higher is a pretty strong indication of no cancer, there is a wide area of uncertainty below that level; the doctors I follow view findings above 10% as equivocal and don't regard the clue as a strong indicator of likely prostate cancer until the result is 10% or below. It used to be widely used in a work-up where prostate cancer was a possibility. My layman's impression is that it is no longer much used; in the wonderful guide to prostate cancer, the 2018 book "The Key to Prostate Cancer," it is not even mentioned.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA, for some reason based on a less sensitive test on 7/20/2021 was <0.05, still apparently cured in my ninth year since radiation (PSA as of 12/2/2020 was <0.01). (T 93 as of 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. I have also had 225 undergraduate classroom hours just in statistics and experimental design, plus more in graduate school, which dwarfs what most doctors have, and that has made my “hard knocks” experience more meaningful. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 11-22-2021, 03:40 PM   #9
    sniper2357
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    Re: Fluctuating PSA

    Quote:
    Originally Posted by IADT3since2000 View Post
    Hi again Bud (sniper),

    You're welcome, and I hope your upcoming consultation gives you peace of mind.

    I'm looking forward to your review of the urologist's impressions. As she is new to the field but has obviously gone through all the hard work and education needed to become a specialist in urology, her advice to you should reflect the state-of-the-art in the urologic community, informed by recent findings from research. Sometimes older doctors, while having a big advantage in knowledge gained from long practice, have a disadvantage if they have not kept up with research, or if they have become committed to approaches that are now obsolete. I suspect those influences are typical of all of us, no matter what our occupation. We're human.

    Here's one more thought. You wrote:

    "Free PSA" is often a useful clue, but it is not that specific to prostate cancer. Unfortunately, the percentage can also be reduced, as it is with cancer, if the patient has an infection. For that reason, some of the other more modern tests that include free PSA as one of their constituents can also mislead if infection is present.

    Also, while a result of 25% or higher is a pretty strong indication of no cancer, there is a wide area of uncertainty below that level; the doctors I follow view findings above 10% as equivocal and don't regard the clue as a strong indicator of likely prostate cancer until the result is 10% or below. It used to be widely used in a work-up where prostate cancer was a possibility. My layman's impression is that it is no longer much used; in the wonderful guide to prostate cancer, the 2018 book "The Key to Prostate Cancer," it is not even mentioned.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA, for some reason based on a less sensitive test on 7/20/2021 was <0.05, still apparently cured in my ninth year since radiation (PSA as of 12/2/2020 was <0.01). (T 93 as of 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. I have also had 225 undergraduate classroom hours just in statistics and experimental design, plus more in graduate school, which dwarfs what most doctors have, and that has made my “hard knocks” experience more meaningful. What I experienced is not a guarantee for all but shows what is possible.
    Jim:

    Thank you again for your taking the time and making the effort on my behalf. Much appreciated and I will update

    Bud

     
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    IADT3since2000 (11-23-2021)
    Old 11-26-2021, 06:26 AM   #10
    sniper2357
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    Re: Fluctuating PSA

    Had my appointment with the urologist on Wed and went over things as I noted in my previoius posts.

    She did a DRE as I was not confident in our new PCP's ability and it appears my thoughts were on point. Everything is fine, but slightly enlarged, which the urologist said could easily be missed by someone who does not do many DRE's and she said that her department does one on every patient that comes in, every time.

    She did an in office urine check and fluid check from the prostate, all good.

    The pain she said was referred pain from a passing kidney stone and that the one on the most recent CT was small enough so that I could have passed it and not know I had done so except the pain was gone after a few days, which it was on the day of the exam and the night prior. So, based on her assesment I think I did pass a stone and that it's movement over the past month or so was the urination and pain issue.

    The result is that for a 73 year old she said everything looks good, we have another PSA test and office visit in May of 2022, unless something else comes up and then to contact her and come in again. I am good with her assesment as she also had the head of the department look at things as he was not operating nor seeing patients that day, and was sort of wondering around. He only operates now and has removed or partially removed a number of my friends prostates and after a few months they are all doing well, except one who had let things go way too far.

    Thanks again for all your input and best of luck to you all.

    God Bless

    Bud

     
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