fluctuating PSA results

[Princeps]

advice, please, from the group:

my condition was diagnosed in Nov / '18 with a PSA of 4.2. A biopsy confirmed a gleason of 7 (3+4). After much wrangling and questioning of the typical prognosis (surgical removal or radiation; with all the associated side effects) and MANY urologists later, I have arrived at "watchful waiting" reprieve.

My PSA stabilized for a year at 4.2. In May of '18 it spiked to 4.5, and in Nov of '18 it went back down to 4.2.

I was very encouraged.

However just last week during a routine physical exam (Jan'19) it spiked again to 4.89.

Aside from indicating the worst; does anyone know what else could be causing the PSA to fluctuate up and down? My next appointment with my urologist is scheduled for April with another PSA test and MRI....however due to this current spike I am going to call him and ask him. Of course if it continues to go up I know I will have to go for some kind of treatment.

curious to know if anyone else out there has experienced this?.

thanks guys,

Frank

[HOPEFULSPOUSE]

Did you happen to engage in any vigorous exercise prior to the test?

[Tall_Allen]

It's pretty common for PSA to fluctuate. Probably due to some prostatitis you got from the biopsy - antibiotics usually don't help.

[Princeps in reply to Tall_Allen]

Thank you;

The biopsy was a year ago; and the spike was recent.

Of course, i am assuming the worst and want to prepare for it

[Tall_Allen in reply to Princeps]

There is no "preparing for it." That only causes anxiety. It's important to take it as it comes.

[Princeps in reply to Tall_Allen]

Yes, thank you tall allen; for your reply.

However i disagree. I can prepare by educating myself as best i can; and learn from the experience of those before

Me.

I do agree ( emotionaly prepared) to deal with it ( treatment) as a last resort

When and if that time comes

[Tall_Allen in reply to Princeps]

I invite you to think about this idea of "emotional preparation." In practicing mindfulness, I've come to believe that it is a fiction. I knew my parents were going to die (of cancers) years ahead -- plenty of time to prepare, eh? Yet, when the day of their deaths came, it hit me like a ton of bricks. I envy those whose loved ones who die die quickly and suddenly - the grief of the survivor is the same, but it is not prolonged as it is with a long illness. All "emotional preparation" does is rehearse the events in one's mind, freshly creating anxiety each time. It doesn't make it easier - we feel our emotions when we feel them. It's not easy to get out of the habit of doing that - it took me 3 months of daily practice, and I still do it (just less often than I used to).

[Princeps in reply to Tall_Allen]

Yes, i had a similar experience when my parents passed.

Thought i could deal with it ---and WHAM....the grief was overwhelming.

And you may be right about the cancer realization also.

It is hard for me to grasp now when i have no symptoms.

I continue to work towards some kind of solution...one that will allow me to keep my "quality of life"

But the thought of losing my sexual ability and having to deal with incontinence is spurring me onto what is considered risky ( not being treated immediately) and not what most medical practioners advise.

I will deal with it when i have reached the conclusion of my "rationalizations"; that is when all indicators show that the disease is progressing.

I also am appreciative and sensitive to all who have preceded me in this process who are posting on this site; realizing that although the degree may be different, we are all dealing with the same disease.

[Tall_Allen in reply to Princeps]

I thought you were getting SBRT/CyberKnife? It's what I had. No lasting urinary or rectal side effects. Never had any incontinence. No ED at all. Only I have dry orgasms - but some lucky guys even get to keep their semen. If you wait for symptoms, you have already waited too long.

[charlesmeyers1964 in reply to Princeps]

i like some investigate all about pca but sometimes u know more then u should. it was only frightening when i would talk to my oncologist and i knew more then he did about my condition

charlie

[charlesmeyers1964]

u know a normal guy no cancer has the range of 0-4.0 psa. i would continue to stay and watch. u must know everyone on this site has tons of different treatments. some u have to travel overseas for it not available or a waiting period. i was dx with a Gleason score of 9 went with radiation then followed the routine of meds as oncologist tell u. then one of my oncologist felt my cancer had localized so another bout with radiation. recently finished with PROVENGE couldn't get Zytiga for 6 months now on it.i'm starting my 11 year battling this disease. i have a psa of 38 just had my 2nd shot of lupron/eliguard and i feel find.

charlie

[Princeps in reply to charlesmeyers1964]

Thank you charlie, for sharing

Best of luck with your treatment

[GeoffNoLongerAS]

I was diagnosed in November 2008 with PCa. 2 of 12 positive, 5% each, Gleason 6 (3+3). Originally scheduled for surgery, through a serious of events I decided on AS and entered an AS study in the Chicago area in August 2009. I had 2 second opinions before starting the survey and had my diagnosis slides read at another lab. I I have had additional biopsies, most did not find cancer, the study entry biopsy was the same as the diagnosis biopsy.

PSA does vary for several reasons. Infection, exercise, sexual activity, and a DRE prior to the blood draw (I know a case where this did happen). In addition different assay methods can produce different results. If the PSA level is at a high level (say 10+ for most AS studies). the absolute value is not as important as the change and rate of change. There are calculators available in the internet to calculate PSA velocity.

In my case 10 years ago my PSA started out at about 3 when I entered the AS study. Over time it increased slowly to about 4.5. Then the research center decided to change assay method (i was not pleased) and the new level was about 5.8. It has slowly increased to about 6.8 or so until the last PSA which had dropped to 4.8. I am still on AS and for the foreseeable future expect to stay on AS.

If you have not had your diagnosis slides read by a different lab, I would suggest the you have that done. Reading slides can be as much art as science. I have known cases where the diagnosis was upgraded as well as downgraded. In my case it matched almost identically (minor change in the amount of cancer but not Gleason score or positive cores) which made me feel better about my decision.

The other piece of advice I would have for you is to follow the prep instructions for the biopsy carefully. Though rare, one possible complication is a blood infection. I have had at least 6 biopsies one of which allowed me to take a 5 day vacation in the hospital on antibiotics. One question to ask your Doc is how often in their practice biopsies have resulted in blood infections.

As to "directed" biopsies being able to locate the cancer, I have had a couple of those. The first was color doppler back when that was all the rage. I went to one of the top urologists using the color doppler. The biopsy was negative. A couple of years ago I had an MRI guided biopsy, same result.

Good luck going forward with your decision. You are going about it the right way, trying to get all the info you can. Your decision will balance the information you have gained, as well as your outlook on life and those close to you. Hope this adds some info to your search.

[Princeps in reply to GeoffNoLongerAS]

Thank you, GeoffAS,

Best of luck with yiur treatment

[j-o-h-n]

Make sure you use the same lab all the time for checking your PSA.

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 01/08/2019 5:22 PM EST

[Princeps in reply to j-o-h-n]

Thank you j-o-h-n

Good luck and good health all around; but especially humor!

👍

[leach234]

You are playing with fire. The longer you wait for treatment the greater chance of Stage 2 becoming Stage 4. Don't be stupid. Have surgery or radiation ASAP.

[Princeps]

Thank you, leach; for your reply.

However, not all is black and white.

My prolaris genetic testing tells me that although i have the cancer, it has a 3% chance ( out of 100) of metastisizing over the next 10 years.

Weigh those odds against the chance of surgery or radiation side effects ( average odds 70 % full recovery). I have yet to meet a surgical survivor who is not i continent and impotent; some 10 years after surgery.

My condition is being monitered quartly for any advancement, at which time i will pursue treatment.

"Playing with fire?" No, i disagree.

A calculated risk ; yes.

At this stage of life ( 62) i have come to realize that there are no guarantees with anything or ANY treatment...."caveat emptor"

The least i can do is educate myself and make an informed decision as i move forward