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PSA Unreliable

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User
Posted 13 Jun 2023 at 14:02

I was diagnosed with prostate cancer on the 2nd May '23 and am having surgery next week. I had an MRI 15 months ago and there was something showing up. My consultant wasn't concerned because my PSA was 3. We decided to wait a year and monitor it instead of doing the biopsy straight away. I had a second MRI a year later and it had changed slightly but my PSA was only 3.1. My consultant said we should now do the biopsy, although he still thought there was nothing to worry about. I had the biopsy and my Gleason score was 4 + 5 = 9, hence the surgery. PSA blood tests seem to be very unreliable?

User
Posted 14 Jun 2023 at 13:33

PSA test is a reliable measurement of PSA.


However, PSA level over quite a common range isn't well indicative of prostate cancer or not. Also, what you may have fallen foul of is that about 15% of prostate cancers don't raise PSA, and these can be the highest Gleason cancers, because when the cells mutate very significantly, they can lose their ability to produce PSA at all. It is good you were picked up and not missed.

User
Posted 13 Jun 2023 at 14:37

Yes the PSA test was never intended to diagnose prostate cancer, it was intended to monitor the disease post treatment. However there are not many diagnostic test for PCa so it has been co-opted as a diagnostic test.


I hope all goes well with the treatment.

Dave

User
Posted 14 Jun 2023 at 21:04
But you have adenocarcinoma Peter, you seem to be confusing your situation with someone who has a mucinous or small cell cancer.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
Posted 13 Jun 2023 at 14:37

Yes the PSA test was never intended to diagnose prostate cancer, it was intended to monitor the disease post treatment. However there are not many diagnostic test for PCa so it has been co-opted as a diagnostic test.


I hope all goes well with the treatment.

Dave

User
Posted 14 Jun 2023 at 13:33

PSA test is a reliable measurement of PSA.


However, PSA level over quite a common range isn't well indicative of prostate cancer or not. Also, what you may have fallen foul of is that about 15% of prostate cancers don't raise PSA, and these can be the highest Gleason cancers, because when the cells mutate very significantly, they can lose their ability to produce PSA at all. It is good you were picked up and not missed.

User
Posted 14 Jun 2023 at 18:52

Nice comment from Andy but it worries me that my slow psa increase from 0.06 to 0.1 in 18 months has around a 15% chance of being an understatement after surgery with Gleason 4+4.  Ha!

User
Posted 14 Jun 2023 at 21:04
But you have adenocarcinoma Peter, you seem to be confusing your situation with someone who has a mucinous or small cell cancer.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 02 Jul 2023 at 19:16
I had my surgery on the 21st June and all went well with clear margins. I had the catheter taken out last Thursday (29th) with no problems. However, the last couple of days I've had quite bad burning in my penis and general aching/soreness in the perineum. I'm not the best patient and I guess this is normal?
User
Posted 02 Jul 2023 at 20:06
You have to remember that your penis has had a foreign object jammed up it for 7 days so some soreness is to be expected as is pain around the area between the scrotum and anus - that's roughly the area that the prostate was removed from so it will feel weird/tender/sore for a week or so.
If it hasn't started to improve after a few days then a trip to the doctor for quick check would be worthwhile - but it all sounds the same as I experienced for the week after catheter removal :)
User
Posted 02 Jul 2023 at 20:30

John, possibly an infection, could be a bit of scab or debris irritating the urethra. Pain in the water works system is transmitted from another area of the water works. Drink plenty of water and avoid drinks that could irritate the bladder.


Thanks Chris 

User
Posted 02 Jul 2023 at 21:10

Hi John Clarkson,


I had pain in the Perineum area for about 2 weeks after surgery.  I also had tenderness at the 'eye' of the penis, where the catheter was emerging and causing friction to the penis head.  I put some 'Instillagel' (numbing cream) on the area which helped a little and it cleared up after about a week.  However, as Colwick Chris said, if you have a burning sensation lower down in the penis, then you might have contracted an infection somewhere in your urinary tract.  (Does your urine smell strongly and/or is it a dark colour?).  As Chris also said, I would suggest that you drink plenty of fluids,  to try to flush it out, but if no progress, then I would recommend you speak to your G.P.


Take good care of yourself.


Jed See.

User
Posted 02 Jul 2023 at 21:43
Thank you for your replies really helpful. I'm drinking lots of water that will hopefully flush it out, if not I'll speak to my GP
User
Posted 02 Jul 2023 at 22:11

PSA is more indicative  than conclusive. Often it's the rate of rise over a period of say year or more that should worry you. However, I would not ignore a result which is above your age appropriate value. Better to be safe than sorry. The only way to be sure is to have an MRI guided biopsy.

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate


 


 

 
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