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Rising PSA
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Jembost posted:
Age 53. In April 2010 my PSA was 1.2. At my next general checkup June 2011 it raised to 1.8. My doctor recommended another test in 3 months. In Sept. 2011 it raised to 2.1. I know these are low numbers, but I understand that you also need to be concerned when your PSA is rising. One article I read said an increase of more than .35 in a year may be cause for concern. My doctor wants to wait another 3 months and test again.

Does that sound prudent?
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RandomPseudoNym responded:
(to quote Douglas Adams) Don't Panic...

I wonder if any of these tests have looked at free .vs. bound PSA. When I hit the "retest in 3 months" point my doctor also had (though he didn't actually tell me this ahead of time) the free percentage measured on the retest - and that was low enough that we had real cause for concern.

PSA is also associated with enlargement (BPH) that is not cancerous. PSA velocity (ie, the rate of rise over time) is on the one hand a cause for (some) concern, though at exactly what rate is a subject of debate, and it's also very much in the "may" indicate, not "does" indicate cancer camp, with various studies showing various correlations and lack of them.

There is also some variability in PSA tests if different labs are used, as well as variations if you have an inflammation or have recently ejaculated before the test. I think that variability is well within the range of the differences in your last two tests, but others can comment with more authority on all of this.

So, as merely another unlucky guy who's learned 99.9% of what I know about this disease over the last 3 months, I'd suggest you ask your doctor about details on the results you have, and ask about having the free percentage checked in December if it hasn't already been checked. But that timing seems prudent, given your quite low numbers thus far.
 
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az4peaks2 responded:
Hi Jembost, - Although there is no need to panic, there is justification for reasonable concern because of the steady upward trend in consecutive readings.

For ball-park reference, in the AUA's PSA Best Practice Update in 2009, the age-specific PSA value medians (50% above/50% below) cited, were 0.7 ng/ml for men in their 40s, 0.9 ng/ml for men in their 50s, 1.2 for men in their 60s, and 1.5 for men in their 70s.

The first of the two most notable studies concerning PSA annual velocity indicated 0.75 ng/ml in any one year justified a Biopsy recommendation. The second and most recent Study indicated that 0.35 would be a more appropriate threshold, particularly in younger men (53 qualifies).


However, PSA results need to be weighed along with other diagnostic data in the medical record and a subjective judgment made as to its significance. The Doctor's recommendation to re-assess in a relatively short 3 month time frame would not appear to be an unreasonable suggestion, in my layman's opinion.

At the levels you quote, a Free PSA test would have questionable reliability. Both the manufacturer and the FDA approval state that it is intended for use in men with PSA levels between 4.0 and 10 ng/ml Total PSA results. More recent Studies have suggested an expanded reliability down to 2.5 ng/ml. Free PSA must be run on the same blood sample as the Total PSA, to which it relates and using the same manufacturer's complementary assay material.

If the next PSA continues the upward trend, you may wish to discuss the possibility of having a PCA3 Urine test to help clarify the PSA result (and any Free PSA result, if done). This would require an office visit, however, because it requires a vigorous massage of he Prostate prior to obtaining the Urine sample for submission to the Laboratory.

Good luck and I will be happy to answer any specific questions you may have. - John@newPCa.org (aka) az4peaks
 
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Jembost replied to az4peaks2's response:
Thank you both for your quick responses. Much appreciated.

Best...J
 
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RandomPseudoNym replied to Jembost's response:
With no idea what your presnt activity level and weight are like, the other thing you can actively do that appears to be correlated with decreasing your risk, or rate of growth if it turns out you do have a tumor, is to engage in "brisk walking" or other "intense" physcial activity for 30-60 minutes a day, or more, and try to shed any excess weight - both in consultation with your doctor. Articles about both have been on the webmd prostate cancer page above the discussion area for a while. If you are already doing these things, keep it up - if not, consider it a wake-up call - and it will help with more than PCa if you keep it up.

Let's see if I can link them here: http://www.webmd.com/prostate-cancer/news/20110524/brisk-walking-may-help-keep-prostate-cancer-in-check

and http://www.webmd.com/prostate-cancer/news/20110516/obesity-may-raise-risk-of-prostate-cancer-spread
 
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Jembost replied to RandomPseudoNym's response:
Thank you for the links, good info.

I'm not overweight, actually on the thin side, but I only get to exercise on the weekends. Have wanted to exercise more often for lots of reasons, you're right, good wake-up call.
 
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cmh9220 replied to Jembost's response:
My husband just turned 51. His PSA levels jumped from 2.1 to 3.2 over the course of 2 years (missed his yearly physical in 2010). He had very early stage cancer. Had prostate removed 5 weeks ago.

Keep an viligant watch on the numbers.


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