PSA results

[PositiveSurvival]

I’ve just seen the results from my PSA test done on Monday.

My PSA is 2.3. I am 49 years old.

However the last test I had done was in 2014 and it was 0.7 then. Not had follow up chat with doctor yet.

Although my latest test is within the “normal” range for my age- should I be concerned at this stage about the velocity of change between the 2 tests?

Thanks

[MarkBarnes]

I have a strong opinion on this matter. My father had PC at 74...which is an age at which it's debatable whether there is a genetic/hereditary risk. Regardless, I have been vigilant. PSA every 6 months, and an annual visit to a urologist (to get an independent exam and opinion) in addition to my primary care.

My PSA was hovering at 4 for two year, and then went to 5.3. My primary care doctor said not to worry, we'll look again in 6 months, because PSA goes up and down and it's the trend. I said ok, and when I got home I made an appt with a urologist. The urologist somewhat agreed with my primary care doctor, but seemed to be stuck on my father's PC, especially since I wasn't sure of the exact age (apparently if it was younger, it represents an elevated risk for me; if my father's PC was later in life then he was at an age where many men get it.

He agreed to do an MRI and it came with with 2 areas of concern. When the biopsy was done there was lots of Gleason 3 and a small amount of Gleason 4, and now I'm looking at a RP without nerve sparing.

BOTTOM LINE: doctors follow guidelines and are always hesitate to order tests (especially expensive tests). If I had my MRI 2 years ago, I'd be in so much better shape. I contacted my brother (5 years younger), who monitors his PSA regularly, and strongly recommended that he get an MRI, which will show stuff well before the PSA elevates. DON'T TAKE chances. Say whatever you need to say to your doctor to get the test. If s/he is hesitant, go to another doctor (and explain you family history of PC...hint hint....not that I think being less than truthful with doctors is a sound practice, but you must advocate for yourself.

For reasons unnecessary to explain here, my brother's MRI will not be covered by insurance, but can be done for under $1000. If I knew what I could have avoided, I would have spend $5000 out of pocket.

And the MRI must be a "contrast enhanced TESLA 3." TESLA refers to the power of the magnet; TESLA 3s are relatively new and usually only available at major medical centers.

[nacinla in reply to MarkBarnes]

Hi Mark. Yes, some doctors hesitate to do a lot of tests. Good advice here. My question: did you consider radiation instead of RP? Sounds like that's an option in your case and you can avoid losing those all-important nerves....

[MarkBarnes in reply to nacinla]

Yes I have explored radiation, and it seems like a reasonable option, although it has it downsides. ED can easily occur...although not right away...it tends to show up months, a year, or even two years, after treatment.

[nacinla in reply to MarkBarnes]

Thanks. Yes; it's possible. Of course, ED shows up right away if the doctor can't spare the nerves during surgery, which you said was your case ("now I'm looking at a RP without nerve sparing"). It's all a very personal decision, ultimately. My urologist said either therapy would be effective for me. I decided, among other things, I did not want to risk damage to nerves, which no surgeon can guarantee. With radiation, it seemed to me, they could treat areas outside the prostate without using a knife. Also, as one ages, functionality can decrease, so it can be hard to tell whether the onset of ED later is the result of the radiation or just the aging process. I know people who have had RP surgery and are very happy; I hope that's the case for you.

[MarkBarnes]

Here's what I know: As you get older, the prostate gets larger, and as it gets larger, the PSA may/will rise along with the size. Size (BPH) is in no way related to cancer, so many doctors will tell you not to worry. If it were me, I would absolutely tell my doctor that I wanted an MRI (doctors may resist doing this) which can either diagnose or set your mind at ease.

If you get an MRI, it must be a contrast-enhanced, Tesla 3 (Tesla is how the strength of the magnet is measures; most MRIs now are Tesla 1.5; you can find 3s that are administered with contrast at major medical centers.

After my diagnosis, I told my brother to get one (his insurance has a very high deductable; I told him to spend the $1000 and get it done and have peace of mind for many years.