Prostate Cancer Network

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alarming PSA for a 26 year old?

Hi guys,

I have been having a change in bladder habbits for over a year. I find that I need to strain to start urinating and the urine flow is weak. I also remember that the onset of this was sudden. Anyways, I recently learnt that my grandad was diagnosed with prostate cancer in his 50s and that pushed me to look into this matter.

I googled and found that a PSA test was the best screening test out there for PC. I took one and the result came out to be 2.34 ng/ml. Now I know despite being well under the 4ng threshold, it's still high for someone my age (I'm 26). Should I be concerned? In light of my symptoms, is it more probable that a relatively high PSA at my age is attributable to a prostate problem other than cancer? I'd appreciate if someone shares their valuable opinion. X

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36 Replies

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At 26 you would be the youngest person I have ever heard of to have prostate cancer. If your grandfather had prostate cancer it a concern for you. Certain cancers run in families. Prostate cancer is one of them.

However, at 26 I don't think that is what you have. Odds are you have an infection of the prostate or an enlarged prostate. See a doctor, and remember, even if it's not prostate cancer now keep an eye on your PSA from here on.

Hi and thank you for replying. You're right about Prostrate cancer running in families and indeed there's a couple of cases of breast and prostate cancer in my mother's side of the family.

I'm actually pretty tense about the potential long process ahead to either diagnose or rule out PC in my case and wary of the potential side effects of a biopsy should it come down to it.

You said that if I were really with PC, I'll be the youngest cancer patient you'd ever heard of. Is it really that rare in one's mid 20s? Should I find relief in the statistical unlikelihood of this being cancer?

The odds are with you. I was diagnosed at age 47 and that is rare, not unheard of but rare. There are a few warriors on this site that were diagnosed in their forties.

By the way I was diagnosed 27 years ago, and the medicine is a lot better now so don't sweat it. I know it is scary for you now but you do need to see a urologist now even if it only and a bladder infection (forgot, that could be a third diagnoses with your symptoms).

I'm so glad that you've been able to fight it for so long. Were you cured or do you still have active disease that you get treated for?

Still fighting, I am going in for a biopsy tomorrow. The results will determine my next treatment.

I wish you the best of luck for the procedure. Hope the report of the biopsy is as good as it can be. Keep us posted!

I will.

Unfortunately, recent news highlights the issue of increased incidence of PCa in adolescents and young men. It's probably not in your case, but although it's more likely a prostatitis, I wouldn't ignore this.

onlinelibrary.wiley.com/doi...

I did read of one young man of 16 with APC . super unjust for that kid...

Hmm... Express your concerns to your doctor and ask him if you should be referred to a urologist.

At this time, I wouldn't worry about it.

Best

You should be concerned, but not about prostate cancer. Urinary retention can be a serious problem. Make an appointment with a urologist ASAP. Leave the PSA test (which is a very poor indicator of prostate cancer) until your age has doubled.

Hi and thanks for replying. Is it really that rare for someone in their mid 20s to get prostate cancer? Is the risk raised in the background of urinary symptoms that I'm experiencing? Thanks in advance.

Yes, your risk of urinary retention is high, given the symptoms you describe.

What about my risk for prostate cancer? Is it non-existent?

Non-existant

In fact very low, but not non-existant, and increasing--for unknown reasons. Obviously, the dynamics of PSA testing could be expected to affect the incidence, but survival for adolescents and young adults diagnosed with invasive PC is worse than for older men.

Obviously too, one must tread a line between alarmist and complacency--I don't envy urologists' job here.

onlinelibrary.wiley.com/doi...

I think we can agree that an incidence of less that 5 in a million (Figure 2) is virtually non-existant given that there are only 2 million men of his age in the US. I think it is a mistake to highlight changes in small numbers - going from 1 in a million to two in a million is a 100% increase, but the actual increase is negligible. I think diagnosis should begin with the most probable causes first, unless there is a compelling reason to believe otherwise.

I don't disagree. And apparently this young man has not yet been examined by a urologist, so I think alarm is premature. Nevertheless, he should definitely be checked.

I note that the death rate is declining as well for younger patients. But some cancer trends are troubling, as in the increase in lung cancer incidence in women who have never smoked. This is firstly a problem for the epidemiologists, but as I know from experience, if it happens to you or someone you love it is 100% your problem.

Hi and thanks for the heads-up. I'm personally deeply concerned over what it is and determined to get to the bottom of this.

I actually did see a urologist a week ago who thought it was probably a UTI or STD, but my subsequent urinalysis and urine culture came clear. He's now suggesting retrograde urethrogram and post void ultrasound to see if any abnormality can be identified that way. But honestly, as these tests keep coming out clear, my worry is increasing. I wish he had given me a DRE to see if my prostate felt fine.

Also where I come from, the age adjusted incidence rate for PCa is 5.3 as opposed to 150 in the US. So I'm trying to keep my sanity based on these numbers and hoping for the best.

Prostatitis is extremely hard to diagnose. I wish there were a good blood test for prostatitis (there isn't - rarely there is blood in urine), or that it usually responds to antibiotics, but often it shows up as a see-saw pattern of PSA, and the prostate sometimes feels hard on a DRE. Sometimes inflammatory markers are elevated (e.g., platelet count, neutrophils, C-reactive protein)

The negative findings so far just means that you can eliminate the rarer forms of prostatitis (e.g., acute bacterial).

It is far more likely to be a prostatitis than cancer. DRE is a pretty blunt tool anyway. My urologist felt nothing, but I had a significant cancer. And as Tall_Allen says, it's tough to actually get a positive culture in most cases of prostatitis. You can ask your urologist if any imaging studies are advisable, and I'd listen to what he says.

Tall Allen is one the more astute members of this forum. I would just go do what he said ASAP.

Liver-mareez - I personally would suggest checking this a bit further....I was diagnosed with stage 4 prostate cancer at 40. If I crunch the numbers and work backwards, I would guesstimate that this killer got me in my mid to late twenties for me to be at stage 4 at 40 years old.

Everyone keeps saying that you should start testing yourself at around 50 years old, but if you're feeling uncomfortable then eliminate prostate cancer as a possibility now if you can...the earlier you catch it, the better. Just my suggestion, but there are rare cases of younger people with PCa

Check your free PSA to PSA ratio and if it is less than 0.25 start searching deeper.

>>>

You should be concerned, but not about prostate cancer. Urinary retention can be a serious problem. Make an appointment with a urologist ASAP. . . .

>>>

+1. Urinary retention can give you bladder infections, which can become kidney infections. And back-pressure, from bladder to kidneys, affects kidney function.

Get it checked out.

. Charles

Far from being an expert, my understanding would say that it isn't PC, but could be any of a number of things (infection, pressure on the prostate...bike riding, sex can also affect).

Where I do feel I have a strong opinion is to NOT let doctors call ALL the shots. My PSA was stable at 4.3 for years, and both my primary care doctor and 2 different urologists said that as long as the PSA was stable there weren't any major concerns. When 1 PSA test came in at 5.5, both my primary care doctor and urologist said we should wait 6 months for the next PSA and see where it's at. After thinking about it for about 15 minutes, I went back to the urologists office and said that was an unsatisfactory response. My father had PC and so did my maternal grandfather. The urologist asked their ages, and he said that since they were beyond 70 years old when they got PC, it wasn't indicative of a family history. I then responded that I really wasn't sure of their ages (I was, but I wanted the next level of screening, so I planted doubt that maybe both sides of my family had a history). The urologist then, somewhat on the border and sensing my determination, agreed to do an MRI (only consider a Tesla 3 MRI...some hospitals haven't upgraded from a 1.5 Tesla, which doesn't provide as good an image). I had the MRI done and it came back showing that there were areas of significant concern. Then a biopsy (a 7 week wait for a time slot).

Bottom line is that had I listened to my doctors, I would have started this whole process 6 months later.......All because a doctor wanted to work within cost guidelines.

My brother (5 years younger) is considered to be at an elevated risk; his doctor also said that his PSA is below 3 and there is no need. Keep in mind that PSA was often thought to be relatively useless in diagnosing, and I think that line of thinking is history (everyone I know with PC was diagnosed due to an elevated PSA). My brother wound up spending $900 out of pocket for an MRI, which fortunately came back clear.

Advocate for yourself. Guidelines may work 98% of the time.

I wont forget the awkward doctors visit with my primary care doctor (the one who said to wait 6 months and sluffed off my concerns) when I went in for my semi-annual visit with him...he knew that I had surgery and that I got a 2nd opinion which revealed that waiting 6 months wouldn't be a good idea. I didn't say anything to him, because I do like him and think he is a good doctor.

HAVING A GOOD/GREAT doctor should in now way moderate your vigorous advocacy for yourself.

Hey Liver-mareez!

I would think that the first thing your doctor will do is a prescription for antibiotics. Something other than a fluoroquinolone is in your best interest. A little info!

Updated Black-box Warnings for Fluoroquinolones | Floxie Hope

floxiehope.com/2016/08/19/u...

Aug 19, 2016 · The FDA is acknowledging, in a highlighted black-box section of the warning labels, that fluoroquinolone adverse-effects can be serious, irreversible, and disabling. They’re also acknowledging peripheral neuropathy and central nervous system effects, in addition to the adverse-effects on tendons, in the black-box warning.

To find out what is wrong a MRI might be helpful.

You are young. A little about ex-rays.

Possible Link Found Between X-rays And Prostate Cancer ...

sciencedaily.com/releases/2...

Jul 15, 2008 · Researchers at The University of Nottingham have shown an association between certain past diagnostic radiation procedures and an increased risk of young-onset prostate cancer …

Those who practice would be quite upset with those in research if more studies were done. The dental ex-rays use one of the lowest amounts of radiation yet you will find that those who have the yearly dental ex-rays have a much higher incidence of thyroid cancers.

CT scans use much more radiation than ex-rays. A MRI is appropriate. A younger friend of mine, a neighbor was limping. I asked him what was wrong. He had sciatica. He was scheduled for an ex-ray the next day. I showed the above and a few other articles. The CDC has listed ionizing radiation as a carcinogen. The FDA does not regulate imaging techniques. The FDA requested that The American College of Radiology along with input from another college or two issue guidelines. He took in this info. He called his chiropractor and cancelled the ex-rays. He was booked for a MRI without an argument. He became what is known as "An Informed Patient"!

Be an "informed patient". There are antibiotics that aren't dangerous. I have had adverse reactions to fluoroquinolones which have now been linked to a doubling of the instance of aortic aneurysms.

Consent forms--ask if before certain procedures that require a consent form if you can add a sentence such as that you are assured that an ex-ray is not a carcinogen and watch for the reaction.

My best to you,

Currumpaw

it would be rare, but not impossible, for it to be prostate cancer. i suspect something else is going on, but i think it warrants further investigation by a urologist (or two). there was a 14 year old at my state's cancer 5k last month who was diagnosed with PCa at nine years old, recurred at 11 and had to have it removed. follow up. you're right to want to know more.

Hi and thanks for replying. That's immensely shocking to learn a 9 y/o could get PCa. Suggests to me that I'm definitely not in the clear. Do you happen to know any specifics about the case? Was the cancer aggressive? Was it caught early or at an advanced stage? And were PSA levels raised above 4?

i’m not sure of the details of his case, i only know he did have a recurrence that required prostate removal. he’s doing well now, 5 years after initial diagnosis. he had a less than 1% chance of PCa. i have met guys around 30 years old getting diagnosed, some stage IV, but again it is VERY rare so don’t panic. you are far more likely to have an infection or BPH. a PSA test can be elevated for several reasons. a follow-up PSA test (and biopsy with MRI, if necessary) would say much more than a single blood test.

because of his age, they weren’t taking PSA tests. i know he had to have surgery and chemo upon recurrence. he’s been NED for 3-4 years now.

See a doctor!

1. Instead of worrying, get yourself checked. See a urologist.

2. Probably from inflammation and swelling, not cancer.

3. If you are not already, try masturbating at least daily for two weeks and see if that helps receive the pain/pressure.

4. When you ejaculate (cum) do you get any symptoms?

Hi and thanks for replying.

I actually masterbate Atleast once a day and have been doing so for as long as I can remember.

Also I haven't noticed any changes in the way I respond to genital stimulation using the hand. No pain during ejaculation either.

The urologist hasn't yet been able to figure out what it is though. That kinda gets me worried

Your urologist has proposed a sound plan. Prostatitis is a kind of garbage can diagnosis because it is virtually non-testable. Pay some attention to Currumpaw's warning about fluoroquinolones. He is correct about the risks. Most urologists will default to that family of antibiotics and you need to make an educated decision about asking for another antibiotic. If the doctor prescribes a fluoroquinolone, you can politely ask if the doctor is aware of the black box warning about soft tissue damage. Once the doctor knows that you know, s/he may consider an alternative. There are alternatives.

I hope that you will continue to keep the forum updated on your progress and on any answers that may emerge. We become obsessed with the prostate gland, even after we have lost our own.

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