Increase in PSA over 15 months from 3.9 to 6.4

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What should I do about this? I don't like the sound of prostate biopsy - suffering from prostatitis the last thing I need is an infection from the biopsy - especially as I react badly to erythromycin

Advice please

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  • Posted

    The first thing I would recommend is asking for a 'free PSA' test. This is, from what I understand, a more definitive evaluation as to the chances of actually having cancer.

    You don't mention your age, but certainly our PSA numbers go up as we get older. I'm now 67 but about three years ago I also had a PSA number above 6.0. The urologist wanted to to a blind biopsy, but I declined. So he prescribed the free PSA test and the results showed that I did not have prostate cancer. Since then my PSA numbers have gone down. After my Rezum procedure the PSA numbers went down again. The latest result for me was around 2.4.

    Certainly if you do have cancer, it might be a good idea to deal with it. But I think that proceeding slowly, as you are doing, is OK at this point.

    Also, keep in mind that certain activities prior to testing, can cause elevated PSA levels. Bicycle riding, sex, as well as some other acivities, can cause the numbers to be higher than they are normally. Anything that causes some activity or irritation to the prostate can cause elevated PSA readings.

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    • Posted

      I'm 67 too Ken - I wasn't aware of free PSA tests before you raised the subject Ken, so thanks for that. I am having another blood test tomorrow to check the 6.4 figure - I feel a biopsy would not be the way to go. Take your point about activities - I won't be indulging in anything before the test - my prostatitis is rotten so maybe the elevated reading is caused by that

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  • Posted

    Definitely get a 3T MRI before doing a biopsy, That way, if there are suspicious areas on the scan, if you do opt for a biopsy it can be a targeted biopsy rather than a blind biopsy.

    Also, take heart. My PSA went from 3.1 to over 11 over several years. Before I knew about 3T MRIs, I has two blind biopsies (both negative). Third time I had a 3T MRI which showed a suspicious area, so had a targeted biopsy which was also negative.

    Finally, not sure about this, but doesn't prostatitis cause an increase in the PSA number?

    Rich

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    • Posted

      I think the MRI I'm having done on Friday is 1.5T - as per the hospital website; I'll ring tomorrow and check

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    • Posted

      I believe the answer to that is yes. When my PSA was elevated on last year"s medicare checkup, my GP gave me he option of biopsy or taking a round of anti-biotics to see if it brought down my level. I went ahead and did two more weeks of some a/b, not Cipro as I had done two years earlier when I had protatitis. As I recall it brought it down from 9 to 7 (its lower now). I've been doing cic for over two years now. About a year when this was checked. My doctor admitted that doing cic (which he doesn't really like but is going along with it) will raise you PSA level.

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  • Posted

    Ian, I saw in another thread that you asked about using D Mannose for your prostate infection. Did you try taking it?

    I realize that it's primarily recommended for UTI's, but evidently some feel that it also helps treat prostate infections.

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    • Posted

      I didn't because my semen tests came up negative for E Coli - one cultured - one hospital lab and one done by Microgen DX - my understanding is that D Mannose is effective for E Coli infections

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  • Posted

    Ian,

    First of all, none of us are doctors but we have been through some battles and have gleaned a lot of knowledge and experience.

    Secondly, you should be concerned over a PSA rise that quickly, but certainly not dismayed.

    You've received good advice: get an MRI. It must be a multi-parametric MRI. The 3 Tesla magnet produces better resolution. By your name, I gather you're in the UK? My guess is that a higher percentage of imaging centers in the U.S. have 3T machines vs. the UK. Even so, a 1.5 T machine will still give you and your doctor important information.

    As others have said, your prostatitis could be the cause of your PSA rise. PSA is not specific to cancer cells but to prostate cells. Inflammation of the prostate could raise PSA.

    Request that they check your free PSA. If your % free PSA is 25% or higher, you have about an 8% chance of cancer at biopsy if you are under age 60. I think the number jumps to an 11% risk if you're age 61-70.

    I don't know if the UK does the phi test or not, but you should ask for that. phi = Prostate Health Index. It was developed by cancer researcher William Catalona at Northwestern Hospital in Chicago, Illinois, U.S.

    phi measures % free PSA and 2[pro]-PSA. These, combined with a negative MRI, give better ability to rule out cancer than total PSA alone or % free PSA alone (although % free PSA is better than only total PSA).

    Also, the MRI will measure your prostate volume. You should know your PSA density (PSAD). Simply divide your PSA (total value) by your prostate size (in cc) to arrive at a ratio. For example, a man with a PSA of 5 and a prostate of 50 cc, will have a PSAD of 5 divided by 50, or 0.10.

    If your PSAD is < 0.15, your chance of having cancer drops. Preferably, it should be < 0.10.

    If you have the MRI, you'll be assigned a PIRADS score if any lesions are seen. If your PIRADS is 1 or 2, that is essentially a negative MRI and you can probably watch your PSA and not rush to biopsy. If your PIRADS is 4 or 5, you must do a biopsy. It could save your life. A PIRADS score of 3 is a tougher decision.

    Before your next PSA test, avoid a DRE for at least one week, avoid ejaculation for at least 4 days, avoid bike rides for at least 4 days.

    There are other things you can do, such as the PCA3 test, which is a urine test.

    I'd imagine some of these blood or urine tests can get pricey. But they do give you/your doctor more information for decision-making.

    Don't be filled with anxiety. PSA can rise for other reasons.

    But, for the present, do not subject yourself to a random ultrasound-guided 12-core biopsy that just blindly probes the prostate. If the MRI shows a suspect lesion, they can overlay the MRI imaging onto the ultrasound and target the lesion.

    God bless you going forward, Ian.

    Michael

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    • Posted

      Thanks for your good wishes Michael

      . Even so, a 1.5 T machine will still give you and your doctor important information."

      I think that's what it is

      "Inflammation of the prostate could raise PSA."

      My inflammation is chronic and awful - this would make sense

      I'm having another PSA test tomorrow - blood taken by a nurse - NHS GP practice

      I've got an NHS urology consulation week next Friday - I'll raise the topics you've outlined then - free PSA; PHI test; PSAD - thank you..

      I haven't ejaculated for some time - so PSA blood test tomorrow will be unaffected - I won't be blundering into any biopsies - thanks again Michael

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  • Posted

    You should have a doctor write you an order for a 3T MRI from an imaging location neare where you live and then you should send it to an Interventional Radiologist who is specialized in Prostate cancer. It is fast, painless, and is very conclusive as to weather or not you need a targeted biopsy.

    Miss diagnosis is the worse fault of the urological industry and needs to be addressed. I know that some talk is going on about a group starting a 501c3 foundation to work strictly on lobbing the American College of Radiology Association about a protocol for diagnostic procedures and teachings. If this is successful, it is the begining of the end of the hold and abuse of urology in regard to men and the deaths caused by horrible diagnosis failures.

    This is analogous to the treatment women received in the sixties and seventies with regard to the hysterectomies that were handed out like pills by the OBGYN and surgical side of medicine. It happened, it was a sad thing, but it is just not acknowledged anymore. Now it is the mens turn in the barrel.

    If you are in the states, I can personal message to you the two best and most specialized IR doctors that will review your MRI and advise you on weather or not you have PCa and give you their opinion on the options you have. One of them does not even charge you any money to review you MRI and tell you what the film shows. Both have this on the web with an upload protocol available. It's a lot better than 12 non-focused blindly inserted needles. That is sure to raise your PSA a lot more.

    If you have interest, let me know and I will personal message to you there names.

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    • Posted

      Many thanks ji

      Looks like the MRI I'm on Friday will be 1.5T - private hospital - I'll check tomorrow

      Thanks for your kind offer

      I'm in the UK and I certainly haven't been awestruck by the quality of the 4 urological consultations I've had so far - far from it - seems like a combination of wading through treacle and a minefield

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    • Posted

      I don't wish to politicize this thread - or get censored - but it does seem healthcare in the States surpasses that in the UK.

      The 1.5T MRI will be helpful in determining if you need a biopsy.

      I'm facing a similar situation right now, to go for a repeat biopsy or not.

      I hope you will not need one, Ian.

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    • Posted

      I did not read through every post here so forgive me if it has already been covered. This is just my opinion based on my personal experience. First, insist on a three tea MRI before agreeing to a biopsy. then of there are "areas of concern" (and you agree to do a biopsy) insist on a fusion biopsy where they use the images of the MRI with the images of the rectal scanner to target the areas of concern. (This is called a "targeted" biopsy. Not a blind biopsy which can be hit and miss and may give you a false sense of security).

      If the T3 MRI shows areas of concern, I would strongly recommend doing the targeted biopsy. Don't stick your head in the sand. If there is cancer you do want to find out as your options are more and better the sooner you know. If the MRI does not show areas of concern. If it was me, I would wait 3 months and see what the next PSA test shows.

      Hope that helps.

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    • Posted

      Eastern Europeans I've met in the UK think healthcare here is rotten and their own systems back in their own countries are much superior - I am sure they're right. I wish I could find some way to get the inflammation right down - probably that which is elevating PSA - cancer has to be a possibility though

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    • Posted

      Thanks for your advice - next stop is the MRI I've arranged on Friday - think it's 1.5 T, see what comes of that

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