Increasing PSA

[ironmanburg]

I am on AS with another MRI, psa and office visit with my urologist scheduled for May; however, my pcp recently included a psa test in my yearly lab tests and I find the psa has increased to 7.0 from 6.0 and 6.4 since last July and August. Has anyone else had their psa increase like this and did you stay on AS or elect to treat the pca? Here are my psa levels since 2013:

PSA History

7/21 6.4

2/21 5.4

1/21 5.1

6/20 4.6

2/20 4.5

2/19 3.5

1/18 3.9

1/17 3.7

2/16 3.6

1/15 1.9

10/13 3.2

Thanks everyone.

So, I had the MRI and saw the Urologist who is tracking my PC. This is the 3 MRI I have had in the last couple of years with similar results.

IMPRESSION:

Benign prostatic hyperplasia with peripheral zone scarring. PI-RADS 2. Elevated PSA density, increased from prior study. Continued follow-up is recommended if repeat biopsy is not elected.

My PSA went down from 7.0 in February to 6.7 in May. I informed my Urologist I wanted to continue AS so we will do another bx in October and go from there. Just wondering about the PSA. I already know I have Gleason 6 PC and BPH so do I need to be overly concerned about the PSA if it doesn't get up into the teens and twenties? Thanks for any follow up.

[Justfor_]

In your place I wouldn't wait until May to get the MRI. And I would made absolutely certain that it will be a 3T mpMRI read by an experienced radiologist. Alternatively, if you could spare the cost, as insurance will not cover it, a PSMA pet scan would provide a more reliable picture of your current state.

[ironmanburg in reply to Justfor_]

Thanks.

[Tall_Allen]

Most AS programs have found that PSA changes are not a good indicator of grade progression. It is likely that your prostate is enlarging (BPH). You may be experiencing some signs of BPH - like getting up more at night to pee. It is important to know your prostate size - PSA density (=psa/prostate size) is more predictive than just PSA. In fact, there is a test called Prostate Health Index (PHI) that you can ask for. It includes PSA, but also includes types of PSA that are more predictive of cancer. Tracking with PHI may be more useful than tracking with PSA alone.

The next time you go to see your urologist, ask him to track your prostate size too.

[ironmanburg in reply to Tall_Allen]

Thanks.

[CarverD]

My PSA ran almost exactly like that. After the MRI if you find anything suspicious you can have a targeted biopsy. I ended up with favorable 7(3+4), treated it, and have as good a QOL as before finding the PCa. Hope it's just an enlarged prostate which is just as likely.

[ironmanburg in reply to CarverD]

Thanks. Good to hear that your QOL is as good as it was before treatment as I don't hear that often enough. I will treat (probably high dose radiation) when it's time but I don't want to begin too soon.

[ironmanburg in reply to CarverD]

What treatment did you have if you don't mind me asking?

[CarverD in reply to ironmanburg]

I had HDRBrachytherapy. 2 treatments a week apart. Worst part was pulling the catheter on Friday morning after Thursday treatments. Preformed at UR Medicine in Rochester, NY. Worked with the doctor that introduced HDRBT to Western NY so he had oodles of experience preforming the procedure. Took about 6 hours start to finish for each treatment. Up and on a mountainside bow hunting whitetail deer 6 days after 2nd treatment. Feel free to message me if you'd like additional information or have any questions..... Regards - doug.

[ironmanburg in reply to CarverD]

Thanks. I was leaning toward the same thing except it was 3 treatments each week for 2 weeks.