How large is a prostate with 3.0 PSA ?

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Last check, my PSA was 3.0. I am just curious, how large can my prostate be. I know the PSA does not correlate well with its size but perhaps statistically it should be within a reasonable limit. I would appreciate any data on your PSA vs size.

I have mild urinary retention from BPH, currently self catherize (CIC) 3-4 times a day. Not having enough problems to ask uro to check for size. Also scared and not wanting to see uro because all uro wanted to do was TURP.

Hank

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  • Posted

    DO NOT SUCCUMB TO FEAR!  THe Uro-doc CANNOT tell you to have a TURP, he can only recommend!  If you want to know size, find out.  

    As for PSA vs. prostate size, this National Inst. of Health study from 2010 says:  

    RESULTS

    Median preoperative PSA was 4.9 ng/ml (SD ± 4.6), mean prostate size was 51.7 grams, and mean tumor volume was 5.6 cc. PSA had a significant correlation with prostate size only at a prostate weight =54.6 gm (p=0.01). Regardless of prostate size, PSA had a more robust significant correlation with tumor volume than with prostate size (all p<0.0001).

    CONCLUSIONS

    PSA was significantly correlated with prostate size only in the largest prostate glands, but was significantly associated with tumor volume in small, medium, or large prostates. Thus, PSA continues to be a better marker for tumor volume than for prostate size.

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  • Posted

    Hank.  2 years ago my PSA was 4.0 and my urologist said that it was fine.  Last year my PSA was 0.7.  What ever procedure you have you are the one to pick it  Ken
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    • Posted

      Ken. How did you lower your PSA ? With an operation ? Do you remember its size at PSA 4.0 ? Hank

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  • Posted

    My prostate was big. PSA was low.
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    • Posted

      PSA I don't remember. He told me the range and I was at the very bottom. Size I never asked. But was told by uro and his assistant, who I saw once, that it was huge. Esp for a guy my age. Labs came back twice no cancer.

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    • Posted

      The prostate size can be anything and it may not cause.  2014 my prostate was the size of a lemon.  That is when I had my Uro-lift.  My prostate was closed together and I had to force myself. After the urolift had another PSA it was 4.0 And last year my prostate got smaller and it PSA was 0.7.  Don't rush into anything because it will change  Ken 

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    • Posted

      I did not do much.  I took cisprofloxacin 1000 mg for a month for a prostate infection and I all way take a vitiman D.  My urologist thinks it was the cispro but he said he can't be sure When he went in to check my stricture one of the implants got loose and had to have it repaired he had to tighten the other three.  I'm glad it gor smaller  I wish I know why so I could help others.  I also drink alot of cranberry juice but cant driink it know I am on 2 blood thinners    Ken

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    • Posted

      That is what my doctor said.  December of 2015 I had the prostate infection and took Cispro 1000mg for a month.  In february of 2016 he did a scope to check the stricture that is were he found out that the one was off on one side.  He tryed to hook it back on but it was to painfull.  4 weeks later I went in for the repair.  He put a new one in and tighten the other 3.  I go in march for a bunch of test and blood work  Ken  .
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  • Posted

    Hello Hank,

    PSA is a protein excreted by the epithelial cells that line the pores of the prostate gland. So for a healthy prostate the rule of thumb is that the serum measure of PSA (in the blood) is about 0.12 (ng/ml) / gm of prostate. So if your blood PSA is 3.0 (ng/ml) then that would mean your prostate size is about 25 gm which is very good and should not cause you retention problems.

    But since you are having retention problems it might be worth getting an ultrasound to see if you have any bladder neck obstructions from bladder stones, or urethral strictures or a large median lobe growing into your bladder neck. A cystoscopy would also be worthwhile. I don't see how your uro can be recommending at this point. Maybe try a different one if feasible?

    Regarding PSA and prostate size, my prostate was 280gm but my PSA was only 12. By the above formula my PSA should have been over 30. What is more important than the PSA value is the PSA density which divides the PSA by the measures prostate size. This is another reason to get an ultrasound - so the uro can measure your prostate size.

    If you are needing to CIC (which I do as well), you should find out the cause of your retention long before considering any surgery (I refuse surgery though I had a failed PAE last summer).

    Bottom line: if your uro scares you then find another uro!!

    Take care.

    Neil

     

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    • Posted

      Thanks Neil,

      My retention problem was most likely caused by both BPH and long time high liquid consumption + trying to hold it in. Right now I am doing CIC and waiting for the right procedure to come along. I like to know my size to see what procedure I qualify.

      Hank

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    • Posted

      Hi Neil, I had a kidney + prostate ultrasound but uro did not tell me the size and I was too dumb to ask. Also, uro suggested TURP so it can not be that large, can't it ?

      Hank

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    • Posted

      Hi Hank - First you are to be congratulated for doing CIC as that is really beneficial for your bladder with no side effects and as you say it buys you time to figure out the best course of action.

      Having said that you need to determine the cause of your retention problems. Is it a large prostate clamping down on your urethra or some bladder neck obstruction like a large median lobe or bladder stones or a number of other things. So you need to have a discussion with your uro and ask for ultrasounds at a minimum to determine you prostate size and possible obstructions.

      It is also possible that your LUTS problems has nothing to do with your prostate. It seems your prostate is a normal size for your age and your PSA of 3.0 can be elevated due to many other things like recent sex or CIC or prostatitis. It is the trend of the PSA value over time that is important and not just one or two elevated values.

      But your LUTS symptoms can also be due to your bladder wall muscle not contracting fully. This can be due to that muscle not getting enough blood due to diabetes or athersclerosis/hypertension and other causes which have nothing to do with the prostate. So if you have any of those conditions you should look at that too. Urodynamics testing can shed some light on the health of your bladder muscle (the detrusor muscle).

      So you need to sit down with your uro as well as your primary care doctor and figure out an investigative approach to find the cause of your retention. It is way too early to try something like Turp or any other procedure. You are very smart to be doing CICas it gives you all the time in the world to figure out what is happening.

      Good luck.

      Neil

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    • Posted

      Hi Hank

      I forgot to ask you if you keep track of how much you pee each time naturally (NV-natural void) and how much you take out with the catheter (CV- catheter void). It is improtant to keep track of those numbers.

      Neil

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    • Posted

      Hi Neil, Thanks for your elaborate analysis and advises. I will take them to my GP at next visit. I have PSA of around 3.0 since 2010. I am currently taking 4mg doxazosin and it seems to help with my natural void (NV) a little bit. I do keep logs of my natural void and cath void (CV). My NV depends on how much I hold it in, can be from a few squirts up to 300ml. My daytime post natural void volume (PNVV) is around 150-250ml. Night time PNVV is higher depending how much and how late and what I eat and drink during the day and how much I oversleep before the CIC, can get up to 400ml. Night time is the time my kidney is at risk because total void (NV + PNVV) can get higher than 600ml at times. I do not set alarm to get up at night. Now if I happen to wake up and look at the clock and see that it is past 2AM, urge or no urge, I will get up and do CIC. Before I used to try to hold it in and went back to sleep, sometimes with a bloated bladder, lol. Daytime I try to natural void often, at least every 2 hours, urge or no urge, so the total is hardly ever over 400ml.

      Hank

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    • Posted

      Hi Hank,

      Your situation/schedule sounds similar to mine.  Do you have an enlarged median lobe?

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    • Posted

      I don't know much about my prostate. Perhaps I should try to find out. However, without any serious problems, I am afraid insurance may not cover it. Uro did not suggest anything other than TURP, lol. smile

      Hank

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    • Posted

      My PSA was normal in 2013.  Haven't had it checked since then as I've been told the readings may be artificially skewed while going through this.

      Leading up to my PAE in Sept '15 (which only helped about 5% - probably due to enlarged median lobe).  It was estimated/calculated atabout 40-50, 55 and 57 (the latter 2 readings were from MRI & CTSCAN).

      I had developed a case of hives in 2014 and was prescribed 3 OTC antihistamines which sent me in to acute urinary retention.  I had to go to the ER, was catheterized and peed about 1500cc's.  I tried to get off the catheter 3 times in the next month but each time I ended up back in the ER or uro's office to get catheterized.  They put me on an indwelling catheter for 2 /1/2 months until I said "Uncle" and learned how to CIC.  Self-cathing is so much better that I would always recommend learning it immediately when faced w/ the choice of that or indwelling Foley.  I have still not come back from this.

      I had a very small initial imrpovement after the PAE but over the past 6 months my natural v cath ratios are horrible (about 1/50, whereas for the preceding 2 years they had been about 1/1) and I'm having to catheterize about 4-5 times daily. 

      Like you, I'm taking the watch and wait approach re another procedure and am reluctantly content to contine CIC'ing.  I still think the PAE is a viable option if they can figure out how to help those w/ enlarged median lobes.

      I'm taking Rapaflo 8mg and have been on some type of med since 2014.  I wanted to take Alfuzosin because of better side effect profile but I had a reaction.

      Best of luck!

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    • Posted

      Hank  Look into other procedures before you do anything.  There are many less invasive things out there.  Don't like the insurance company push you into any treatment  Take care  Ken 

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    • Posted

      Thanks. Did you know that PAE has a problem with enlarged median lobes before your operation ?

      Hank

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    • Posted

      Hi Hank - I don't think you should worry at this point about the size of your prostate until you know the cause of your retention. I had an almost 300gm prostate yet I could still natural void ok with some retention. Other men cannot void at all with prostates ten times smaller. The prostate has many sections to it so in my case I had very long lateral lobes but with no median lobe protruding into the bladder neck. This prostate structure was discovered after I insisted on a trans urethral ultrasound and a trans  peirtoneal ultrasound to look at my bladder and kidneys. Both ultrasounds took only 5 minutes each and were done at the same time. My uro just wanted to do Turp on me for many years so after that I fired him (or he fired me?) and I got a better uro. Then I had a cystoscopy to confirm all this up close and personal which also was easy and took just a minute.

      What I am saying is that with a stable PSA of 3 for many years and an inferred small prostate it should be fairly easy to determine the cause of your retention. Then a targeted treatment can be designed for you of which there are a great many non-invasive or minimally-invasive procedures and/or drugs that should help you. Neil

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    • Posted

      You are welcomed. If you take 2 Tylenol before bed or in the middle of the night after CIC there is nothing to worry about at all. It is only a problem if you take more than 8 a day every day. I don't take it for pain at all - just to relax. I also tried magnesium with melatonin but did not see much of a difference. take care. Neil

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    • Posted

      Hi Neil, I could use the Tylenol because I have mild shoulder pain (probably from impingement that is going away slowly) that may keep me from falling back to sleep after CIC. I used to take ibuprofen once a while. It seemed to help the pain, probably by reducing the inflammation. I stopped taking it after finding out that I had urinary retention and mild kidney function decline. Hank
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    • Posted

      My excellent and very honest Dr. (Isaacson at UNC) told me that the the PAE had about an 80% chance of helping but that w/ an enlarged median lobe that chance went down to 60%.  Then, when they mapped the arterise just before the procedure he told me it was down to 50% due to a lot of plaque.  I had maybe a 5% improvement (mostly w/ fewer nightime trips) for about 8 months but now my ratio is worse than before.
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    • Posted

      As long as we can still CIC, I see no point of rushing into any operations. Right now, I am only interested in iTind. Take care. Hank

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    • Posted

      Hi Hank and Arlington - I also had a PAE at UNC back in August. I was told before and after the procedure I was an excellent candidate beause I had a very large prostate with well developed arteries and no median lobe or other obstruction. The procedure was a huge success according  Dr. I. But I have seen no improvement in my IPSS scores/symptoms (high 20s). I had Dr. I order a 3T-MRI for me the end of October to see why it failed but he still has not interpreted the images for me. I had to go to another IR who is really great (Dr. Karamanian in Houston).

      Anyway now that I can do CIC I am with you Hank and will not try any other procedures until something really benign comes along.

      I did not find that ibuprofen helped me much but steroids like prednisone cleared up all my BPH symptoms but unfortunately that is a dangerous drug.

      Take care

      Neil

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