Hi everyone. I am a 57 and had a routine physical in September. I agreed to have my PSA level checked. It came back high at 9.5. I did some research on the internet (bad idea) and started getting anxious over what I found. I thus asked for a repeat test which I underwent almost exactly one month later. The result was 6.0. Can PSA go down that much with prostate cancer? My GP was of no help. I should note that I'm into weightlifting and drive about 100 miles per day, four days per week. I'd appreciate any input you might have.
Question about PSA: Hi everyone. I am... - Prostate Cancer N...
Question about PSA
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DadofOne
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Yes it can bounce like that. Weightlifting, cycling, sex, less than about 72 hours can effect PSA so refrain if you are getting tested. Does your GP want you to see a urologist? I think that is the next step. I would be shocked if it hasn't been already suggested. Infection, (prostatitis), can cause an elevated PSA also. PSA in itself cannot diagnose prostate cancer.
TimCo• in reply to
I would completely concur with EJC's advise above.
All the best to you.
Thanks for your input, ejc and Tim. Yes, my GP has suggested that I make an appointment with a urologist. Given the large drop in my PSA level, I may ask for one more PSA test first, this time refraining from all activities which could increase the level. I sort of wish I had never consented to the test given all the uncertainty surrounding it. It is what it is, though.
• in reply toDadofOne
Well if you never had the PSA draw, you wouldn't know what you're dealing with. Look at it as the check engine light going on. It's how you and your medical team approach the data. My first elevated PSA was in 2016 at 5.2. I went a year before getting a biopsy. My PSA is currently at 4.0. It sucks to hear this but take it one day at a time. My mind was at one time where yours is now. We all become more knowledgeable over time.
DadofOne• in reply to
Thanks for the encouragement. I'm optimistic because of the significant reduction in the PSA level which Tall_Allen said was due to prostatitis. Still, the level is elevated and I'm nervous.
It can go down that much, but not due to weightlifting or driving. Assuming you got the test from the same lab, fluctuations of that size are due to prostatitis. Try to get a "PHI" test next time. It includes PSA and some other stuff that makes it less sensitive to benign causes.
Thanks, Allen. That's somewhat comforting. I'll ask for the PHI test when I meet with the urologist.
PSA can fluctuate from infections and irritations of the prostate or bladder.
Yes!! to your question DadofOne. It went down, but is still a 6, which to me is a cause for Concern. Mine was on a similar roller coaster starting back in 2010..... it was over 8 back then. Then back down into the two's (prostatitis). More recently, bouncing around between the 4s and mid 6. Diagnosed with Gleeson 6 in 2 of 16 cores less than 5% back in july.
Just had a radical open prostatectomy on Monday after several voices, some of which were doctors at Mayo telling me to just stay on active surveillance. Found out today, post RP pathology that the PCa was upgraded to a Gleeson 3+4 or 7. Cancer was in 15% of the prostate, Gleeson 4 in 6%. The biopsy in July at Mayo completely missed the Gleeson 7 part-dangerous. All of it was contained in the prostate, negative margins, no lymphnode or seminal vessicles involvement. Most likely I dodged a bullet.
Some of the language and terms are probably Greek to you right now, but may not be in your future.
IMHO, You need a 3T MRI and a biopsy ASAP.
If you don't have symptoms of prostatitis (you would absolutely know if you did), then your high Gleeson score could very well indicate a prostate cancer....
Get it checked Now. Don't wait till 'next time'.
I'm not trying to scare you. Don't be fooled thinking it can't happen to you. It can happen to anyone. You are Always better safe than sorry. Remove all emotion from you decision making process.
I'm 52 btw.
Dr. William Catalona removed my prostate. He is like Morpheus in the Matrix when it comes to PCa.
Also, having a PSA test within 12 hours of sex/ejaculation is about the biggest thing that will affect short term PSA rise by about only ~ 0.3. As tall allan said, prostatitis also has a dramatic effect on PSA levels, but most often, prostatitis can't be missed. Getting your PSA test done at the same place is critical also, as different labs may calibrate to different standards.
Clearly, I'm in the "can't be too careful camp". It can be lonely here, and hard on the emotions, if one let's it.
G.
AZ
How are you doing after the surgery? How long was your hospitalization?
First night, Monday, was very very rough. They put the cathater in traction, meaning they pull it and tie it down. Puts pressure on the balloon end in the bladder. Think about drinking a liter of water, and then having to hold it for 15 hours. 2nd morning when they released the traction eased the pain and discomfort tremendously. Catalona does not allow for narcotic pain killers after the initial recovery room, so the two nights in the hospital, all they administered was 30mg of toridol /6hrs and 650mg Tylenol /4hrs. This is to insure your bowels reboot quickly from the anesthesia. But, beginning the 2nd day, it was manageable. Staff at Northwest Medicine in down town Chicago are top! notch! Lots of lap walking around the ward starting from the morning of day 2. Discharged yesterday. Fly home to AZ tonight. Catheter is uncomfortable, but not as bad a full blown prostatitis. Catheter comes out a week from today. Doctor spared all nerves. It is important that the doctor has a plan for penile rehab............ Much more to share.
Keep in mind of course, that getting it out early, and completely beats hands down having to deal with a PCa that has spread into the bones and body... HANDS DOWN!!!! nomogram says I have 92% chance now given my exact circumstance that I'll see no BCR in 5 years, 86% in 10 years, and 99% chance it will not have killed me at 15 years. That'll get me to 67. Of course, I'm actually an optimist, so I think it's gone for good.
Typing from my phone, so when I return home, my whole experience will be recorded here to help those who have to go after me.
G.
AZ
Hey TB2G!
DadofOne should get a mp 3.0T MRI as you said but-- a biopsy should only be done --if something is seen.
The in bore biopsies when having a mp 3.0T MRI by an experienced doc are light years ahead of any other imaging used in biopsies.
The damage that can be done to a man by saturation type biopsies is well documented.
You are so right about the mp 3.0T being the imaging technique. The old TRUS should be put to bed.
Currumpaw
Not all cancers show up on MRI is my understanding right now, though my Knowledge and experience in this area is weak. I'll ask Dr. Catalona when I next speak to him.
Hey TB2G!
This doctor--
Dr. James Busch, MD - Reviews - Chattanooga, TN
healthgrades.com/physician/...
Is said to be so proficient in reading a MRI that his thoughts on the Gleason grade of a cancer is rarely proven to be wrong when the pathology results are in. I have read that it is something about how the liquid within the prostate moves or whatever during the MRI. Amazing! Vast experience. He also does the in bore biopsy. He just opened a new center. More expensive now but there is help with submitting billing to insurers.
He is known for biopsying that which is necessary rather than going off base taking cores from healthy tissue to be "sure".
I am not associated with Dr. Busch nor am I one of his patients. I have read much about him and would consider him to be my number one choice for a biopsy. The in bore biopsy during a mp 3.0t MRI is the most accurate--in my opinion.
Dr. Catalona? The doctor who developed the PSA test? He certainly does earn my respect. How much experience does he have with in bore biopsies?
Currumpaw
Dr. Catalona did pioneer the PSA test, that's my understanding. He has also performed more nerve sparing prostatectomies with one of the lowest complication rates than any surgeon in the World. I had my 3T MRI and bx at Mayo in Phoenix. First saw Dr. Catalona in September after the dx from July. My MRI came back pirads 5 before the bx, but the bx showed only a small amount of G6. Was told the bx over ruled the MRI pirades 5 by doc at Mayo. Clearly that was not a good call by the doctor who did the bx. Much of the lesion was in fact benign based on many of the bx cores as only 2 of 16 came back pos. for PCa.
Hey TB2G!---and ejc61
TB2G, 16 cores? A TRUS biopsy?
The mp 3.0T in bore is the best today. In 10 years I expect it will be considered as the TRUS biopsy is now.
I have a friend whose PSA was around 7. He had the TRUS. A Gleason 4+3 was found. He went for a MRI and was judged to be clear. he has lowered his PSA through diet and done well. Even the best imaging technique has failed to show cancer. Inflammation yes but no cancer. I imagine that in the future imaging techniques will be so sensitive they will pick up cancers that our immune systems will keep in check.
We all look for cancer cures or ways to cure, treat, suppress or stabilize our cancer don't we?
Why aren't the doctors, scientists and us more concerned about testing for inflammation of the prostate too? The biopsy is geared toward finding cancer. When cancer isn't found inflammation is always a reason given for an elevated PSA. Inflammation can lead to cancer! Should more importance be placed on ways to eliminate inflammation of the prostate?
Currumpaw
So, he had a bx and they found a G4+3. Then he had a MRI and was judged to be clear? That's rediculous, short of Devine intervention, Cancer doesn't just spontaneously regress and disappear.
As for "We all look for cancer cures or ways to cure, treat, suppress or stabilize our cancer don't we?".... IMHO that equates to wilfull ignorance/foolish hopefulness. Sorry that I don't minch words.
IMHO EARLY Definitive treatment is the only way to treat PCa in a way that will put you in a definitively higher nomongram bracket. Anything else is just gambling with your life.
Cancer is brutal, cold, and has no feelings or mercy for its victims, but its victims all too often allow their feelings and fears to guide the decisions they make on treatment.
People often believe what they want to believe vs looking at the evidence and acting difinitively based on Logic and reason.
Hey TB2G!
Did you read these sentences in my post carefully?
"Even the best imaging technique has failed to show cancer. Inflammation yes but no cancer. I imagine that in the future imaging techniques will be so sensitive they will pick up cancers that our immune systems will keep in check. "
The mp 3.0T isn't sensitive enough to pick up a cluster of cancer cells or whatever. Is it possible that his immune system and diet changes have kept check on whatever he had or has? Our immune systems are designed to kill and do kill thousands of cancer cells everyday.
He keeps a close check with testing and MRIs.
We may be within years of a cure prostate cancer such as Harvoni was for Hep C.
Unless of course--profit gets in the "way"! More profitable to develop an ongoing treatment than a cure!
Goldman Sachs asks in biotech research report: 'Is curing ...
cnbc.com/2018/04/11/goldman......
President Jimmy Carter was given weeks or months left to live. Amazing what a little immunotherapy can do isn't it?
Currumpaw
I agree with much of what you said. But, like tall Allan once said to me, "once you find it, now you have to deal with it." I think in only a small percentage of the cases, does cancer not progress. People who bank on that are taking a significant risk.
Hey TB2G!
I should have mentioned that even if the best imaging was unable to reveal cancer, a lucky biopsy would get it. That is the reasoning behind saturation biopsies I guess which sometimes can cause nearly as much damage as a prostatectomy.
As Dr. Klotz said, someone with a 4+3 is sort of sitting on the fence, if I've got that right. I've watched that video a few times.
My friend's way of dealing with it is frequent testing and scheduled MRIs. Nothing has been seen during imaging yet and the diet and lifestyle changes he has made may keep it in check for some time.
Currumpaw
"Lucky biopsy". As for me, I prefer whenever possibly not to rely on luck.
"Diet and Life style may keep it in check"... Back to my first point. It's great until it doesn't.
I am an optimist, don't get me wrong. But, misplaced hope is another thing.
Best regards.
G.
AZ
I cannot agree with you. I was diagnosed in 2009 and joined Johns Hopkins Active Surveillance program. My latest set of tests shows less PCa than I had in 2009.
No treatment, nor any special regimen. I believe that about 25 percent of men with PCa have indolent cases like mine.
I hope you're able to continue indefinately. That would be the second best alternative compared to never being diagnosed to begin with. Not all of us were as fortunate.
Thank you.
Our opinions are all formed by our experiences, and I respect yours.
• in reply toCurrumpaw
I'm not sure what's happening here. I need to stay on the AS Board or off completely. I want to be level headed about this. Good luck to all.
• in reply toTB2G
Yeah the PiRad 5 was the determining factor I would say. This is why getting multiple tests are critical. No single test result stands alone IMO. This is the real takeaway from this discussion. Every thing needs to be factored together.
TB2G• in reply to
"No single test result stands alone"....
I'd say that a positive bx for PCa is a single test that stands alone, and is enough to sound the alarm that treatment is necessary either immediately or in the future. Atleast 55% of those deemed AS candidates will fall out of AS guidelines in only a few years, and often by then the disease has progressed. Always remember that Cancer prefers to grow and spread.
• in reply toTB2G
Yes the bx is the only way to confirm cancer. My point was that more testing is better than less. Sorry for sharing.
TB2G• in reply to
Certainly don't be sorry for sharing. Apologies for being too direct in my response. I agree 100% more testing is better.
Currumpaw• in reply to
Well Hidden,
You are wrong. The only conclusive way to positively confirm prostate cancer is by pathology on the REMOVED prostate!
Pathology results on removed prostates was how Beth Israel Deaconess in Boston determined the percentage of accuracy of their 3.0 T prostate MRIs using an endorectal coil. Who gives the MRI and who reads it are important factors.
There are some areas that are literally inaccessible with a trans rectal biopsy. Some of those areas are accessible by transperineal biopsy. The transperineal biopsy is much less apt to cause sepsis eliminating the need for fluoroquinolone drugs. The fluoroquinolones are deadly. Not only do they attack old athletic injuries they are also known to cause aortic aneurysms. Nice huh? Especially for our age group. How many men have had aortic aneurysms and died from fluoroquinolones being used as a prophylactic for sepsis and it is attributed to our age. "When they get older that can happen"--I can hear it now!
Cefdinir and Rocephin are viable alternatives to Cipro and Levaquin. responsible urologists should, after the more stringent warnings by the FDA about the fluoroquinolones, use alternative drugs.
Currumpaw
The Precision Point transperineal biopsy system can sample all the prostate regions. does not cause infections, and requires no antibiotics. No general anesthesia and only a regular exam room.
It is now standard for biopsies at NIH and Johns Hopkins. I have had one.
Hey ASAdvocate,
Thanks for your supporting info and that Johns Hopkins uses the transperineal biopsy.
It is time for the transperineal biopsy to become the standard.
Currumpaw
Hey ASAdvocate!
Would you be willing to disclose the details of your transperineal biopsy?
Points of interest would be--
The type of imaging used during the biopsy.
The number of cores taken. Is there a type of grid that is used or is a core taken only if something is seen as Dr. Busch does?
Have there been any infections resulting from the transperineal biopsies done at Johns Hopkins?
Does follow up mp 3.0T support the results of the transperineal biopsies done?
I would consider discussion of the transperineal biopsy procedure to be a topic of interest to all of us. Perhaps it should get it's own heading--HINT!
You're the man with the details!
Thanks again,
Currumpaw
The Precison Point biopsy followed a 3T mp-MRI, which is a normal part of my AS schedule. There was only one PIRADS 2 lesion seen. That's down from one PIRADS 4 and two PIRADS 3 lesions in 2010. So far, I am a poster boy for AS.
In April, Dr. Carter did the PP biopsy using a systemic grid, but also taking two extra cores from the MRI lesion. The device allows free hand movement and uses a rectal US probe.
Zero infections so far at JH and NIH. No need for antibiotics. There was constant discussion with him asking if I needed more local anesthetic.
The biopsy pathology supported the MRI report, with five percent G6 seen on one core from the targeted area. This was my sixth prostate biopsy and I will only have this method, if more are ever indicated.
Dr. Carter, who recently retired, was the founder of active surveillance in the USA, and would strongly disagree with Dr. Busch's advocacy of MRI targeted-only biopsy. He insisted that JH's data shows that 15 percent of significant PCa lesions are missed on MRI, and only found by systemic biopsies.
• in reply toTB2G
Actually 50% over a period of 10 years.
TB2G• in reply to
I've seen less favorable stats, though I'd be hard pressed to say where. I think I have also seen that more favorable Stat as well. Another interesting Stat would be probability of and rate of bad outcomes after failing AS. Having been one who almost instantly failed AS, I am biased now in my thinking to believe that is the norm, as someone who was successfully able to stay on it for a long time would likely be biased to think that the norm. As humans, our reasoning tends toward looking for and believing information that confirms our biases... Though I don't know it what psychologists call that, I am not one.
• in reply toTB2G
For those classified as low risk/borderline low risk which I fall under, the outcomes of someone straight into treatment and someone that goes on AS for 5 years is similar. After 4 years since my first elevated reading, I've picked stuff up. There was another board I frequented that had such bias towards AS and considered those patients uneducated. I don't know what to say to you. If I should pass, you get to feel vindicated. Peace to you and good luck on your recovery.
TB2G• in reply to
I would not feel good at all ejc61. I wish no ill will toward anyone. My mother died of cancer when I was 18. My grandfather from PCa as well. Certainly for some, AS is a safe bet. Unfortunately, when we do AS we are banking on things working in our favor. And apparently there is a 50/50 chance they will at least for a period of time. Age and life expectancy clearly plays a role. The younger one goes on AS, the longer they 'll need to be on it to consider it a successful long term solution, and conversely, greater might be the cost should things not work in their favor. The upside is you get extra years without serious potential risk of adverse post treatment problems like ED. Extra years are great for those that get them. I got mine by burying my head in the sand and telling my doc I didn't want psa tests. All that ended when I started getting serious prostatitis symptoms.
I wish you and all the folks here only the best. I think everyone wants that. It'll be a great day when medicine someday defeats PCa, maybe with a simple vaccine. I hope for my son's sake, and everyone's sake.
All the best.
G.
AZ
• in reply toTB2G
Got it.
Studies from Johns Hopkins have shown that there is no additional mortality risk for those men who started AS, and then were upgraded and had treatment, versus those men who chose immediate treatment.
Not true. Over fifty percent of the men in the Johns Hopkins and Sunnybrook AS programs are still there after 15 years.
It is true that about 30 percent are upgraded upon required testing in the first two years, and they are advised to have treatment. Not progression in their cases, but initial under-diagnosis.
• in reply toCurrumpaw
I wonder if this "liquid moving around in the prostate" is why I was told that MRI's are "a point in time measurement" and not static and probably why my 2 MRI's showed different results.
Currumpaw• in reply to
Hey ejc61!
I can't say as I am not an expert. The accolades that Dr. Busch has had from his patients over the years has made me think that like anything else. the more you do, the better you get --if you have the potential.
Those old biopsy techniques missed often.
Currumpaw
• in reply toCurrumpaw
I hear you brother. I'm all about overload of data. The more tests you have done, the possibility of missing something should go down. Things have evolved from even 2-3 years ago.
My husband went to Dr Busch in Sept and had the biopsy done while in the 3T MRI machine. Dr Busch is very good and I highly highly highly recommend him. He spent tons of time with us explaining everything and he knows his stuff.
Hey RunnerGrl!
I have yet to hear anything bad about Dr. Busch. That is why he would be my #1 choice for a MRI and if necessary a biopsy. Saturation biopsies are dangerous and can cause lasting, irreversible damage.
You made a good choice! My best to you and your husband.
Currumpaw
• in reply toTB2G
Agree with 3T mpMRI.
This summer my yearly PSA went from 2.0 to 4.0. My Urologist told me to abstain from sex got a week and take test again. It dropped to 3.5. However the DRE showed hardness. MRI then biopsy revealed cancer in 10 of the 13 cores.
Removal prostate scheduled for December.
So beware that low PSA doesn’t mean one is cancer free.
TB2G• in reply to
Yes, exactly. Read Fox2018's account.
• in reply to
Yes I'm at 3.96 currently and was diagnosed at 4.4.
• in reply to
I agree. My PSA was only 2.7 when a DRE turned up a palpable tumor. Got sent to a urologist for a biopsy. Gleason 8 in one core, 6 in one core and 7 in 3 cores.
No. Technology and protocol has moved on. 3T BEFORE the bx, so when they do the bx, if a lesion is there, they can do a ultrasound guided biopsy with the 3T image overlaid. They did that on mine, which turned up the G6, but not the G7. Otherwise, just an unguided bx is only a shot in the dark looking for something potentially small. Small grows into something eventually deadly.
Best to find it early with a higher degree of certainty.
G.
AZ
I agree with the other inputs. Get a good urologist and talk through next steps with them. Another PSA may not be as telling as a biopsy or an MRI. My urologist/surgeon actually plays down the PSA scores that I get each 6 months (unless they jump dramatically) because of the variability. I am also 57 and have PSA in the 5.5-6.5 range. The other tests yield more detail in terms of Gleason scores and % affected. (# of cores)
Clearly one bx alone is not enough information for a urologist to consider AS for the reasons discussed above. TB2G makes a correct point about getting the MRI first and using the results to do a target bx. Insurance is slow to come around to that but it's gaining momentum. I suppose you can pay it out of pocket. Regarding the MRI first, I've been told by 2 urologists that that is very beneficial if tumors PiRads 4 or 5 are found. Not as beneficial if PiRads 3 or less or no tumors are found. I guess the thinking is that if they don't see anything significant on MRI, what will they target? I don't know. I've had 2 MRI's, one with a Pirad 2 and 3 and the most recent one nothing seen. So in the long run, if you become a candidate for AS, it means it's important to follow up with an MRI most likely annually, continued PSA checks most likely quarterly, continue with DRE's. Bx are being stretched out. Of course if any trigger point is reached like any core at Gleason 4+3=7 or higher, PSA living over 10, any cores with over 50% involvement, PSA doubling over a 3 year period, all bets are off and you will probably be looking at treatment. A person is on AS until they are not. That's kind of my mindset at least.
As a sidenote, you can also check with your insurance company to see how much they would pay for a genomics test like OncotypeDX. In my case, The test was $4k+ but I paid about $900.00. It gives a genetic review of the positive samples and predicts disease aggressiveness. That's strictly a money issue, but it may help decide sway a decision either way about whether AS is possible. Also, if a bx is in your future, it would be a good idea to get that sample sent to Johns Hopkins for a second opinion. It costs about $250.00 but I think the second opinion is well worth it.
I've kind of gotten off track a bit. You're not at that point yet but just some thoughts to possibly think about down the road.
P.S. I don't work for OncoDX or Johns Hopkins. Just a patient.
PSA tests save lives. There's no doubt about it, and the official guidelines that advise against PSA tests are based on statistics, not the real world of each individual man.
Yes, according to the US Preventive Services Task Force, there's a "small potential benefit" of discovering cancer "in some men" to be weighed against the risks of PSA tests - false positives, psychological stress, unnecessary biopsies, the negative effects of biopsies themselves, not to mention overdiagnosis and overtreatment - but that's for men in general. The word "general" doesn't apply to each specific man; each of us is specifically only "myself," and what is true for us individually is not necessarily true for all men.
And the Task Force recommends that men over 70 not be screened at all. Speaking for myself, I think that's reprehensible.
Regardless of statistics saying the odds are against finding cancer, each man cannot know what his own personal odds are, whatever his age. At least the Task Force recommends - but only for men under 70 - that the decision to be tested should be a product of discussion between a man and his doctor, including risk factors, and if the man doesn't ask for a PSA test, the doctor shouldn't do one as a general blood test (like a complete blood count). That makes sense. But for men over 70? It's all about statistics again - 70 is the miraculous cutoff age. After that, the balance of the numbers weighs against getting tested.
99% of prostate cancer occurs in men over 50. Well, if you look on these relatively small sites - 8,754 followers on Advanced Prostate Cancer and 2.025 on this forum, and on other forums - you will find men who were diagnosed in their 40s.
Regardless of statistics, the pesky problem of each man being unique raises its head again, to the annoyance and disdain of people who live by the numbers. Prostate cancer can be present and growing without symptoms, and not be found until it's too late. A PSA test at any age can save a life. Maybe yours.
jamanetwork.com/journals/ja...
Thanks for all the advice, everyone. I really appreciate it. I have an appointment with a urologist next month; will try not to freak out before then. 
Hopefully, this will turn out to be something benign.
Excellent post and exactly on point. I was a follower of that logic for several years, and specifically said I did not want a psa test thru my late 40s because I bought into the task force recommendations.
• in reply tokapakahi
A PSA test alone (reading of 2.7) wouldn't have gotten me into treatment. The DRE test did.
Dad of One, be aware that you can order a PSA test online at sites like Ulta Lab Tests without a prescription and get the blood draw at places like Quest. Cost is $25 to $35 depending on discounts.
Great to see the respect for everyone's opinions here - kudos to all. My thought here DadofOne is that it is always best to have more information than less. Don't regret taking the PSA test and continue to get more info. You can't make a well-informed decision unless you take the test(s) - whichever ones you choose. Stay positive and stay informed. Thanks to all.
I was confused when I first started reading this post.... after reading all of the comments I am now fucking confused...
Good Luck, Good Health and Good Humor.
j-o-h-n Friday 10/25/2019 10:42 PM DST
You need to see a urologist.
Once you are diagnosed with prostate ca, either you chase the cancer (and AS I consider to be "chasing") or the cancer chases you. I chose SBRT over RP, and understand the risks of both. I also got the OncotypeDX test -- which is still controversial among docs. I was influenced by its results.
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