Very high PSA

I am sorry to hear of your fiance's concerns.  I am also a 70 year old man.  When I was screened at the age of 50 by my primary care physician my PSA was 10.  He sent me to a urologist and I had a blind biopsy.  No cancer was found although I am certain it was there.  Two years later a second biopsy and still no cancer.  At age 60 I had a color doppler guided biopsy and two cores had cancer 3 + 4.  PSA doubling time varied right around five years.  Although the urologist urged me to have a prostatectomy, my readings suggested that the risks and liabilities outweighed what I came to understand as very limited benefits.  Shortly thereafter the US Preventative Services Task Force produced a document that supported my hesitancy.  I am now 70, have eschewed treatment all these years, my PSA is just over 100 and I have no symptoms and would not know that I have cancer were it not for PSA screening so many years before. The median age of death from prostate cancer is 82 years.  My predicted life expectancy is 14.1 years getting me to 84.  I am happy that I chose not to engage in treatment as my life would have been irrevocably altered for the worse.  I remain reasonably active, work for pleasure, and recently became a grandfather.  There has been a woman in my life for over eight years who is a pleasure to me and who I would like to be my fiance/spouse.  As yet I have been unable to convince her.  If I am fortunate, I hope to live longer than the life expectancy table would predict and live those years in good health and die with the prostate cancer that I chose not too fight and have learned to look at as my old age companion.  We'll see.  

With that said, my best to your fiance......and to you.  Carl 

Hi JJ.  Glad to hear that you are interested in a 70 year old.  I turned 70 this last year and have a very delightful woman that is interested in me.

It never ceases to amaze me how little physicians seem to understand about PSA. And just to keep you interested in what I am writing, my PSA is just over 100.  And for what it is worth, I have not had any treatment for cancer nor do I anticipate having teatment.  In my country prostate cancer is wildly overtreated.  An important thing for you to read in its entirety would be The US Preventative Services Task Force Recommendations on Prostate Cancer.  

Back in 1995, at the age of 50 my doctor recommended that I be given a routine PSA test (the first mistake).  It came back a 10 so he then ordered a biopsy.  A blind biopsy came back negative and a follow-up biopsy two years later also came back negative (at that point my prostate had been stuck a total of 16 times with a needle that tracked feces into my prostate and tracked prostate cancer cells out of the capsule the prostate lives in.....a conceptually flawed methodology if I ever heard of one).  I am certain that I had prostate cancer 20 years ago, it just wasn't found with the biopsy needles.  In 2005 with a PSA approaching 26 I went for a color doppler guided biopsy and watched as they stuck needles in hot-spots (blood engorged areas in my prostate).  Two of eight needles came back positive for adenocarcinoma (cancer).  Gleason was rated a 3 + 4 (you should also look up grade creep, a phenomenon that is the result of a vigorous malpractice industry in my country).  My urologist recommended a prostatectomy but could only justify his recommendation by telling me "people get a prostate diagnosis and get scared and want it out."  Scared didn't seem like a very good justification for a surgery that would dramatically alter my life, so I refused, met with a much older urologist who quietly confided that he wouldn't have my cancer treated if it were him.  He explained that my cancer is slow growing Gleason 3, diploid, and a very long PSA doubling time (approximately five years).  The latter is a very important concept to wrap your mind around.  A slow-growing cancer doubles in two or more years, fast growing in less than two years.  But what that means is it would double from 2 to 4 in the first two year period but it would double from 64 to 128 in the sixth two year period.  While the latter looks scary, it is the same slow doubling time.  

What I don't know about your husband is what his PSA doubling time is.  The high number could mean that he's had a slow-growing, non life threatening prostate cancer for a very long time (like me).  Also, it would appear that your fiance's PSA is very erratic.  That can be caused by such simple things as an infection, sexual activity including masturbation, injury, etc.  

With regard to testosterone, there are also many misunderstandings.  First, prostate cancer is extremely rare in young men who have very high testosterone typically.  The incidence of prostate cancer predictably goes up as men age and their testosterone levels predictably decline.  There is a belief that prostate cancer feeds on testosterone and that is to a degree true.  So, in order for it to live as it is it needs a daily dose or feeding.  When you go on hormone blocking, the cancer gets activated and often mutates into androgen (testosterone) independent cancer, a much more virulent, aggressive and potentially life threatening version of prostate cancer.

Like your fiance, cancer wants to live.  When you tease it, abuse it, or otherwise taunt it then it mutates and eventually metastasizes in order to continue to live.  While it is true that if you have a very aggressive cancer (hard to define)......maybe Gleason 8, more likely Gleason 9 or 10; haploid vs diploid, rapid PSA doubling time; and you're less than 65 you might consider treatment otherwise, read the US Preventative Services Task Force Recommendations on Prostate Cancer.....it will open your eyes!

Finally, prostate cancer is considered the "old man's disease."  At 70 years old your fiance has a 50 50 chance of having prostate cancer.  Clearly, far and away most men die of something else.  The modal age of death from prostate cancer in the US is 82 and a graph of age at death shows a skew to older age.  A 65 year old man in the US has a life expectancy of 18 years.  

I am taking my chances with prostate cancer and avoiding treatment.  I have no symptoms and am enjoying life.  

But ultimately it is between you and your fiance to make the call.  I wish you the very best,  Carl    

That is high for sure, but if it is stage 3 or 4 then I don't understand what good is a biopsy. It is my understanding that a biopsy is used to determine if you have cancer and if it has spread beyond the prostate. You can get another opinion and the doctor shouldn't force you to take a test you are not ok with. In my case 10 years ago I was told that I have Ulcerative Colitis and my doctor at the time told me the best thing to do is have my Colon removed and I would to deal with a colostomy bag the rest of my life. I was given no other options from this doctor, so I told him he is crazy to suggest this to me without going over all my options so I told him he is fired as my doctor and I will send for my records when I find a new one. I found a good doctor that found a medication that worked for me and I still have my Colon. The decision was totally up to me and your care choices are up to you, after all you are the one who has to live with your choices not your doctor. The doctor is supposed to be working for you not the other way around. I hope this helps. I wish you luck and take care.

My father have large prostate and when we checked his PSA, PSA is 85.20 but he is suffering from UTI at that time. After three week treatment by antibiotic his PSA is now 84.51 . still to much high. What should I do kindly suggest me.

He is diabetes patient.

HI

I am 81 PSA 48.

I had a T2 type scan then  Template Guided Prostate Biopsies with general anaesthesia.

I was told that  there was no cancer and that the high PSA was probably caused by having an enlarged prostate.

I would strongly recommend this procedure to anyone who has prostae problems and can afford K£4

15 years ago my PSA was 10 l had 8 biopsies  this caused sepsis  and I was ill. Since then I have had 9 Mri scans 1nuclear scan PSA 3test and my PSA is 70 now. The biopsies were negative. I have prostate cancer possibly slow growing. They want me to have template biopsies but after last time no thankyou. My PSA doubles every 40 months. I get very tired but no pain yet.l read about taking bicarbonate of soda check it out on the Internet.then check your ph tests if you keep them about 7 you are alkaline if not you are on the acid side check out cancers growing on sugar.keep to a Mediterranean diet avoid red meats. Keep trim and not overweight gentle exercise.who knows what the future lies but is this better than surgery chemo or radiation treatments.like to hear your comments good luck.

There's a load of bs about this. My psa has always been 1.8, 2.2..... but one time I was in the hospital for a minor heart problem and a random psa test showed a psa of 43. The doctor told me I probably had prostate cancer and it is serious at that level. So my urologist prescribed 2 weeks antibia tics because a dre showed nothing. In 2 weeks it was down quite a bit, and 6 months later it was back at 2. The facts are that even at a psa of 40, you only have a 67% chance of having prostate cancer. My father in law has a psa of 6.8 and he had prostate cancer. He had seed implants and died at age 85, 15 years later and of a heart attack.

My jouney just begins at 67. With a PSA average of 2.4 over the last 12 years. In April I had a severe UTI, which happened a month before my annual blood test. After the  UTI subsided with antibiotics my PSA went from 2.4 to 12 over a 4 month period and still rising. Here is Australia, takes a 2-3 months to see urologist. So while waiting, I am thinking about getting a mpMRI ($500)with a tesla 3 machine. This way, I can front up with my blood/urine work as well as the MRI, which should help? Also, I will get the results of the MRI before my urologist visit, so this may put my mind at rest...or otherwise, when I read the radiologist report.

While understand the logic of the biopsy, not sure if jabbing and provoking the prostate and causing it to bleed into my system with possibly cancer cells such a good idea. Hoping the mpMRI will say, "you have prostatitus" or maybe, ummm, some thing not right there.. Anyway, will report back later.

Jed

HI All,

I am 41 and had a regular blood test 4 weeks ago and my PSA was 74... 1 week later the doctor felt my prostate and said it feels normal and asked for me to come back 3 weeks later for another psa test. My psa has risen to 82... There is no infection shown in bloods or urine test.

I am being referred to a Urologist and expect to see him within 2 weeks.

I am so frightened that I have cancer and can't think what else it can be? Everything seems to point to Cancer and haven't spoken with anyone that's made any sense... Is 82 really high? Should I be worried?

Any advice would be gratefully received?

For all of you on here that are have been diagnosed or know someine going through it.I wish you all a speedy recovery.