new here…. Just got a psa read from 4 ish last year to 8.5. No diagnosis yet but I’m totally freaking out has it been high for a year. Is it

[MrPaulyP]

cancer or bph, or prostatitis. What happens next??

[fireandice123]

You’ll need to see a urologist. Most likely they’ll perform a biopsy to see what’s going on and go from there. It isn’t definite that it’s cancer yet but it’s a possibility. My doctor once told me that only about 25% of high PSA readings turn out to be cancer.

[RyderLake2]

Hello,

If it is indeed prostate cancer then the bigger question is: “Has my cancer spread outside the prostate gland (in other words has it metastasized) or is it still confined to the prostate?” The latter is much easier to deal with than the former. Either way you need to see a urologist or better still an oncologist. They will outline treatment options. You also need to educate yourself so you can make a wise decision. Hope that helps!

[petabyte]

Your urologist will probably suggest this as the most patient friendly option,

1 Digital Rectal Exam and transrectal ultrasound. A negative does not tell you much and you will still need an MRI but it is easy to do.

2 Multiparametric MRI. This will tell if there is suspicion of cancer (a negative can avoid biopsy).

3 If suspicious, transperineal biopsy (less infection risk than with transrectal) using the MRI for guidance along with ultrasound (fusion biopsy).

A biopsy is no big deal, don't put off getting a diagnosis.

[petabyte in reply to petabyte]

When I got the first indiction it could be cancer (palpable tumor, visible on ultrasound) I then had a PSA test: 10.3. Two days later I had an mpMRI and the following week a transrectal biopsy.

For a transrectal I had to take antibiotics and I wasn't thrilled about potentially killing off my gut bacteria. With a transperineal you can skip the antibiotics.

See conclusions section (AP = antibiotic prophylaxis):

auajournals.org/doi/pdf/10....

When I was first diagnosed, I was like a deer in the headlights and I was not assertive enough. I should have pushed for a transperineal and MRI fusion biopsy.

Conclusions: This systematic review found no significant difference in infection rate, fever, sepsis or readmission rate after TPB between those cases utilizing AP and those cases without AP.

[Tall_Allen]

Ask your urologist for a Prostate Health Index (PHI) test, which is pretty good at distinguishing prostate cancer from benign causes.

[allie2020]

The rise could very well be from an infection. Many years ago my PSA went from the 3's to

11. My uro. put me on antibiotics and it went back to the 3's.

[Oatmeal2]

Please see a good urologist asap. The doctor can send you for a prostate mri before a biopsy. My husband’s was 3.85 and then next year it jumped to 6. His doctor wasn’t that concerned because it was just mildly elevated. It was during the pandemic and we had to wait a while to see a urologist. Retested, it was still at 6.2. To make a long story short, he was diagnosed with Gleason 9 with spread to a lymph node. He had no symptoms either. But many months had passed before he went to the urologist because he was convinced that it was just an enlarged prostate from cycling.

Of course it could just be an infection or an enlarged prostate but try to get that mri asap.

[MrPaulyP in reply to Oatmeal2]

How is he?

[addicted2cycling in reply to MrPaulyP]

As T_A suggested, you can have newer testing such as PHI and even via urine and additional blood tests that were NOT AVAILABLE 10 years ago when I was diagnosed with a 14+ PSA and 5+5 Gleason 10.

PLEASE INSIST on a Transperineal Biopsy since the TRUS is very OLD SCHOOL and lacking in area of prostate biopsied.

Good LUCK

[Oatmeal2 in reply to MrPaulyP]

Thank you for asking! He is doing very well thank goodness. He did 26 sessions of IMRT full pelvis radiation and is on 2 years of Firmagon injections. It’s almost 2 years from his diagnosis and so far PSA is still undetectable. The plan is to continue ADT until August and then I guess it’s continuing blood tests to check PSA testosterone and everything else to make sure the little beast isn’t back. I guess that will be the worst part.

[TJGuy in reply to Oatmeal2]

You need to educate yourself on what may be in your future. You need to understand your PC inside and out. Don't rely on local urologist or oncologist, they will just follow SOC which will result in Castrate Resistance soon enough down the line. If you had spread you still have chances to kill it or slow it and control it. You need to understand PSMA scanning, SBRT, cryotherapy, these tools are the ones that prevent you racing towards castrate resistance. Your goal is to not die from PC, but to be free of it, or die with it not from it having had a life least impacted by the negative effects of drugs, processes and procedures.

[Conlig1940]

MrPaulyP Great advice . 1st determine you do not have an infection .

Then consult with your Urologist .. Have an MRI and determine if you require a Biopsy . If so have a Transperineal MRI Fusion Biopsy . NOT A TRANSRECTAL .

NOTE : When your Biopsy results come back -- i.e. Pathology report : ALWAYS GET A 2nd OR 3rd OPINION of the results . My 1st Biopsy came bback negative with a RADS 5 .

6 months later , the recommended wait time for a next Biopsy ( prostate swelling etc. ) I had a 2nd Biopsy 6 Cores from 16 taken , were positive . I subsequently had a 2nd & 3 rd opinion of the results before determinning my most likely Gleason Scores .

[j-o-h-n]

Greetings MrPaulyP,

You're come to the right place. When you have more info regarding tests/evaluations please update your bio. All Info is voluntary but it will help you and help us too. Thank you and Keep Posting!!!

Good Luck, Good Health and Good Humor.

j-o-h-n

[RoseDoc]

Time to see a urologist. There is testing that can help distinguish between PCa and infection/inflammation. A 3T MRI is the next step if it is PCa followed by a biopsy.

[RMontana]

MrPaulyp, I would not want my PSA to be anywhere near 4.0, let alone above it, unless I had done additional scanning and testing to make sure 1) there is no tumor present and if so 2) that is not cancer. PSA of 4.0 is too high in my view. If you had any PCa in your family (father, ect) its definitely too high.

If I were you I would get a parametric MRI done A.S.A.P.. If that shows a tumor then you need a MRI guided biopsy done right away. I would not put this off any longer. Here are some articles that I posted some time back. Again, me being you I would move on this thing right now and not wait any longer. TNX Rick

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