3.7 psa to 4.4 psa

[Cynthgob]

I am on this blog for my husband but my son in law just got his psa checked. He is 51 and his mother had ovarian cancer. His psa last year was 3.7 and has now gone up to 4.4. Of course we are panicked as we know what this could mean. What is your suggestion as first step as I worry his dr will suggest watch and wait. Can ovarian cancer be a precursor for her son to have prostate cancer? Thank you❤️

[LearnAll]

First of all...find out which assay they used to measure PSA. There are 2 common assays (1) Beckman Coulter and (2) Siemens. If the assay has not been calibrated to WHO standard then, Beckman Coulter give PSA reading 20% higher than Siemens. A lot of unnecessary biopsy have been done as PSA was not 5.0, it was in fact 4.0 when adjusted to WHO standard.There are 3 major causes of PSA increase (1) Inflammation of prostate (prostatitis), Benign Hyperplasia of prostate (BPH) and (3) Prostate Cancer. Your doctor must try to find out the real cause of PSA rise before embarking on toxic treatments.

Over 80% of prostate cancers are slow growing so its not an emergency...you can afford to get all relevant testings and scans to get accurate picture.

[LowT in reply to LearnAll]

And one or two or all three of these can exist at the same time.

[Muffin2019]

Just my personal experience, my number in my early 60s was 5,4 with no symptoms, then went to 7.4 for a year with no symptoms, then at 66 I developed urinary issues and lost about 5 pounds. Then the readings came in at 156 and had a biopsy done to find it was a Gleason 9, stage 4 that had spread to the bone in 4 places, went to an oncologist and started ADT with chemo which went well, PSA dropped to .6, gained weight and started another line if defense last December. PSA still under 1 and stable, gained about 35 pounds due to the medicine but my BMI is normal due to my height. I did cut red meat to once a week, lots of fish, chicken, turkey only 3 eggs a week but kept dairy products. I feel good still work part time, when life throws lemons at you you try to make lemonade. The side effects are hot flashes, some tiredness and weight gain along with elevated blood pressure but at 70 I feel good and plan on being around for a long time. Keep watch and do the relevant testing, he has time but not to wait until it comes a bigger problem. Wish him luck, take care and stay safe.

[Hidden]

One common risk factor for Ovarian and Prostate cancer is the BRCA mutation. That's something he could check with a simple germline genetic test.

ncbi.nlm.nih.gov/pmc/articl...

If he has it, it would mean he should have more diligence regarding prostate cancer, especially if his PSA continues to rise.

[HopingForTheBest1 in reply to Hidden]

Absolute agree. He definitely needs to get genetic testing, and to see a genitourinary oncologist preferably at a major cancer center to discuss all options.

[NotAlwaysSunshine]

My husband and his older sister share a mutation called Rad51c. It's rare and it's down the BRCA chain. My husband's sister had stage 3 ovarian cancer. Our children will test to see if they have the mutation. Consider a genetic test.

[LowT]

A percent free PSA may be helpful. Easy blood test. Not diagnostic but may point toward something. Inexpensive and non-invasive.

[Tall_Allen]

(1) There is an element of heredity to prostate cancer. There is a good germline test that you can get called Color Genome Dx:

prostatecancer.news/2018/02...

(2) PSA is usually elevated from benign causes- prostatitis, BPH, or urinary retention. They should be investigated before a biopsy is given. There is a test called Prostate Health Index (PHI) that can be given before deciding on a biopsy. It is more selective than PSA or % free PSA (it includes both).

[cesces in reply to Tall_Allen]

"There is a test called Prostate Health Index (PHI) that can be given before deciding on a biopsy. It is more selective than PSA or % free PSA (it includes both)."

Does the phi test have any benefits over regular ultrasensitive PSA testing if you already have prostate cancer and are just monitoring it?

[cesces]

It's not the absolute reading but the doubling rate that counts.

Time to start doing monthly PSA tests in my opinion.

[spw1]

Our urologist kept telling us not to worry and that PCa is the slowest cancer there etc. Never asked about the history of cancer in the family. Almost a year went by before biopsy was ordered. Without wishing to alarm you, I wish that I had read Dr Walsh's book as soon as the first small PSA test came back at 4.1 or something. He gives various indications for alarm bells to ring. Also, get a free PSA check done.

Dr Walsh "If your PSA level is above 3 or you have a prostate exam with a suspicious lump or hard spot you need additional testing. You can proceed directly to biopsy or consider a second line test to help determine if a biopsy is really necessary. ...what matters is a significant change over time, ...

For men with PSAs greater than 4, an average, consistent increase of more than 0.75 ng/ml over the course of three tests is considered significant. Say that over eighteen months, a man's PSA level went up from 4.0 to 4.6 to 5.8 ng/ml. Clearly, something is going on here. ...If you have a PSA level between 1 and 4 and it is consistently rising faster than approx 0.4 ng/ml a year, you should get a biopsy. ...

Several large studies showed that men who had a PSA velocity of 2 within the year before diagnosis were much more likely to have an aggressive form of caner... if the free PSA is less than 10%, it's more likely that most of that PSA is coming from cancer, that the caner is significant in size, and that it will prove aggressive. ... evidence shows that free PSA can predict which tumours will be aggressive - and need to be treated as soon as possible ..In ... Johns Hopkins study using the large database ... urologist ... compared blood samples ...and found that fifteen years before cancer was diagnosed, all the men who turned out to have aggressive prostate tumours had levels of free PSA that were lower than 15%. Men with slower growing, nonaggressive cancer all had free PSA levels greater than 15%. This landmark study suggests that free PSA percentage may be an excellent predictor of aggressive tumours that will need to be treated." According to Dr Walsh between the ages 50-59, only 3% men have PSA between 4.1 - 9.9. He suggests a range of 2.5 to 3 to strike a reasonable balance between early detection and overdiagnosis.

Our urologist gave a 30 day antibiotic course for PSA rises instead of further tests. Dr Walsh's book says that this should not be done unless something shows that there is an antibiotic infection.

I write this not to worry you but we wish that we had acted sooner than we did instead of relying on the urologist to tell us not to worry about anything. If it is not PCa, and I hope that it is not, then nothing is lost except a bit of effort and time for ruling it out.

[TJGuy in reply to spw1]

What was Dr Walsh's book named?

[spw1 in reply to TJGuy]

Dr Patrick Walsh's Guide to Surviving Prostate Cancer.

[Hidden in reply to spw1]

My personal opinion after five years reading here is that urologist mess up a lot . Mine made me wait 5 weeks to get a biopsy . I was self cathing until I went to k failure under his watch . That ended up with me having tubes and a foley for 18 months . I Was calling out that I wasn’t going to make it . They didn’t listen .

[2dee]

In MY case my PSA slowly and steadily rose over many years. My primary did nothing to pursue. It reached 7.5 and we ignored it for 2 years. WRONG.Next PSA test after 2 yrs came back as 1303 and rising a point a day. Stage 4, fully metastized. Extreme pain throughout body, lost 55# in 2 mos. Too late for any treatment except Lupron. Given months to live. That was 3 yrs ago. Now past 15 MO on Xtandi and on to Lymparza because I later tested positive for BRCA2 mutation.

Be concerned when above 4 and follow up with lots of self education and regular testing. You might catch yours before it explodes and treatment choices are limited.

Good Luck...

2Dee

[Hidden in reply to 2dee]

I macho-ly ignored my issues until it was almost too late . 😳

[TJGuy]

Is he taking fanisterid? If taking Fanisterid in any form, ANY rise no matter how small and he should be seen immediately by a urologist. If your Primary care physician doesn't agree drop him/ her immediately and get a new one.A bad PCP is your greatest risk!

[Fightinghard]

Recommend having him get it checked out by a good urologist. My family Dr was a great guy but ignored my slowly rising PSA for 5 years. When I moved and changed to new Doc, he immediately sent me to urologist. Testing then showed cancer.

If if if I had reacted 5 years sooner, my chance of cure would have been much higher.

[Dban]

My story is but one and please take what you wish from it, but with knowledge that I have now I would have done things differently in hindsight. Age 39 annual blood tests for military service had a PSA check added as a well man check. Result 3.2.

DOC- ‘probably nothing, probably an infection, you are too young’ No DRE, no ruling out infection.

Not tested again until age 42. PSA 3.7. Same story.

Age 43 - new doctor- PSA 4.2. Referred to surgeon and had prostate out. But if a bulge of tumour but thin negative margins.

Point is I was dissuaded and told not to worry - which I accepted as they knew best. Or so I thought. Wish I had researched a bit and forced an earlier investigation and perhaps I might not be Stage 4 at 50.

Understand your situation better ( this site is a great start) and get a feel for the path you may want to follow vs risk appetite, remembering that prostate stuff is different for everybody!

[j-o-h-n]

Mine spiked like that and sure enough the little bastards were having fun inside my prostate while I was having fun outside. I would have a biopsy...performed asap.... but I'm no doctor even though I look handsome in a white coat...(and not a straight jacket)....

A stitch in time......

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 11/10/2021 8:11 PM DST

[strummer]

i would definitely get this checked out. Dr. Crawford the former head of Univ of Co Urology Cancer Clinic said a psa of 2 is when you need to investigate. Wish we knew that before we had to meet him!

[slpdvmmd]

Agree with strummer. Shortly after my diagnosis I did a pretty thorough world literature review and concluded you should take any psa value above 2 seriously. If your provider does not respect that then change provider.

[Hidden]

My dad had APC . So I was 50% more likely to get it .. I don’t think there is a match between ovarian and the son getting pc . My first Psa test was at 52 it was 8 . My GP told me to see an urologist . I stalled a few months and took all of the natural stuff for a few months until my Psa was 20 and I stopped peeing .. I had urgency to pee . If he has no symptoms just monitor the Psa . He has to be vigilant !

[Scott1963]

Ask him how many hours prior to the test that he had an ejaculation. Some tests say 24 and some say 48 hours. That could throw off the results.

[Hidden]

My dad had this and I found out after dx that I Should have checked my Psa starting at 40 . I did not . I Almost died at 53 from pc tumors k failure. He must keep checking . Sorry about this .There is hope for him of some miracle treatments coming down the pike !