3 weeks ago I had a PSA test added to my annual physical blood work. I'm very healthy and no sypmtoms. Came back at a shocking 10.7. My primary doc called me on Saturday to tell me to get an appt with urologist asap. Had an elevated WBC too.
Was able to get in to see the urologist's assistant that Monday. Ran a urine culture and DRE, which he said the prostate on one side felt firm. Prescribed Cipro for 2 weeks and a PSA retest. The culture came back negative for UTI.
Of course I dive in to research all I can on what could be going on with me. Little pissed that we went straight to Cipro after reading potential side effects, especially tendons. I'm an active runner. My grandfather had PC and lived into 80's, and my dad did not and lived until 80. So trying not to get too worked up, but all this talk about turbo cancers is a bit worrying.
I asked the office to include a PSA free test, which they agreed but apparently never updated the lab orders. Went in yesterday to lab and got results this morning only to see PSA total result. Thankfully it's down to 4.5, but still has me concerned. So I went ahead and found a way to order a PSA free test myself and went in today for the draw. Have an appointment with the urologist on Thursday and didn't want to wait until after the holiday weekend to get it straightened out with their office.
Assuming the PSA free comes back greater than 25% should I even consider imaging if the urologist suggests it? Does prostititus or other issues ever result in the PSA going that high then go back to zero?
Written by
Poorredman
To view profiles and participate in discussions please or .
A free to total PSA ratio greater than 25% is a good indicator (the higher - the better), but still a low probability for PCa isn't dismissed. A MultiParametric MRI will shed more light.
Tall Allen, I interpret your comment to indicate that you suspect prostatitis, not prostate cancer. I agree. A huge variation in PSA over three weeks is extremely unlikely if the underlying cause is cancer. ncbi.nlm.nih.gov/pmc/articl...
I understand there is small % risk involved in a biopsy. I was one of those - landed in icu due to sepsis. That was a directed biopsy. My first one was uneventful. If one was necessary, a transperineal biopsy (% safer) rather than a transrectal is another option.
A little over six years ago I was in a similar position as you. My Urologist ordered a 4KScore test which was helpful in my diagnosis. I'm sure the PHI test Tall Allen suggested is excellent. Both are blood tests and should be covered by insurance. I really like my Urologist and he seems to believe the DRE's are very important, as well. He told me they are looking for a "bump." IMO, a biopsy at this point would really be jumping the gun. Good luck.
I would do a MRI first, and then a biopsy second, so that the Uro has something to target his needle sticks into. (assuming there is a tumor). That's what I did.
At the end of the school year, last year, I found a PSA 5.6 and went to a Urologist. The Urologist set me up with a urine test for cancer, MRI, and an appointment 2 months out. Both tests came back High Risk for Cancer. At the time, the MRI revealed no involvement in lymph nodes. Dropped the slow first Urologist and found a quicker one. The second is not to quick also, only slightly better. Then a biopsy and now a PET scan reveals 10mm lymph node involvement. WAIT, WAIT, and WAIT, DON'T WAIT ON A UROLOGIST TO CURE PROSTRATE CANCER. They are not specialist in cancer. My cancer has progressed believing a Urologist can help. Well Urologist may be able to help, but.... DON'T WAIT, CALL A CANCER SPECIALIST ORGANIZATION NOW. I called Fox Chase Cancer Center in Philadelphia. I now have a team addressing the matter. If you have to travel, do it. If you don't have the funds, tell the Cancer Center, and they will assist you. "You need top-of-the-line care and be relentless at getting it quickly." I screwed up with excessive waiting and trusting Urologist Specialists while my prognosis went from good to poor. Let me repeat, a Urologist isn't a Specialist in Cancer. Yes, prostrate cancer grows slowly, but I spent all summer waiting while my prognosis changed to "Poor", quality of life may become less, and death may await. "Your life is worth it." Let me repeat, "YOU AND YOUR LIFE ARE WORTH IT"
Anecdotally, my cousin has a PSA over 10 and needed a catheter recently. After a host of tests at a top facility in Chicago it was determined no cancer. I was happy and a little amazed based on what he had gone through to get there. He is still fine in low 70s and running marathons so......
I had positive DRE like you on my right side and PSA of 4. Next step was MRI which showed lesion also on the right. Then a fusion Biopsy that found PC on right side (Gleason 3+4).
I had a positive DRE with PSA only 2.7 at that time. Had a biopsy with Cipro day before, day of, and day after. No harm from that biopsy, just a Gleason 8 score. I opted for HIFU rather than the external beam radiation I was prescribed. Eight years later and at age 74 I am now on dutasteride after PSA reached 3.4. Axumin, Pylarify, and MRI scans all have come back clear. With an intact prostate I wonder if a PSA of 3.4 is just normal at my age? Do I even need to be on dutasteride?
Appreciate everyone's comments and advice. Just received the results of the Free PSA test:
PSA-Total: 4.6
PSA-Free: 0.6 --> 13%
Interesting note at the bottom of the results is that they used a different assay than what my other 2 PSA test used and that this test would be 20% higher when compared to those, which means it could be down to 3.8 a day later.
Not the results I was hoping for. My appointment with the urologist got moved from this Thursday to Monday. Assuming he wants an MRI next, I'll make sure its a mpMRI. But I'll also discuss the genetic tests mentioned.
Is it normal to do the MRI, get results, and then if warranted schedule a biopsy? Or do docs push to do both at the same time?
Based on my experiences your focus should be to do all you can to affirm you do not have prostate cancer. Prior to my diagnosis my PSA bounced quite a lot, larger range than yours and over just a few weeks as well. But, with clear DREs we focused on the drops and turned out we were falsely dismissive of the very thing we were screening for. Prostate Cancer.
Does it not make sense that many/most/all men that face prostate cancer would like a screening do-over? Doctors such as Matt Cooperberg, UCSF are promoting newer thinking about PSA, suggesting men in their 40's should be looking for a PSA of less than 1.0.
Based on your updated results I would think an mpMRI is next - and yes before a biopsy. I found and still find second radiology opinions very useful. If a biopsy is warranted, based on my experiences, genomic and genetic testing are very useful as well. All the best!
Just to update this thread, have my MRI scheduled in 3 weeks.
I inquired with the urologist's assistant if the order was for a mpMRI. Didn't get a reassuring response. He just said that they sent the order to 1 of 2 imaging labs that can send the image to their biopsy machine. They use the UroNav biopsy system.
When I called the imaging lab all they could tell me was that the older was for a prostate scan and they use a 3T machine and will be done with contrast.
The urologist's website and the imaging labs website mentions both mpMRI and 3T MRI somewhat interchangeably, but el-Google says they aren't the same thing.
Another update. Was supposed to have the MRI today, but got notified yesterday that United Healthcare denied the authorization. Nothing like waiting 3 weeks to be let down the day before. Sounds like the urologist didn't write up the order correctly and so they had to send in an appeal. The imaging center said they rarely see denials for prostate imaging. Just my luck.
I did go ahead and order myself a metabolic panel and PSA test and had that done yesterday. Blood panel results look great. PSA Total is now 2.5 and Free was 0.5 or 20%. Still out of range, but makes me feel more confident then MRI will not show anything major.
I had free psa of 22% and still had 4+3 Pca. The dre result of firmness is concerning. Push for a 3T mp MRI at a center of excellence. Find the best urologist at a center of excellence. Good luck 👍.
Finally had the MRI done yesterday. Received the report last night and what a relief. I'll meet with the urologist on Tuesday, but it appears I'm only dealing with an enlarged prostate.
From the report:
FINDINGS:
Statements: None.
Prostate:
Measurement: 4.7 x 3.8 x 3.5 cm; estimated volume: 33.8 cc;
Focal lesion(s): No focal lesion detected with imaging features of clinically significant prostate cancer.
Diffuse abnormalities: None;
Bladder: Trabeculated appearance.
Adenopathy: No pathologically enlarged lymph nodes.
Bones: Degenerative changes
Other: No significant pelvic free fluid.
IMPRESSION:
1. No focal lesion identified concerning for clinically significant prostate cancer
2. PI-RADS score: 2.
3. Estimated prostate volume of 33.8 cc
During the wait to get insurance to approve the scan, I took another PSA test on 10/18 that came back at 1.46. So it has been consistently halving every 3 weeks since August. Interesting data.
The industry has an imaging problem. They have equipment that can shoot smaller bits of cancer than they can see.
I concluded that they were kind of guessing what was in there.
I was inexperienced, but now wish i would have moved to biopsy earlier. I got a saturation biopsy, 1 needle per 1 cc volume of prostate. It found my cancer first time.
Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.
It is best viewed on computer or just print it on paper. Not so viewable on phone.
To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.
Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.
And, this is a very dysfunctional industry from my view. Loads of bad info mixed in with the good info. Same with the docs. Some of them are more dangerous than the cancer.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
decisions/decisions
Blood in Urine
Trying to decide Active Surveillance vs other options
PSA Score Doubling / Lab Error?
Rising PSA
