43 YO male 13.8 PSA Negative biopsy, MRI

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Any advice for 43 year old male with 13.8 PSA, negative biopsy, negative MRI, estimated prostate size 52 ml. Relatively good health...

Every test has thankfully come back negative, but not sure how far to chase the PSA?  Any thoughts are appreciated.

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  • Posted

    Joel

    That PSA is very high for only a 52ml prostate.  The PSA needs to be tracked over about 3 tests at least.  Your biopsys were clean and that is great,   You have one of those conditions where you are still young, but are having the issues of a male that is older.  PSA also can be higher if your prostate is larger and you are older.  My prostate is 108 and my PSA is upper 8's.  I had the Truss Biopsy with 12 darts in the dark trying to find out something.  Thank goodness mine were all negetive as well.  I have BPH pretty bad, 4-8 times a night.  Can't deal with it any longer and am going to get FLA  procedure done to take care of it.  

    Mike

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  • Posted

    Hey Joe sorry for your problem.  What does your doctor say.  I would not rush into anything.  A high PSA could mean alot and it could be a false reading.  Did you have sex before you had the test or a infection.   Your Biopsy was good and the MRI was negative.  If you don't have any problem going to the bathroom  I would just keep checking the PSA.  Don't be forced into any surgery at your age.  Leave well enough alone for now  Ken

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  • Posted

    I agree with ken. If nothing's wrong, don't fix it. Reading posts on here I found so many things can effect PSA.

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  • Posted

    Hi Joel, I had a PSA spike of 13, up from 2.4 avg. I stopped at the MRI PIRAD 2 score, and did not look further. My prostate is 37cc.They put it down to a serious UTI event I had a month prior to annual blood tests. Will get another PSA done in 6 months and recheck. Due to the clear MRI, if there is some thing, must be small and just starting. 

    In your case, at 42, I would ignore and in say another 6 months, redo the PSA. If you had a serious UTI, it can take 2 years plus for your prostate to settle.

    Geoff

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  • Posted

    Try not to be concerned over a single PSA. There are many things that can effect it, the most common are BPH and prostatitis. Do a search on Dr Ablin, the researcher who first identified the antigen and his opinion on its use to diagnose prostate cancer. He is far from alone in this opinion. 
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  • Posted

    I'm going to go further than the others - forget it and move on. PSA tests are only an indicator - something they use to decide whether to do more definitive tests like MRIs and biposies. Both were negative - you don't have cancer and whatever caused your PSA to spike is inconsequential given that. If you have BPH symptoms, that's another issue (but not a life threatening one) and if not, chalk the PSA number up to a false alarm and forget about it is my advice

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  • Posted

    I think there are several things that can raise your PSA. Riding a bicycle, a digital examination, sex, or other activities may influence a PSA reading. I agree that, with no other symptoms, further testing and waiting is the best course of action.  
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  • Posted

    If I were you I wouldn't have another biopsy done until you had a 3T MRI. A high resolution MRI will show if you have a prolem or not. It may be caused by something else. PSA doesn't always indicate cancer. If you read up on it you will find that there are some that had a low PSA and still had cancer. The MRI should show if you have cancer or not. I would have one done.

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    • Posted

      I think it is like a logic tree :

      Is PSA normal ?  If yes then very unlikely to be aggressive cancer, as that would hose out PSA; could be mild, indolent, early cancer, but no further action sensibly required. 

      If PSA high, do (ideally 3T MP) MRI.  If MRI doesn’t show possible cancer, no further action required

      If MRI dodgy, proceed to biopsy.  If biopsy clear, proceed with caution, maybe re-testing PSA after a year (depends on specifics) - but nothing else. 

      Reason to do nothing if MRI clear :

      Google : “diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study” – you will see that it came out last week, is a big study, and it says “MP-MRI has significantly better sensitivity and negative predictive value for clinically important prostate cancer compared with TRUS-biopsy. Thus, MP-MRI could be used as a triage test before first biopsy to allow one quarter of men at risk to avoid biopsy. The lower specificity and positive predictive value of MP-MRI means that a biopsy is still required with a suspicious MP-MRI. Men with suspicious MP-MRI areas can have biopsies guided by these findings. Overall, this strategy could improve detection of clinically important prostate cancer and reduce the number of men diagnosed with clinically unimportant disease.” 

      In other words, if MP-MRI says you might have cancer then you do need a biopsy (even though it gives false positives, gave me 4/5 and I had no cancer even on a PSA of 16.92 from a tiny 22cc prostate at age 49).  If MP-MRI says you don’t have cancer, on the other hand, THAT is reliable enough to not need a biopsy at all.  And this is also my own uro's approach.  He said if my MP-MRI didn't show trouble, I could dodge the biopsy.  It did, so went to biopsy.  Biopsy clear, not even any PNI, just chronic inflammation in all 13 cores.  HOLEP done, chips removed tested, same : not even any PNI, just chronic inflammation in all samples.  PSA tested 2 months after HOLEP : miracle, 0.66 !  Tested again 2 months later (just as part of regular medical, not done specially) : 0.66 again.  Am ignoring PSA now, the sudden sharp extreme exacerbation of my long-standing (years) LUTS symptoms that caused me to get the PSA test, was all just due to inflammation …. presumed to be due to an infection that was confined within the prostate, and not showing in urine test.  No antibiotics given; it seems to have cured itself so by time of HOLEP operation 2 months later I was down to “normal” chronic non-bacterial prostatitis symptoms = mild LUTS = 2 to 3 times a night with slow flow. Proceeded with HOLEP as I was tired out with peeing  2 to 3 times a night and slow flow rate and preferred a surgical fix, to going onto alpha blockers and dutasteride, or maybe drifting over the next decade or so to needing to do CIC.  Also once you've had acute prostatitis, it often comes back.  

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  • Posted

    NB that is quite a large prostate for age 43.  I expect you've been told that already.  Prudently, for now, you could consider the anti-prostate cancer diet : avoid eggs.  Eat red or orange peppers, and at least one of broccoli, cauliflower, sprouts, cabbage.  Also Nuts (just a small handful is OK), especially almonds and pumpkin seeds.  Pomegranate (seeds) and avocado also may help.  Maybe slightly reduce red meat and processed meat; reduce salt.  That diet also reduces risk of stomach cancer and colon cancer, in fact most cancers (except a few like brain cancer that are independent of diet).  The egg thing relates only to prostate cancer, eggs are no risk for any other cancer.  

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