Decline in PSA

[Longrunner]

I am 70 years old, and I have a scheduled Biopsy following a Prostate MRI and a PI-RADS Assessment Category: 5, (clinically significant cancer highly likely).

While a biopsy may be the next appropriate step in diagnosis of potential cancer, I am still trying to understand what might explain my decline in PSA.

My most recent PSA reading of 3.324 (2/3/22) decreased from 6.24 (10/8/21).

Has anyone had a similar experience or can point me in a direction for further investigation?

Thank you for any insight you may be able to provide.

[Justfor_]

Reporting down to 2 and 3 digits after the decimal point betray different labs. Either or both can be in error. From lab to lab a 20% variance is allowable, yours is way more. Only retesting, preferably with a third lab, can give you some better insight.

[Longrunner in reply to Justfor_]

Thank you very much for your speedy reply. All of my tests have been at the same lab, part of a university medical system. You confirmed my hunch that I should retest. The advice to go to a different lab makes good sense.

[Justfor_ in reply to Longrunner]

I routinely interleave two labs for monthly tests and if there is more than 20% difference use a third one for a majority vote decision. Up to now, in almost 30 PSA tests, it has occurred only once but in between I have banned another two labs when their reports were -300% and +600% out of the anticipated range.

[Tall_Allen]

It just means that you have some prostatitis going on. It's very common.

[thudson1965]

For age 70, PSA 6 is not uncommon. Why did the doctor order an MRI? Digital exam detected lump? Having other problems or pain in pelvic area?

I hope I did not offend. I am 57 and the reason for me was PSA increasing by one point every year for 3 years.

Thank you

[Longrunner in reply to thudson1965]

Thanks for your questions; I appreciate your responding to my post and no offense taken.

No symptoms , no lumps. However, my PSA was 2.4 (3/2018); 4.161 (9/2020); 6.24 (10/2021).

I posted because I thought it odd that my PSA (taken the day before my MRI early this month) had dropped to 3.324.

I guess I was looking for some positive news while I absorb the PI-RADS Category 5 Assessment from the MRI and an upcoming biopsy.

[miscdenver]

Hello:My primary never checked on PSA for 15+ years then early Jan '21 I went in to get a suspected UTI checked. Urine came out clear but the blood test found PSA at 25.

Less than a month later PSA was rechecked prior to biopsy and found to be 17.8

Despite that much of a drop without any treatment (except for some supplements that I had begun taking) the biopsy result came out with 80% malignancy on right and 1% on the left side of the prostate. Subsequent bone and CT scans were clear and MRI came at RAD=5.

I was judged to be high risk and went with the ASCENDE-RT study's prescribed treatment: 2 weeks of Casodex+ 12 months of Lupron + 20 sessions IMRT + Brachy Boost(Needles).

Finished my treatments over three months ago. Now considering getting my first post-treatment PSA test.

Hopefully, this gives you a bit more information for any decisions you may be considering.

Best wishes to you!

[Longrunner in reply to miscdenver]

Thanks for your reply. I am trying to think a few steps ahead. Learning from the experience of others is very helpful . . . although a bit frightening.