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Very high PSA

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jj1003
jj1003

My fiance, almost 70, has had excellent health his entire life...never hospitalized, no sutgery..just never ill. He has been athletic and is still strong and energetic. He has had restricted urine flow for past year, but no pain. His gp ordered Psa and when it was still 137, referred him to urologist and diagnosed him with BPH. Physician assistant did DRE and noted one spot and set him up for biopsy. He and I researched thoroughly and there is so much conflicting information on internet. He decided to cancel biopsy and scheduled his appointment with more experienced dr in group. Before that appointment he had another PSA and it dropped to 107. He had changed his diet in that interim.When we went to Dr appt we were prepared with so many questions. We just got even more confused and distraught. Dr did another DRE and found prostate only somewhat enlarged and found one or two unusual spots. He admitted he had never seen such a high PSA. Of course the dr wants to do a biopsy, which is scheduled for later this month. He told us that he likely had stage 3 or 4 cancer and purpose of biopsy was to determine what kind of cancer. He admitted he would certainly recommend removing prostate and then radiation and/or chemotherapy. We begged him to order the tests like ultrasound and or bone scan and blood tests to determine if cancer had metasticized without undergoing the risks of biopsy, especially at his age. He refused.

Can anyone give us ideas as to what might cause the high PSA other than cancer. These are our concerns. It appears that just about every 70 year old has cancer cells in prostate as the prostate seems to be vulnerable to chronic health issues, maybe due to proximity to colon (he has been extremely constipated for same year as restricted urine). Other than urine flow issues he is very healthy. We have heard that cadmium is directly related to prostate issues but dr is not interested in etiology of issues. Also, he has had clow Testosterone for two decades, together with extreme loss of hair on legs, and chronic ED, and sometimes blood in ejaculate. We have learned that low Testosterone leads to prostate issues but Drs don't seem to pay any attention to it...but to us, the signs and symptoms are possibly related to some problem that is causing the unusual PSA. We just don't want to fall headlong into a prostate cancer treatment if the real cause is something like a glandular or brain driven hormonal slump that drives up PSA.

Does anyone have experience with these outrageous psa numbers, How can we get dr to order tests to determine spread of any prostate cancer without risks of invasive surgery.

1 like, 37 replies

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  • mike04186
    mike04186 jj1003

    Posted

    I'm a young 69 year old and had a TURP last Friday, and I'm on the mend and doing very well. You are going to get a head full of opinions on the Internet and most of it is BS. Get to a specialist that you can have faith in and trust and have a biopsy done. Once the tests are back then you can go from there. PSA numbers can be off as well and are not exactly fool proof. There is certainly nothing wrong in getting a second opinion, and it sounds like in your case, it would put you more at ease.

    If the prostate has to be removed, so be it. It could very well save his life, it doesn't take a rocket scientist to figure out what to do next.

    I wish you both well and I hope that things will work out. Keep us posted.

    Mike

    There is alot of men on here who can be helpful, they have been thru the gamit of prostate isssues and surgeries, they are worth listening to.

     

    • jj1003
      jj1003 mike04186

      Posted

      It's very hard to know which data to believe. Every body has a dog in the fight. The only ones that have nothing to gain are those that have experience health issues and everyone has different health problems. Some have cancer at o.oo8 psa. It took us forever to figure out that psa is a misnomer and both men and women produce it. It is really just an enzyme that is apparently more associated with prostate but should not been in blood. This might explain bizarrely high psa and occasional blood in semen. There must be some non invasive test that could measure vascular health of soft tissue like prostate without putting patients at risk of infections etc. We are very concerned about the risk of infection since infections increase future risk of prostate cancer.
    • mike04186
      mike04186 jj1003

      Posted

      Hello

      Yes your right and its a damn shame that one can't get to the truth about PSA's, I've heard both sides of the equation. I know that I am now slated for one in March. I cannot recall my last PSA # because it was so long ago. I do know that after 59 days of having a Foley in me it was time to do something about it.

      Has a biopsy been discussed? Surely that would provide definitive information about what is going on? I have to agree with you in regards to so much conflicting data being online, and the more I read, the more confused I became, and I just had to settle with my gut instinct and advice from three surgeons. I was not about to start arguing with them about procedures, because all 3 of them came up with the same conclusion. I will get the pathology report back in a few weeks from my surgery, until then all I can do is follow post-op instructions and focus on getting well again. I have 2 days left of antibiotics and I had started them 2 days prior to surgery to keep infection away, that was his main concern at the time. I was at risk of having aggressive sepsis.

      If I find anything that may be of assistance I will reply again, until then, stay positive and know that others out here, care.

      Mike

       

  • roger100c
    roger100c jj1003

    Posted

    I watched my PSA creep up from 5, over 15 years ago to over 23.5 in June of this year, just after I had had an attack of Urinary Retention. I kept a graph with all my PSA test readings on it over the 10 years, and what my doctor was more interested in, was the rate of climb, rather than any absolute vale (if the difference between two readings shows an increase greater than 25% then you can get fast-tracked to see a specialist in the UK). Two weeks after my highest reading the PSA score was down to 16.5! This coincided with my urinary symptoms settling down a bit. I had had three biopsies over that period, all negative and the only thing the urologist seemed to want to do was to wait for two years to give me another. Whilst all this was going on my ability to urniate was getting worse and worse. I was desperate to go to the lu but when there, unable to pass any urine!

    I ended up by going for a HoLEP operation in July and now all the syptoms have dissappeared and can urinate freely, when I want.

    As others have said, you need to get advice from someone you can trust (perhaps via a friend who has travelled along the same route as you). If there are irregularities in the DRE then maybe the biopsy is the next step - better safe than sorry.

    This forum can also be useful to compare experiences of different treatments and can give a measure of solidarity, with others going through similar experiences to your fiance.

     

  • pete25515
    pete25515 jj1003

    Posted

    Hi- sounds like you're going through a turbulent time.

    It is unusual to have a Psa that high without significant cancer being the cause. Having said that it does happen and the fact that the PSA is falling is a good sign.

    An MRI scan if available may be a good move - if there is cancer it is fairly accurate at assessing whether it has spread outside of the prostate. It may also demonstrate the presence of significant tumour within the prostate that would be worth biopsy.

    Be sure to clear any urine infection before any further Psa tests as this can increase the psa to high levels of this order.

    I hope all works out.

    • jj1003
      jj1003 pete25515

      Posted

      Could an ultrasound tell us the same information. I think they are safer. We don't want to encourage any irregular cells to grow.

    • mike04186
      mike04186 jj1003

      Posted

      I would thnk that an ultrasound will only tell you the size of the organ in question. A biopsy will tell you the rest, i would also recommend an MRI and ultrasound and then a biopsy. Once those are done you should have a much clearer picture of what is going on.

      Best

       

    • pete25515
      pete25515 jj1003

      Posted

      MRI is as safe as ultrasound from an ionising radiation point of view ie non-ionising, uses magnets. It will give a lot more information.
  • CaptainAl
    CaptainAl jj1003

    Posted

    My PSA is being monitored and I have been offered a 'high resolution' MRI scan prior to a biopsy shoud there be a significant rate of increase in the PSA level. The latest range of MRI scanners are able to detect early tumors within the prosatate and possible spread.

    I am pleased with this arrangement as I was uncomfortable regarding the risk of infection from the biopsy. If the scan identifies a tumour I would then feel comfortable about the follow up biopsy.

    It might be worth investigating this possibility of having a high resolution MRI scan with your GP/urologist.

    check out: http://www.harvardprostateknowledge.org/improved-magnetic-resonance-imaging-mri-may-aid-detection-of-prostate-cancer

    Best wishes,

    • nealpros
      nealpros CaptainAl

      Posted

      Also, with the MRI, the doctor knows where to do the biopsy (ies) resulting in fewer biopsies, more accuracy, and less risk of infection.

      Neal

  • nealpros
    nealpros jj1003

    Posted

    Hi JJ,

    You raise several issues. I will try to provide some info on some of them:

    Hige PSA can be caused by several things. Mostly, it is an indication of irratation to the prostate of some sort. Cancer can surely do it. So can growth of the prostate itself. The outside of the prostate does not expand easily. The inside does. That causes increased pressure inside the prostate, and makes it difficult to urinate, since the urethra runs through it. The increased pressure also increases the PSA. So, as someone else has advised, be sure he doesn't have a urinary infection nor an infection in his prostate. Then, he had better have the biopsy, but, if possible, it should be guided by an MRI to insure that the areas of concern are explored.

    You mentioned low T. That can have many side effects, including decreased interest in sex, and impotence. The treatment for low T is testosterone supplementation, either through periodic shots, or daily gel or patches, which are applied to the skin. They work wonders, BUT increasing his testosterone level will cause his prostate to GROW exasperating the problems he already has.

    The loss of hair on his arms and legs is most likely caused by low thyroid hormone. That can be easily tested, and the treatment is a daily pill of Synthroid. He should see an endochrinologist for the low T and low thyroid.

    If the result of the biopsy is that he has cancer in his prostate, then he needs to be in the hands of a good urologist and an oncologist. If he doesn't have cancer, you and he should explore a Urolift, or a PAE before considering a TURP or laser treatment. They have far less side effects. Note that the PAE is done by an interventional radiologist, not a urologist. A urologist will NEVER recommend it, since they make no money from it. You can find info on all of these treatments on this blog, and on other sites on the internet if you search for them.

    If he has serious problems with impotence, search for penile implant info blogs, or contact me separately, and I will send you to a very informative site. I hope this helps.

    Neal

  • tom86211
    tom86211 jj1003

    Posted

    JJ,

    I am 69 and last year had HDR Brachytherapy for my prostate cancer. I have had two biopsies and was on active surveillance for a while. I have had and still have BPH symptoms and have been buried in the literature for about 5 years. Your fiance has obvious fear issues related to the biopsy - either fear of pain or fear of finding out that he may have prostate cancer. You both need to know what's going on. NOT knowing is very stressful. He is not doing himself any favors by avoiding the issue. 

    The only alternative to a biopsy is a MP MRI (Multi Parametric MRI). This is a non-invasive procedure and some believe may be just as effective as a biopsy. A standard 12 core biopsy is only a sample anyway, so the MRI is a very good alternative.

    I took a couple of Tylenol just before my biopsies and there was little pain - just minor stinging. It's over in a couple of minutes. 

    An ultrasound can tell you the size of the prostate but not what's going on inside. 

    I am not a doctor, but you and your fiance really need to just move forward with this, find out what's going on, and get treatment.  

    My very best to both of you...

  • jackal
    jackal jj1003

    Posted

    I can well understand your concern for your fiancee but there are a number of good reasons why his PSA might have escalated.

    I am a fit 67 year old who has exhibited the symptoms of BPH for around 7 years, but incautiously tolerated the nocturia and urinary urgency rather than seek medical interventions. 16 months ago I woke at 03.00 for one of my incessant nocturnal pees and couldn't go. By the time the doctor arrived to catheterise me at 08.00 I was climbing the wall in agony. Unfortunately, he did a poor job of insertion and I was in a similar position by 19.00 and had to have the procedure repeated by the district nurse.

    I saw my GP after the weekend and was given a blood test. I received a phone call from him a few days later to tell me that my PSA was 30 and he suspected cancer, but I was being placed on a 14 day referral with a urologist. The urologist performed a DRE, told me that my prostate was 40 grms but felt OK, and continued by moaning about why GPs insist on placing so much faith in blood tests.

    Essentially, my high PSA probably resulted from a combination of urinary tract infection (all that stale urine sloshing around); trauma from two catheterisations and the BPH condition itself. He advised me not to have a PSA for 6 months, prescribed doxazosin and finasteride and told me to have the catheter removed in 4 weeks. Everything is now thankfully back to better than normal, having substitued various herbal medicines for the finasteride which was playing havoc with my libido.

    I have subsequently discovered that riding a bicycle and having an orgasm within 2 days of a blood test will also significantly influence the PSA score.

    God bless.

     

    • mal7896
      mal7896 jackal

      Posted

      does ejaculation  within 2 days of PSA test raise or lower the result?
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