Brothers psa is 4!

[Tjc1]

Hi just found out my brothers psa went from 3 to 4 in 1 year. He is 65. Given his age would maybe watchful waiting be in order. Not sure. Thanks

[Tall_Allen]

First - I want to clarify what you mean by "watchful waiting". Watchful waiting means the man has NO INTENTION of ever pursuing curative therapy (surgery or radiation) as his disease progresses. He only intends to use hormone therapy and spot radiation for palliative purposes. It is suitable for men who are elderly and infirm and have life expectancy of less than 10 years.

"Active Surveillance" always means there is an intent to curatively treat the disease if it progresses. It involves having a rigorous diagnostic regimen and an agreed upon trigger for treatment.

Which someone elects to follow is NOT determined by his age. It is determined by his life expectancy. Active Surveillance is also only appropriate for men with a diagnosis of favorable risk prostate cancer.

[charlesmeyers1964 in reply to Tall_Allen]

if he is 4 wait not 10 years go 20 since your numbers at 4 is normal u have many years to worry about with tons of time on your hands

[Tall_Allen in reply to charlesmeyers1964]

PSA is NOT a test for prostate cancer.

[charlesmeyers1964 in reply to Tall_Allen]

so tall allen what is the measure of high psa if its not prostrate cancer then. i remember these stupid docs who say the aligen test (psa) are meaningless will if i hadn't been pro-active against pc i would be dead now. i'm not in the position to not care about my levels each year. as for the guy i talked to before i said like all g[s they have u tested each yeasr or every 6 months to see if there is a problem get on it. i mean the guys on this site talk about there gleason score means to me they have done nothing since they were dx. me dude psa 5.7 had a biopsy found cancer in 7 out of 12 with cancer. by then psa had gone to 8.0 lupron/eliguard shot and after a couple of months later grew more then went with the radiation thats being pro-active on my psa. u see my life is mine i care about living longer. even after 10 years and i'm around is important.

charlie

[Tall_Allen in reply to charlesmeyers1964]

Before therapy, PSA is a test indicating that there is something happening to your prostate that is mechanically squeezing out PSA from its cells. The most common sources of such irritation are BPH (enlarged prostate), prostatitis, urinary retention, sex and bike-riding. The urologist should make an attempt to rule out the other, more common sources of PSA increase before biopsy. Prostate Health Index (PHI) is a better test for prostate cancer than PSA alone. There are also several non-PSA-based tests.

[charlesmeyers1964 in reply to Tall_Allen]

allen good docs and pts say if they are having problems peeing, to the point they have to be cath to pee. more tests easily can dx that quickly. when my psa went up with the finger test they found out i had no enlarge prostrate,i could pee just find and with the finger test they also vertified my prostrate was in my case small so what u mention is easisly vertified before any cancer treatment dude charlie

[David2703]

The European Association of Urology publishes "Guidelines on Prostate Cancer."

On page 21, table 5.2.1 indicates that a reading of 3.1 to 4.0 has a 26.9 risk of prostate cancer and a 6.7 risk of Gleason score equal to or higher than 7 PCa.

[David2703 in reply to David2703]

uroweb.org/guideline/prosta...

scroll down page a little for Table.5.2.1

[charlesmeyers1964]

why don't u worry aftter a year and see what the psa readings are remember 4 is normal for non cancer patience so u have nothing to worry about

charlie

[Tall_Allen in reply to charlesmeyers1964]

No. PSA is NOT a test for prostate cancer among men who are pre-treatment.

[Tonik25]

My husband was diagnosed with. Gleason 9 locally advanced prostate cancer with PSA of only 2.3 which is well under the threshold for his age. All previous tests had been 0.4 or 0.5 so it was the spike that caused him to be sent for more tests. In our experience it was the trend rather than the actual number.

[charlesmeyers1964 in reply to Tonik25]

the biopsy does 2 thing from the exam. once the speed of the growth of the prostrate and the size after that next test is done then do something,don't wait be aggressive. charlie

[stangoldberg]

The research I've looked at equivacates--some say yes, others say no. Along with my oncologist, we've never looked at numbers as "absolutes." What has made the most sense to us is looking at trends and correlations.

For example, Every 6 months we plug in my latest PSA and testosterone numbers into a graph that started after my prostatectomy fifteen years ago (Gleason of 7, evidence of disease beyond surgical margins and in one lymph node). We can easily see which way my cancer is going. Although we arbitrarily chose .3 as the trigger to resume intermittent hormone therapy, it was also important to see the direction of the increase or decrease.

The next data point was to see if there was any correlation between testosterone and PSA. For 15 years every time there was a drop in my testosterone numbers (following Lupron injections, my PSA dropped. What the correlation told us was that my cancer is not resistant to Lupron--at least not yet. Any change in the trend or correlation will give us guidance for a new protocol. Hope this helps.

[dbrooks_h in reply to stangoldberg]

Would you mind listing the treatments you had so far, thanks.

[Tjc1 in reply to dbrooks_h]

He has had none so far.

[HopingForTheBest1]

My urologist told me that it is not just the PSA number by itself, but also the acceleration trend of that number. My PSA had risen from 3.3 to 4.4 within a year. I was told to do nothing. It then rose to 5.7 9 months later.

Decided to have MRI fusion guided biopsy, not the one typically done in the Urologist's office. Found out the day before the biopsy at my previously scheduled appt with my then Oncologist that my PSA jumped up to 20 in just 6 weeks. He had the nerve to ask me why I was having the procedure. Boy was he wrong wrong wrong! I was diagnosed with aggressive advanced PC, with Gleason 9/10. Now on ADT, and PSA is down to 0.12 after 4 months. Also having robotic prostatectomy on Nov 14 as part of SIMCAP clinical trial.

In my opinion don't wait to have a biopsy, and have the MRI fusion guided one which is a lot more accurate.

[larry_dammit]

I was diagnosed stage 4 w Mets at 66. Don’t recommend waiting. Get a doctor to order a full blood panel. That’s where they found mine. But also ct scan with contrast, and a mri. With contrast. Don’t mess around. Mine went from watching to stage 4 in 6 months.

[charlesmeyers1964 in reply to larry_dammit]

u know when u have been dx with prostrate cancer is a 3 when it mets its a 4 so u can go from 2-3 & 4 quickly. it doesn't mean your on your way out. if i could get my zytiga i would be down with my psa and some small mets and still be a 4 remember when i say wait and watch u can have your doc to psa test each month mine does the bone scans & whatever every year to see how my mets have moved or more have acqulimatedd.

[cujoe]

Tjc1,

Not sure I would go for scans right away, but would suggest that having a test for FREE PSA would be a good idea. If the results increase the odds for cancer, then the fusion-guided biopsy and a consultation at a major cancer center would be good practice to follow. Better to be safe than sorry, take it from one who knows first hand. (If I had gotten to a cancer center a year earlier, I would likely now be cancer-free.)

The follwing link describes the test and how/why it is useful. Near the end of the article is a list of other things that can cause PSA test results to vary.

medicalnewstoday.com/articl...

Good Luck & Be Well - cujoe

[Hidden]

My PSA was less than 4 when a digital rectal exam found a lump. Subsequent biopsy found Gleason 3+3. Post prostatectomy pathology was Gleason 4+4 stage T3a.

[Bcgkelly]

Mine went from 3 to 4 in one year. To put my mind at rest I decided to have an MRI in a hospital that specialises in prostate MRI’s. just as well as the cancer was already after breaking through the prostate cap and was in two lymph nodes. Also aggressive. My advice is take no chances and have an MRI done quickly. BTW on a DRE I was told it felt okay.

[j-o-h-n]

That's exactly the same spike I had in my PSA. Got a biopsy and BINGO I hit the jackpot. You may tell him to go in for a biopsy and if he does tell him the doc should perform it under sedation. Just a layman's opinion (oops no longer a LAYman).

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 11/05/2018 4:39 PM EST