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  • Elevated PSA

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    Old 06-15-2009, 09:51 AM   #1
    babette1
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    Elevated PSA

    I just got a full compliment of blood work done by my primary doc and the report shows a PSA of 4.7, up from 3.6 six months ago. Six months prior to that it was 3.9 so it has been going up and down. I have yet to discuss this with my doctor or a urologist but when I got a digital exam six months ago he said the prostate was "smooth" and only slightly enlarged, (1 out of 4?). I am 62 and also am being treated for low testosterone (currently 199) with Androgel. I would be interested in hearing what guys out there think is a sensible approach for me to take at this juncture. Thanks in advance!

     
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    Old 06-15-2009, 11:43 AM   #2
    kcon
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    Re: Elevated PSA

    The purpose of screening for cancer is to detect the cancer at its earliest stages, before any symptoms have developed. Patients who find PC at its early stages have the widest range of options for treatment, and have the highest probability for successful treatment/cure. The PSA test and DRE exam are the standard tests for early PC detection.

    That being said, there are other very plausible causes for a high PSA result besides PC (infection or BPH, a benign issue). I would recommend thinking of a high PSA result as an "early warning flag" which has alerted you to look further into the root cause…if it is caused by infection or BHP, then find this out and treat it. If it is PC, then you will want to know and consciously act on that.

    Unless there are other indications for the infection or BHP, then your urologist will likely recommend a biopsy to more definitively look for cancer as the root cause. While the PSA result is simply a "warning flag", the biopsy can be definitive. I say "the biopsy can be definitive" because if the biopsy samples do find cancer, then there IS cancer. If, however, they do not find cancer, it typically means either (i) there is not cancer, or (ii) the small biopsy samples simply did not find the cancer. The cancer can occur in "zones" in the prostate, in clumps, rather than mixed in homogenously like cream in coffee. Six samples used to be more standard, but is now generally considered too few. Twelve is more common now, and I've heard of 18. More samples simply improves the accuracy of the result/conclusion.

    Here’s a highly recommended book that it is not too early to purchase (readily available via online booksellers): "A Primer on Prostate Cancer - The Empowered Patient's Guide" by Strum and Pogliano. This excellent reference book covers a wide range of topics, from the beginning of cell mutation, through the testing processes and treatment options.

    Does this help answer your question?

    best wishes…

    Last edited by kcon; 06-15-2009 at 11:45 AM.

     
    Old 06-15-2009, 11:50 AM   #3
    babette1
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    Re: Elevated PSA

    Yes, thank you very much. I will begin to research and talk to the appropriate medical experts as I attempt to get to the bottom of this "new" medical issue in my life. It's rough getting old!

     
    Old 06-15-2009, 11:59 AM   #4
    kcon
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    Re: Elevated PSA

    Quote:
    Originally Posted by babette1 View Post
    It's rough getting old!
    I hear ya...

    Stay in touch; let us know your results. You can continue to supplement your learnings from doc consultations, book(s), online, etc. with the real experiences of a lot of guys on this board who have dealt with PC...if needed.

     
    Old 06-15-2009, 02:14 PM   #5
    daff
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    Re: Elevated PSA

    Quote:
    Originally Posted by babette1 View Post
    .... I would be interested in hearing what guys out there think is a sensible approach for me to take at this juncture....
    Mine went from 2.9 to 3.9 in one year's time, and my doctor suggested I wait three months to get another test. I did, and it was 4.2-- so I then had a biopsy of 12 cores and it turned out that I did have prostate cancer. So as kcon mentioned, the biopsy is the next step, but given your bouncing psa, maybe the doctor will suggest you get tested again in 3 months rather than go for an immediate biopsy. There is a recent posting on sexual activity prior to the PSA test-- and how this can impact the results. You've probably read that by now.

    Also, if you get a free PSA test along with the standard test, those results, in conjunction with your PSA and your age, will provide some statistical info on the likelihood that you have cancer. But then again, it's only the biopsy that will tell for sure (and I agree with kcon that the more cores one tests, the better, since this is a sampling biopsy).

     
    Old 06-17-2009, 03:03 PM   #6
    IADT3since2000
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    Re: Elevated PSA

    Welcome to the board!

    You've already had some excellent comment from kcon and daff, so I'll just add a few additional points.


    Quote:
    Originally Posted by babette1 View Post
    I just got a full compliment of blood work done by my primary doc and the report shows a PSA of 4.7, up from 3.6 six months ago. Six months prior to that it was 3.9 so it has been going up and down.

    One sign that PSA changes are due or partly due to infection is a set of PSA scores that go up and down. That is not a conclusive sign, but it does underline the possibility that the changes you have seen are at least partly due to infection.

    I have yet to discuss this with my doctor or a urologist but when I got a digital exam six months ago he said the prostate was "smooth" and only slightly enlarged, (1 out of 4?). I am 62 and also am being treated for low testosterone (currently 199) with Androgel.

    Just a thought - since testosterone is needed as fuel by both healthy and cancerous prostate cells, it's possible that the Androgel accounted for the rise in PSA. When did you start using the Androgel, and how does that relate to the PSA scores?

    If you do have prostate cancer, the doctor will most likely want you to stop the Androgel treatment, but that's down the road.


    I would be interested in hearing what guys out there think is a sensible approach for me to take at this juncture. Thanks in advance!
    I too think a "free PSA test" would be worth a try, but it too can be influenced by infection: both infection and cancer lower the % free number. Another alternative to a biopsy at this point, which is a decent choice, is a fairly recent test known as the PCA3Plus test. It complements PSA tests nicely, being strong ("specificity") where they are weak, and vice versa (PSAs being much more "sensitive").

    If I had to make this call for myself, but with your case characteristics and not mine, I think I would go for another PSA (from the same lab with the same test version) in three months. If the PSA level increased substantially, I would want a biopsy. If it increased only slightly or stayed the same, I think I would want a PCA3Plus test. If it decreased, I think I would go for another PSA test in another three months, maybe six months. All this assumes a DRE that is about the same as the last one in three months. I've thrown in some "I think"s in here because it's easy to speculate when you are not actually in the hot seat.

    One other technique is to do a "challenge" with either of the drugs finasteride" or Avodart (both drugs in the same class). A man's PSA should drop by about 50% on these drugs in about six months. If it does not, that is an added clue that prostate cancer may be present.

    As you probably know, both drugs are used to treat BPH. Finasteride has been proven to have some activity against prostate cancer, based on results of a massive, long-term, gold-standard type of clinical trial, and diligent, talented analysis of the results has proven it to be safe (meaning that it does not foster the growth of more aggressive prostate cancer). Two similar trials using Avodart for PC prevention are due to report this spring, but I've got a feeling we may have to wait a few more months. By "prevention" I mean help in achieving partial prevention; neither drug is going to come close to preventing all prostate cancer.

    Now would also be a good time to start learning about the lifestyle tactics that can help win the fight against prostate cancer. The tactics include nutrition/diet/supplements, exercise (aerobic and strength), and stress reduction. Mild drugs, such as a statin drug, and either finasteride or Avodart, can also be part of the program.

    Take care and good luck,

    Jim

     
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