PSA Velocity over 4 months since UTI
Posted , 10 users are following.
I am 67, and been having PSA tests for the last 12 years. I have no symptoms what so ever with water works, other than a slow stream from birth defect with a uretra stricture. My PSA has always been averaging 2.4.
This year, before my annual blood test due, I got a bad UTI, shakes, shivers, temp 103, pain passing urine, vomiting, dull ache behind pubic bone...overal, not too pleasant. Went on antibiotics for two weeks, and most symptoms went, other than the dull ache behine pubic bone some times.. When all appeared to settle down, had my annual blood test. Ummm, PSA now 7.4. Antibiotics for another 2 weeks, retested 1 month later. PSA was 8.2. Doctor thought such a quick rising PSA was usually Prostatitus, so wait a few months and retest. New PSA last week(some 4 months after first high reading) was now 12.
So, some thing not too right. I arranged for a T3 mpMRI last night and see my general doctor next week. Can't get to a Urologist for 2 months, so I had a look my self at the hundreds of MRI pics after the scan, but no idea what is good or bad, so will have to wait unti I can see my general doctor. He said he can't read the pics either, but the radioligist is the bees knees at reading them, so, have to rely on his notes with the doctors set of pics. When I eventually see the Urologist in October, hopefully, we can sort out what is wrong.
Geoff
0 likes, 115 replies
geoff90305
Posted
Just left the uro's office and he agreed that the PSA "incident" appears to have been a UTI issue and have a revisit in 6 months time with a new PSA. The hope is it continues to fall back into the 2 something vicinity and carry on.
He also said I was a refreshing change that day, as all day before I saw him, he had bad news for many patients. He said, more men need to think....if in any doubt, get it out fast as you can. Surgeons view I guess. Sure life may not be the same again, but you will survive quite well.
skip79435 geoff90305
Posted
My thanks and hat off to you, Geoff, and all others on this forum, for insights and help offered to males having that suprise "high" PSA level. My story ended with a benign 3T MRI result but like many males on the PSA road, I went through a short time of unnecessary worry. Here's my take on the PSA controversy as it's been labeled. I'll avoid citing refereed medical studies--they're dull but my thoughts come from the literature.
However, I will cite the late Dr. Thomas Stamey of Stanford for good reason. The PSA, with backing from Hybritech, was originally a prostate tissue marker, in the seminal NEJM article 1987 by Stamey et al to follow prostate treatment response. It was not developed as a cancer marker, and only later became one as forced through the FDA as a "cancer screen" in the 1990's. The value cited of PSA 4.0 or lower as "normal was chosen "arbitrarily" as referenced in FDA transcripts.
More recent "contemporary" biopsy and PSA studies have shown the incidence of PC in PSA 2-4 similar to higher levels. Most prostate cancers are Gleason 6 or lower, ( indolent), and on autopsy ( as noted in these forums) about 80% of eighty year olds will have clinically, non-significant, asymptomatic prostate ca.
Stamey, the author of "the NEJM paper" that started PSA testing unintentionally to explode in 1987, has done an about face-- to paraphrase -- the mass PSA testing era is over.
In effect, as he stated, prostate cancer is ubiquitous in males of a certain age, and urologists for any reasonable excuse, and enough biopsies, will find prostate ca. A high PSA level was that good reason to biopsy. Stamey later in his career stated far too many prostates had been removed unnecessarily. For values less than 10ug or probably less than 20ug, he and his team were convinced (carefully examining whole radical prostate sections) most often resulted from benign hyperplasia in the TZ. ( His dept. study in 2004)
He was not stating that aggressive prostate ca ( Gleason 7 or more) would not result in high PSA levels or that PSA be ignored And certainly, high levels of some number, be it 20 or 50, indicates serious prostate issues. What's needed he believed is a specific and sensitive tumor marker, without high false postives and false negatives. Perhaps the 3 T MRI MP approaches this while we wait. As for PSA velocity, the Sloan Kettering epidemiology group has effectively cast cold water on this. Stamey has said he knew experts who no longer get their own PSA but, of course this is an individual decision for each patient, and the patient must weigh the harm to benefit ratio. He would not fault a patient who insists on getting yearly PSA, ---the trouble and cascade start when it elevates. The PSA is an incredibly useful assay, the trouble is how it's used.
Clearly, we need something better and I hope it will happen soon.
thanks again and for letting me ramble on my thoughts.
all the best,
skip
geoff90305 skip79435
Posted
Hi Skip,
While all my 'dramas' have been playing out, my general practitioner of 30 years+ said his own PSA was far worse than mine and asked me what I thought about Testosterone, as he takes it as a regular health additive.
I replied I thought he should stop, as a lot of studies indicate the prostate PCs issue can worsen by feeding it testosterone. I also said he should invoke 'mates rates' for a mp MRI asap to see what is going on. While my PSA had risen very sharply, his had been increasing over the last year with no obvious reason like my UTI etc. He is sort of in denial, and is of the view if you have prostate cancer, well, that is it....
YET, when we first discussed my elevated PSA, he was full of platitudes how, even if I have PCa, there are lots of options. However, now HE may have the issue, he is not so confident...don't talk about it and it might clear up...it may indeed, if nothing serious, however....
My view on PSA testing, is every male should get a PSA test at 40, 45,50,55 yearly then on. If any of the earlier tests show an increased PSA, then start yearly or six monthly until resolved. An early history graph is so helpful to determine the increase in PSA over time to see if your prostate is not happy for whatever reason.
Sometimes, men are their own worst enemy by ignoring the PSA issue or even worse, not learning about a cancer that most guys will get some time during their life and how to interpret the signals as what action is called for.
Geoff