PSA Rise
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From: gabachin on 27 May 2006 21:44 I'm 47 and in good health. I have been told since 2000 by my doc that my prostate is enlraged, although I don't know to what degree. I do have on and off slight groin and testicular tenderness/pain, which I have attributed to exercise. No first degree relatives with PCa. but an uncle got it at age 67. On 2/2001 I had my first DRE which was negative, and my first PSA which was .9 On 9/2004 my DRE was again negative, and my PSA was .5 Last week, my blood panel showed a PSA of 1.8 (DRE was again negative), The last two tests were done at the same lab. The first one was done somewhere else. I didn't think too much about it until I started reading about the new PSA and PSAV guidelines. Now I'm not so sure it's OK: I'm confused. Seems like the more I read, the more contradictory information I get. Help! As I understand it, a PSA reading <2.5 in my age group is considered normal, but the .75 rise for two years in a row is not. On the other hand, if the PSA is <2, then testing can be done every two years instead of annually. I guess I'll talk to the doc but I wonder if you veterans can give me some insight. I am soon going to relocate overseas and will not have insurance, at least for awhile and I'm a little freaked out by what I've read Thanks!
From: Steve Kramer on 28 May 2006 07:16 "gabachin" <ptoppo(a)gmail.com> wrote in message news:1148780692.087303.112740(a)38g2000cwa.googlegroups.com... > I'm 47 and in good health. I have been told since 2000 by my doc that > my prostate is enlraged, although I don't know to what degree. I do > have on and off slight groin and testicular tenderness/pain, which I > have attributed to exercise. > > No first degree relatives with PCa. but an uncle got it at age 67. > > On 2/2001 I had my first DRE which was negative, and my first PSA which > was .9 > > On 9/2004 my DRE was again negative, and my PSA was .5 > > Last week, my blood panel showed a PSA of 1.8 (DRE was again negative), > > The last two tests were done at the same lab. The first one was done > somewhere else. > > I didn't think too much about it until I started reading about the new > PSA and PSAV guidelines. Now I'm not so sure it's OK: > > I'm confused. Seems like the more I read, the more contradictory > information I get. Help! The greater indicator of the possibility of cancer is a PSA that rises significantly three consecutive times. If I understand your situation, your PSAs were 0.9 then 0.5 then 1.8. That 1.8 is unnerving, but honestly, it could be the result of a healthy bowel movement. If your DREs are negative, I would not yet worry about cancer. But, keep up the search, because you might have some other prostate problem. Or not. -- PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum
From: gabachin on 28 May 2006 11:01 Thank you for your input! The more I read up on the PSA test, the more confusing it seems. And I'm a math teacher. As I understand it, the test provides a continuum of risk, so that the cutoffs are somewhat artificial. Ths is OK with me, but then it appears that the experts still don't know how to interpret the risk; that is, they know that as PSA increases, the risk of PCa rises, but they don't seem to have nailed down the scale, the percentages. There's too much "noise" in the statistical sample. The fact that a low PSA doesn't even rule out an agressive cancer is particularly disturbing. My doc says the DRE should always be done in conjunction with PSA. I had my blood taken at 8AM after the DRE and interestingly my creatinine came back a little high, and the nurse said I might have been dehydrated. I wonder if that might affect the PSA. I also have en enlarged prostate but that still doesn't explain the jump from .5 to 1.8 in two years. I guess the bottom line is that I should monitor my PSA numbers and look for large jumps. If you were in my position, would you go for a biopsy? When would you get your PSA retested? What number would you use as the red flag for biopsy? I will discuss this with my doc but I'd definitely value your opinions. Thanks again for your help. It's great to talk with people who've "been there." I respect you guys a lot.
From: juniper on 28 May 2006 12:08 gabachin wrote: > Thank you for your input! > > The more I read up on the PSA test, the more confusing it seems. And > I'm a math teacher. As I understand it, the test provides a continuum > of risk, so that the cutoffs are somewhat artificial. Ths is OK with > me, but then it appears that the experts still don't know how to > interpret the risk; that is, they know that as PSA increases, the risk > of PCa rises, but they don't seem to have nailed down the scale, the > percentages. There's too much "noise" in the statistical sample. > > The fact that a low PSA doesn't even rule out an agressive cancer is > particularly disturbing. My doc says the DRE should always be done in > conjunction with PSA. > > I had my blood taken at 8AM after the DRE and interestingly my > creatinine came back a little high, and the nurse said I might have > been dehydrated. I wonder if that might affect the PSA. I also have en > enlarged prostate but that still doesn't explain the jump from .5 to > 1.8 in two years. > > I guess the bottom line is that I should monitor my PSA numbers and > look for large jumps. > > If you were in my position, would you go for a biopsy? When would you > get your PSA retested? What number would you use as the red flag for > biopsy? I will discuss this with my doc but I'd definitely value your > opinions. > > Thanks again for your help. It's great to talk with people who've "been > there." I respect you guys a lot. I am very very grateful that you are following up on this now. Over a 5 year period my husband went from 2.1 to 26.7. In the 3 years before that, he went from 1.8 to 2.1. So I believe your concern is useful, and I am all for aggressive exploration of anamolies. However, a few comments. A free PSA test (also known as PSAII) can be another indicator. Ask for one of those. I believe that following your PSA doubling time is the most important. Use the tools at www.pcri.org and/or the sloan-kettering one at http://www.mskcc.org/mskcc/html/10088.cfm. Warning: These nomograms are for men who have been diagnosed with cancer through biopsy. You have no indications of prostate cancer. There are may more probable reasons for your 1.8 psa, as others have pointed out. Plus, PSA varies as much as 30% in a day. Plus, a friend of mine came up with an unbelievable PSA and it turns out they had mixed up two people's results. Lab errors happen. http://www.cancer.prostate-help.org/capsaif.htm Condition Manipulation Increase Effect on PSA Level Persists Up To Acute bacterial prostatitis 5-7 fold 6 weeks Acute urinary retention 5-7 fold 6 weeks Digital Rectal Exam (DRE) Variable 3 days Exercise - bicycle 0-3 fold 1 week Prostate biopsy Very Variable 6 weeks Prostate massage Variable 6 weeks Ejaculation Variable 3 days TURP Very Variable 6 weeks As you can see, the DRE could have caused the increased PSA by itself. There are references for the size of the prostate and the amount of normal PSA a prostate puts out (by size). I believe that is on the pcri.org site. So if you had an idea of the size of your prostate, then you would be able to calculate the expected amount of PSA. A urologist might be more experienced and able to guess the PSA size, feel something the GP can't, etc. But even TURPs are not that good for estimating size. A biopsy is not accurate enough to give you a valid reason to stop being concerned. You will have to use other clues until the weight of evidence clearly points to a biopsy. And, as you know, a PSA test is not a cancer test. I think someone said to go to a urologist if you have been going to a GP. Since you are such a good researcher, perhaps you can find a local prostate cancer specialist who can really track down the #s and give you specific information about follow through while you are out of the country. If you could do anything you wanted, an endorectal MRI with spectroscopy would identify areas of concern in the prostate (if there were any) that you could focus on. (My gut feeling is that without more indicators of concern, an annual PSA would be enough.) Best wishes, and thank you for taking this seriously. laurel
From: juniper on 28 May 2006 12:22
gabachin wrote: > have on and off slight groin and testicular tenderness/pain, which I > have attributed to exercise. No one replied to this, so I will. I have never heard of anyone who had pain with prostate cancer until it was very very advanced, and then it is usually bone pain. (An enlarged prostate can cause pain, I think, but that is usually around urinary symptoms and not groin.) My impression of this is that you were probably correct about the cause of your groin/testicular pain. |