PSA reading 5.57; At 70+ should I worry?

Hi Rich, as I said I am afraid I don't know the size of my prostate but will find out as a priority task. Previous PSA readings from memory are: ten years ago - 3.1; eight years ago - 4.31; two years ago - 4.88; today - 5.57.

I am afraid I don't know what prostatitis or DRE are, but will look them up (it will be a long weekend if research!). As regards the other items you mention, the answer is no.

So sorry to read about all the biopsies you've had. At least you now know that the elevated readings were the result of the enlarged prostate. I will drink to my prostate density registering 5.5+ cc!

Best, Jeremy

Your PSA progression sounds very similar to mine. See the list below.

Prostatitis is an infection of the prostate that is usaully treated with antibiotics.

DRE is a digital rectal exam when the doc puts his or her finger up your butt to touch the prostate to see if there is a lump or hardness, which would indicate PCa.

As for me, just very grateful that I didn't have any long lasting problems from the mutiple biopsies, and of course that I don't have PCa.

PSA tests

Date          PSA

03.18.03    3.1   

06.15.04    3.0   

06.30.05    3.1   

06.22.06    4.4   

08.06.06    2.88 

10.28.06    3.80 

12.??.06    prostate biposy negative

07.24.07    4.8  

12.27.07    5.0  

05.01.08    5.3  

07.19.08    prostate biposy negative

12.19.08    5.2  

01.07.10    4.6  

01.24.11    5.4    

05.02.12    5.9  

05.06.13    6.3  

05.23.14    7.3  

04.15.15    9.4   

06.16.15    8.7 

08.08.15    targeted biopsy negative    

10.20.15    9.5  

06.16.16    6.7   after taking Finesteride for 6 months

08.24.16    8.9   after stopping Finesteride for about 2 months

 

Thanks for the explanation Rich - will go straight into my doc! Yes our progressions are quite similar - the major difference being I didn't have biopsies. Jeremy

Hi Rich

do you know the size of your prostate?

thanks

Jeremy

MRI reported 98 cc.

Ah, 98 cc..... if you normalise down to a 30 cc prostate (average for a 50 year old man), it is then only 9.7 * 30/98 = 2.96. 

I have read of people having up to 50 and it turning out to be prostatitis, or inflamed prostate tissue (no cancer and no PIN).  Historically, far less has been spent of public monies (from government) and private monies on researching prostate cancer than the amount spent researching breast cancer, even tho' death rates are comparable (I think men in many ways get second rate treatment in society...), and I do wonder whether that is why PCa diagnostics (and, closely linked, the ability to accurately diagnose prostatitis and know its cause/cure) are all so rough and ready

As to size : NB my prostate size was estimated via cheap renal ultrasound at 22cc (22grammes).  The way more expensive multi-parametric 3-tesla gadolinium-enhanced-shading MRI at the Nuada Clinic off Harley Street also said 22 cc.  So it may help to know that you can get the size, without needing an hour's worth of slightly claustrophobic MRI, whether fancy-pants MRI or basic.  A cheap (or free on NHS) 3 minute "renal ultrasound" with prosate included, will estimate size accurately.  My MRI radiologist reported dodgy area (suspected clinically significant tumour) in anterior of prostate = front = DRE can't feel that bit at all.  Targetted biopsy : negative, all 13 cores just showed inflammation, no PNI and no cancer. 

NNB at my first consultation with him, my uro' from DRE estimated my prostate size at 40 cc (40 g).  I reminded him of this, when we found it to be 22cc later on; he said that DRE is a way dodgy way to guess the size, as all he can feel is the back of it and part of the side. 

Hi Paul

What's 9.7 in your formula? And do you know what's the average prostate size for a 70.25 year old? (Trying to apply the formula in your post to my own situation).

Thanks

Jeremy

9.7 was for when my prostate was, pre-HOLEP, 22cc, normalising to 30 cc would give (9.7*30/22) = 13.22.  Normalising my first reading of 16.92 to 30 cc would give 23.07.  

I believe that normalisation is considered to make more sense for inflamed prostate tissue as an explanator of high non-cancerous-origin PSA, as then, the more prostate tissue you have, assuming all is inflamed, the higher the PSA.  If the explanatory factor is a cancerous tumour(s), in or outwith the prostate, with no uplift from inflammation (you could have both), then size doesn't matter, other than that if the rest of the prostate isn't notably inflamed, you get a small uplift of PSA coming out from healthy prostate tissue regardless.  So if a 30 cc healthy prostate gives say 0.6 healthy baseline, then double the same prostate and you presumably would get 1.2 healthy baseline.  If just inflamed, again double the size, I figure you might get double the worryingly-high PSA from the inflammation.  If you've got a given size tumour and its adding PSA 9 to your baseline of 0.6, making 9.6 doesn't make a lot of difference what size the prostate is, does it, because most of the PSA comes from a bad source.  Double the prostate size, keeping tumour same size, and now you have 10.2 (an extra 0.6; assuming healthy prostate was giving you 0.6 in this case - just an example, it might give more).  Also, if no cancer, the healthy prostate tissue itself puts out (web says) more PSA per unit volume as you grow older, irrespective of size effects ... "PSA concentration in men with a prostate volume ~25 cc also showed a continuous increase with aging, starting at 0.8 in the youngest and ending at 1.9 ng/ml in the oldest age group".  So you have two very slow uplifts to PSA going on as the years roll by in healthy men, and another big one if your prostate has inflamed tissue like chronic prostatitis.  But a tumour, will presumably boost PSA in relation to its OWN size as a tumour, not the size of the healthy prostate. 

I am not a urologist and all I write, might be nonsense !

Google "Characteristic pattern of human prostatic growth with age*Shu-Jie XIA", look for table 1 and table 2, has volume by age.  Note : relative density is 1, so 1 g = 1 ml. 

Thanks for all the info, Paul. Very useful! I will google as suggested. Jeremy

Hope you are ok now Vibes.

Hi Vibes,

For how long you have catheter? Are you happy with flomax? I went in to Emergency where they put a catheter and the doctor prescribed FLOMAX but my Uro said, FLOMAX is no good with Catheter in, and advised surgery.

 Did you have the same experience?

 

PSA is indicative of Prostate Cancer, not the size of Prostate. I have enlarged prostate blocking urine but PSA level is normal.

Here's my story of my folly and my doc's calousness. Aug 31- I had "bloody" TURP, released on catheter on 6th Sep. Could not remove catheter because blood was there till 20th. Removed on 21st. Apparently ok for a few days then on 26th. very high fever and a sinking feeling. Was rushed to the hospital. My catheter-induced UTI was so severe it had affected kidneys "acute"ly. And I got resistant to ALL antibiotics except one. So that made treatment difficult. But it stopped just short of my kidneys getting dialysed. 

After 7 days of several high-power antibiotic injections I got discharged but am still on meds.

1) it's a crime for docs prescribing catheters for very long without changing frequently; and friends beware the catheter;

2) if prolonged catheterisation is unavoidable urine must be checked for routien and culture as soon as removal and broad spectrum antibiotics should probably be started as prevention (but I'm not a doc).

NKtoronto PSA is NOT, I repeat NOT indicative of PCa, it is Prostate specific  not Cancer specific, just because YOU have an enlarged prostate and a low PSA level does not a scientific study make. May I suggest you read a bit more on the subject before you come onto a Prostate forum with scare stories.....People here are looking for facts.....your experience is only specific to you

In fact I would go so far as to say you are an exception to the rule Nktoronto!

There are many studies and much information out there on the limitations of the PSA test.

Literally speaking "PSA is indicative of Prostate Cancer" is correct, but most people would read that as "a raised PSA means you have Prostate Cancer", which is incorrect - use your words with care !  You could have written "a raised PSA is indicative of THE POSSIBILITY OF Prostate Cancer, but is often also caused by inflamed, non-cancerous, prostate tissue", and that would have been better.  Your own data is neither here nor there; I had PSA 16.92 and not cancer, so I could say "PSA up to 16.92 means you don't have cancer", which would be incorrect.

While it is true in your case, I don't think that is correct overall. From the Cleveland Clinic website:

Factors other than prostate cancer can cause the PSA level to be higher. These include an enlarged prostate and prostate inflammation (prostatitis)

Many other sources (websites, urologists, etc) confirm this.

 

Thanks Jeremy, 

I'm ok as can be while on FloMax.

Hope some great solution comes down the pike for us all.

 

I had catheter in for about a week.  No, My URO said to keep it in for several days in order for the FloMax to take effect. Also several days worth of anti biotics at that time.  What did your doctor prescribe to allow you to drain your bladder after removal of the catheter?  

I agree that PSA reading may be indicative of PCa, not BPH.  But, during my annual checkup, my GP referred me to URO due to higher than normal PSA. I was not complaining of weak flow or anything really to GP.  When asked, I just commented that can't always COMPLETELY drain bladder on first attempt.  Never, up to that time, suspected infection.   That all started right after my first URO visit.  I think the cystoscope triggered it but uro doubted it.   Probably would have gotten to that point sooner or later anyway.