Prednisolone and PSA Readings

Probably wishful thinking here but with amount of side effects of tablets never know. Had prostate cancer 6 years ago and ever since my PSA reading has been stable. Been on meds for 6 months and just had my 6 monthly test for PSA and for the first time it has gone up. Coincidence or something else to worry about?

[PMRpro Ambassador]

I'm sure I read a post on one of the forums from someone recently saying that pred had increased their PSA readings but then it fell again as they were able to reduce. But with a history of prostate ca I think you do need to speak to a specialist since prednisone can suppress the PSA level when used in patients with prostate ca which might then give a falsely low reading.

[Hidden in reply to PMRpro]

Thanks for reply. I'm having another blood test in 3 months as it has to increase 3/4 times before they look further.

[piglette]

Did you have radiotherapy for the prostate cancer?

[Hidden in reply to piglette]

Thanks for reply. Yes I did have radiotherapy rather than the op.

[piglette in reply to Hidden]

It is just my brother has just had the op. His wife died of cancer so I think he felt that he just wanted to have it all cut away.

[nickm001]

I don't think it is prednisone, but PMR that could change your PSA readings. What happened to me is that my PSA doubled at the time I was hit by PMR ( from already high ~9 to 24!) , but before actual diagnosis. Because of the sudden increase in PSA, I did 3T MRI to make sure that there is no cancer in the prostate. This was 3.5 years ago. As PMR is reducing it's activity, my PSA is trending down and now I am at 2mg of pred and PSA reading has come down to 11-13 range.

Also one has to be aware that certain activity ( sex, bike rides and vigorous exercise ) should be avoided few days before test, or results will be impacted.

If you had history of PC, it would not hurt to do some extra tests and perhaps 3T MRI as well.

[rocketman42 in reply to nickm001]

nickm001- you stated that "Because of the sudden increase in PSA, I did 3T MRI to make sure that there is no cancer in the prostate."

As I am sure you know a 3T MRI does not rule out having cancer in the prostate. I also question your complacency given the fact you had a PSA level of of 9 that rose to 24 and is still, many years later, between 11-13. Perhaps a 4k test or biopsy is in order at this time ?

[nickm001 in reply to rocketman42]

I don't want to take over the thread with discussion about prostate, but I disagree with you. New diagnostic guidance call for 3T MRI to see if there is any abnormal tissue in the prostate and then if they find something of interest, they do guided biopsy. I am not in favor of "blind" biopsy, since it takes few samples from total volume and is pretty much hit or miss. Without imaging information (MRI) if the biopsy is negative, it does not mean that there is no cancer. Only positive test is conclusive.

PSA reading by itself does not mean as much as it was thought before and it leads to unnecessary biopsies. Even the inventor of the test said that alternate tests should be done before biopsy or even surgical steps are recommended. As far as 4k test, it is still considered experimental and is not approved by FDA, as far as I know.

I do see urologist every 3 months and every 6 months he checks PSA. Had MRI twice since I got PMR and yes I have BPH ( enlarged prostate) that causes higher PSA, but no cancer was found.

Edit: rocketman42, I dont mean to come across as argumentative, and I appreciate concern, but there is a lot of outdated info on PSA out there. I try to educate myself as much as possible and share that info as well.

[rocketman42 in reply to nickm001]

I appreciate your response and I don't take it as argumentative. There are many areas of disagreement in this field and it can be bewildering.

I totally agree that far too many biopsies are done and agree that blind biopsies are not the way to go. If a biopsy is done it should be an ultrasound guided biopsy based on the MRI findings ( or an "in-tube" biopsy ).

However, you state that that "without imaging info (MRI) if the biopsy is negative that doesn't mean that there is no cancer. Similarly, if nothing shows up on the MRI that doesn't mean there is no cancer. Your prolonged history of elevated PSA, even with BPH, would be of concern to me. This is the perfect indication for a 4K test since it is very accurate in determining the likelihood of finding aggressive prostate cancer ( Gleason score 7 or higher ) IF a biopsy is done. Its purpose is to reduce the number of unnecessary biopsies while still identifying the probability of high grade Pca.

I wish you the best of luck with whatever you decide to do.

Now back to regular programming.

[Hidden in reply to nickm001]

Thanks for reply. I am seeing the rheumatologist tomorrow so can ask him but what you say sounds promising. No problems with sex, bike rides or vigorous exercise - all in the distant past!

[nickm001 in reply to Hidden]

sorry to hear that