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High PSA possible Prostrate Problems

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HappyH1418
HappyH1418

Hi all

This is my first post so hope I am in the correct area. I live in Spain and with the language barrier I am not sure if I am understanding my diagnosis.

Over the past 6 months I have had two blood test which both confirmed I have a high PSA level (7.2 & 9.7), The only symptom I appear to have is going to the toilet at night more frequently, although to be honest I have always gone to the toilet at night two or three times ever since I can remember, (I'm not a good sleeper and often awake and just go to the toilet without actually feeling the need to go) my Doctor sent me to the Urologist at my local hospital, who gave me a DRE and then referred me for an Ultra Sound examination.

I had the Ultra sound and I the follow up visit to my specialist was told I would have a biopsy, before he even looked at the biopsy results although when asked he said that the Ultra sound was clear.

What I am not sure about is this Am I having the biopsy to ensure I do not have prostrate cancer or are do they think that I do have Prostrate cancer and are looking to see the extent of the problem to ascertain what treatment (if any) I will need?

Hope you can help

regards

0 likes, 27 replies

27 Replies

  • Pepasan
    Pepasan HappyH1418

    Posted

    I've had a consistent PSA around 8 for many years,  and have had various investigations to find out the cause.  Once a Urologist has responsibility for our care, I think they do feel obliged to discover the cause, and ruling cancer in or out is an important part of this. I've been reassured by this, but sometimes it feels as if your body is not your own. Living with uncertainty is the most difficult part, but personally I prefer to have as much information and knowledge as possible - my emotional reactions follow on from that. Clearly they do not know if you are more or less likely to have cancer until the test results are in. Personally I think, while a natural reaction, it's pointless to second guess what 'they' are thinking. Stay with it, and join in the inquiry together, Chances are, even if it is cancer, you may have, like me, the least virulent type which doesn't require treatment anyway. If the glass is half empty it is also half full!
    • HappyH1418
      HappyH1418 Pepasan

      Posted

      Thanks for that Pepasan, your correct it is so worry and you start to think of all the systems and convince yourself that you have them.

      I am a notorious bad sleeper and cannot remember a time when I slept though the night so when i wake up now even if i dont need the toilet I go so maybe I am excacerbating the situation, but not knowing is stressful. And the language barrier is a problem.

      I now start thinking that every time I do go to pass water 'is it hurting, is the flow correct etc etc.

      But it's helpful to know how others cope with it.

      regards

      Tony

    • Pepasan
      Pepasan HappyH1418

      Posted

      Worry has its good side - without it we could ignore signs that need checking out. How to keep it all in proportion to the reality of the situation is a real challenge at times. Not to criticise your spelling, but I'm tempted to say take the r out and you won't be flattened by it!

       

  • stewarta
    stewarta HappyH1418

    Posted

    HappyH: The way to cut through the uncertainty is to have a 3T MRI. Of course, it comes down to whether you can afford this. I wouldn't have a biopsy without having this first.

    PSA results are notoriously unreliable. There are too many false negatives and false positives. A DRE will only allow the GP or urologist to tell you if you have an enlarged prostate .... but, it won't tell you why. Nocturia (getting up to urinate at night) can be due to so many causes that it isn't possible to blame it on the prostate. The MRI will tell you and your medical professionals why.

    Above all, don't stress too much, and be sure to get more than one professional's view.

  • barney34567
    barney34567 HappyH1418

    Posted

    You had two PSA tests. Were they done by the same pathology company? If not, then different methods of measurement could have been used which would not be as reliable as having both tests performed by the same lab.

    Long before a biopsy is to be considered you should do, as stewarta suggests, have a MRI. Ideally 3T. Failing that, 1.5T. Make sure you have the MRI done where a specialist in prostate imaging will report on it, otherwise you are wasting time and money.

    And before a MRI, I would have urine tests: m/c/s and urine cytology,  to assess if you have an infection. This could be in your prostate or the bladder. And if so, antibiotics will be used to treat you.

    I would never jump to a biopsy. This is invasive and not without risk. 

    I say the above because I have had elevated PSA results, undergone urine tests for a few months and a 1.5 T MRI. Given my history I cannot have a 3T MRI.

    i am now deciding who will do the biopsy. I am in no rush. An extra month deciding will not make a difference. 

  • HappyH1418
    HappyH1418

    Posted

    Thanks both, but not sure I can go down the MRI route as i am in Spain, land unless you are registered with private health care you cannot just go and pay for an MRI also the Language barrier is a problem even when using an interpreter.

    The two blood test where done at the same laboritory. 

    I also usually drink to much tea during the day and at night probably drink to much carbonated drinks with alcohol, so there are many reasons why I might be going to the toilet more.

    I really appreciated all your comments and take on board about trying to remain level headed about it.

    Thanks again to all

     

    • charles61038
      charles61038 HappyH1418

      Posted

      I was not offered the MRI either and I got the biopsy. My PSA was at 5.2, I had no symptoms, just the elevated PSA. I took antibiotics for a couple of weeks to see if this was due to an infection. The PSA went down to 5.1, which was still not good enough. This is when my urologist wanted to do the biopsy. The biopsy showed 2 out of 12 core samples to contain cancer cells. Fortunatly they were small amounts 10% in one sample, and 2% in the other. The pathology report said it was a non agressive type of cancer. Because this was considered low risk and non agressive, I was offered active survailance as an option.  But I chose to get treatment to get rid of the cancer. My reasoning was that if I waited for treatment perhaps a year, or two or more, I would be older and might have other health issues to deal with. Treatment now would be easier than if I waited until I was older. After researching options, I chose Brachytherapy - low dose radiation seed implants. Insurance has paid all of it - at least so far I have not gotten any request for payment. I had the treatment 10 weeks ago and I am doing well. Very few side effects. And the side effects I do have are very tolerable. From what my urologist told me, after about 8 months, I should have no side effects and be where I was before all this startedThe biopsy is not pleasant, but tolerable. . I wish you the very best... keep us posted on your progress.

      Charles

    • Roger2Dodger
      Roger2Dodger charles61038

      Posted

      Charles,

      Just read your PSA and biopsy results. Mine were similar to yours only higher in both respects. My PSA 5.83... I had 2 core samples with cancer. Both with 10% cancer. Gleason score was 3+3=6 and the other was 4+3=7. This one of the score of 7 had me concerned. My prolaris score will determine the aggressive and non aggressive of my cancer. Just sitting and waiting on the results.

  • Roger2Dodger
    Roger2Dodger HappyH1418

    Posted

    HappyH1418,

    The advice given here is excellent. I was helped considerable with others that are dealing with prostate issues. Like you I went to my urologist aftrer my PSA went to 5.83. He informed me that the only way I could determine prostate cancer was havibng a biopsy. I had that biopsy, and it proved I had cancer. stewarta mentioned in his reply, having  a MRI done before having the biopsy. My Uroligist did not even mention this option. Now he is sending me for a MRI this month.?? I am wondering if the MRI stewarta is referring to is not available where I live? My pathology remains were sent to Prolaris to determine whether or not my cancer is aggressive - non aggressive. My advice is to be proactive when dealing with this dreadful disease.

    • barney34567
      barney34567 Roger2Dodger

      Posted

      To clarify, I am informed that urologists don't recommend a MRI for a very simple reason: they don't make money sending you for a radiological test. They make money by operating and performing a biopsy. N

      The the fact is, a MRI is non invasive and if it shows something significant, not only is a biopsy then wise to have but the biopsy  can be GUIDED by what the MRI found. Otherwise, a biopsy is little more than 14-28 needles being shot into the prostate.

    • Roger2Dodger
      Roger2Dodger barney34567

      Posted

      Thanks for the clarification, makes sense to me. The MRI I will be having will determine of the cancer has left the prostate, that is what the urologist told me. So, he should have sent me for the MRI first. I now understand why stewarta mentioned  about having the MRI first!.
    • ES28567
      ES28567 Roger2Dodger

      Posted

      Roger, you may also need to have a bone scan done. The MRI only shows if the cancer has spread to soft tissue like the lymph nodes. If you're having any bone pain or the aggressiveness of the cancer will determine if you need a bone scan.
    • stewarta
      stewarta ES28567

      Posted

      ES: Yes, I agree. The order in which I had tests was:

      PSA: {2.4 to 3.5 over 10 years} >> DRE * 2 >>.

      3T MRI >> Biopsy >> Full body scan and pelvic scan >> post-op

      pathology tests 😷

      The last lot all within three months.

    • Roger2Dodger
      Roger2Dodger ES28567

      Posted

      ES, Now you have me wondering why my Urologist did not order a bone scan? I am having back pain, but I have dealt with that over the years doing yard work etc. However, it seems to have gotton worse recently. I don't seem to be having bone pain, just pain in my back. Where wouild bone pain most likely occur?
    • ES28567
      ES28567 Roger2Dodger

      Posted

      I'm not a doctor but from what I have read, pain is usually in the hip, pelvic area, and back. But cancer cells can go anywhere. If you had back problems before, I wouldn't read too much into having more back pain now. The good news is a bone scan is from head to toe so you don't have to worry about missing anything. It is also (at least for me) a very easy test to have done. Much easier than a MRI. If I were you, I would get one done. In my case, when I told my urologist I have some bone pain when I sit on a hard surface, he immediately scheduled a bone scan (he didn't even blink). My bone scan came back clean. So now, just one less thing to worry about and more treatment options available to me.

      Hope that helps.

    • Roger2Dodger
      Roger2Dodger ES28567

      Posted

      Thanks for the info! Much aprreciated. I willl address this with my Doctor.
    • david41094
      david41094 Roger2Dodger

      Posted

      Just to put your mind at ease - with a PSA of 5.83, your back pain is almost certainly unrelated to PCa. 
    • Roger2Dodger
      Roger2Dodger david41094

      Posted

      Thanks David....yes, psa 5.83. Gleason score 2 cores with 10% cancer. Score....

      3+3=6 And 4+3=7. Your reply has me doubting that they are unrelated.

    • david41094
      david41094 Roger2Dodger

      Posted

      As has been said on here many times, 3+3 should not really be classified as cancer because it behaves very differently. So you have one score of 4+3. Nothing in medicine is absolute, but if your back pain was a result of PCa you would expect a PSA in the hundreds. 5.83 is low - indeed, until 1980 any score below 10 was not investigated any further. Doctors will always order a bone scan - it is a precautionary procedure - but they would not expect anything to show with such a low PSA. Worry is a much more likely cause - remember, most people suffer with back ache at our age!
    • stewarta
      stewarta david41094

      Posted

      My PSA was 2.4 to 3.5 over a decade, yet I had a very aggressive PCa that a post-op path test gave a Gleason 9. The trouble with PSA readings is false positive and false negative results.

      I wouldn't place any faith in PSA. Apologies if this disturbs any readers.

    • david41094
      david41094 stewarta

      Posted

      You are correct in that there are rare (less than 10% in total), variants - some of which are agressive which typically have low PSA readings. Others are actually even slower growing than adenocarcinoma (e.g. Small cell cancer). Acinar adenocarcinoma accounts for over 90% of all Prostate cancers and is typically slow-growing. However, these aggressive variants would not also have a low Gleason score so I think Roger can rest assured that his back pain is extremely unlikely to be related to his PCa. Of course, he should check with his oncologist but I think he will get the same response.
    • Roger2Dodger
      Roger2Dodger david41094

      Posted

      You guys are just great! I am gaining more confidence about my condition after reading your posts, and replies. A mind does wonder after you are told you have cancer. Believe me, mine does each and every day. The process of a visit to the Urologist and then a biopsy and the wait of the results of other tests before a game plan is derermined causes distress and anxiety. I know...I have been told I have time to wait, because of the nature of prostate cancer. This forum and discussions has helped me cope with all of it. Thanks to all of you!!

      One question: what is PCa?

    • david41094
      david41094 Roger2Dodger

      Posted

      PCa is a shorthand way of writing Prostate Cancer. One thing you do have is time - I remember ready a study which showed that a delay in treatment led to no noticeable change in outcome (sorry I can't find the link). Worry is your biggest enemy right now.

      ​All the best!

    • Roger2Dodger
      Roger2Dodger david41094

      Posted

      My family keeps telling me that constantly. They are very supportive.. I have 4 daughters and all of them went to The Urologist appointment for biopsy report. I would hate to deal with PCa. Alone. I am fortunate in that respect.

      David, I will let you know the. Polaris and MRI results when they are available.

      Roger

    • barney34567
      barney34567 stewarta

      Posted

      I am with you. PSA looked at alone isn't worth a hill of beans. I often speak to highly skilled medical specialists, who are not urologists and they tell me that they were taught to be guided by PSA many years ago that they both refuse to check it.

      they know plenty of folk who when hearing their PSA is ' high' hit the panic button.

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