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High PSA levels

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User
Posted 26 Aug 2023 at 09:44

Hi, I Recently moved to a new area & as part of registration with new GP surgery I was sent for blood & urine tests, few days afterwards GP called to say my PSA levels were high at 7.04 and I needed to come into the surgery to see the doctor who checked my prostate with a DRE which he said was ok. I was advised to have another blood & urine test two weeks later, which I did & the results came back as PSA now 6.45 & urine ok. 
GP advised I would be referred to see a urologist at the local hospital next to take a further look, can I ask what the next steps entail as I have no symptoms at all everything working as it should, no aches, pains Etc. I’m 65, soon be 66 fairly active, bit overweight & never had any health issues.🙂


 


 

User
Posted 26 Aug 2023 at 13:02

Hi Richard, those first tests are really just initial markers that lead to further investigation. There are people on here who've had low PSA which turned out to be cancer and high which haven't. My first one was 5.1 which eventually led to a T2 diagnosis. No symptoms or family history.


I would imagine your next step is an MRI. If that shows any suspicious areas, then onto a biopsy.


My consultant explained everyone has a different baseline, and high readings can be for all sorts of reasons. The PSA trend becomes more useful after positive diagnosis and treatment. For example if you have an enlarged prostate but no cancer, the figure might not be as bad as it seems. Mine is 29cc at 5.1/5.6 in initial 2 tests.


 


 

Edited by member 26 Aug 2023 at 13:09  | Reason: Not specified

User
Posted 26 Aug 2023 at 16:48
The threshold for the start of investigations is PSA > 4 - given that 12% of men will get prostate cancer in their lifetimes then it's quite common and in most cases there are no symptoms whatsoever. The good news is that IF it is PCa then it will have been caught early and there are lots of treatment options.

Typically the process goes as follows

PSA blood test - repeat every 3 months if > 4
Urine test to check for infection
DRE to check for surface abnormalities
Echo if needed to check for size
MRI to investigate for lesions
Bone scintigraphy to look for any bone mets
Biopsy to remove cores from the prostate to estimate how far the cancer has developed

Then it comes down to the 4 main treatment options

Active Surveillance - basically keeping an eye on it to see if/how it progresses
Brachytherapy - inserting 60 radioactive seeds into the prostate to kill the cancer cells
Radical Prostatectomy - if the cancer is fairly well contained then cut it out
Hormone Therapy/Radiation Therapy - if cancer has spread outside the prostate then hit it with radiation and reduce testosterone with drugs.
User
Posted 28 Aug 2023 at 23:29

The next step will be to get an MRI scan in the hospital.


You'll be called in for an appointment when they have the scan result (that's supposed to be within 2 weeks of the GP referral, but often isn't, and isn't actually that urgent for prostate cancer, which usually moves very slowly). The scan can't normally diagnose prostate cancer, so you will either need more tests if the scan shows any abnormal areas (which still might not be cancer), or they'll give you the all-clear.

Edited by member 28 Aug 2023 at 23:29  | Reason: Not specified

User
Posted 29 Aug 2023 at 00:11

There's no one agreed set of PSA thresholds.


NICE gives:
Below 40 Use clinical judgement
40 to 49 More than 2.5
50 to 59 More than 3.5
60 to 69 More than 4.5
70 to 79 More than 6.5
Above 79 Use clinical judgement


ICBs, Cancer Alliances, and individual hospital urology departments can override these on regional and local basis.


Urologists sometimes use the BAUS recommendations:
40-49 2.7
50-59 3.9
60-69 5.0
70-79 7.2
80-84 10
85+ 20
Borderline results should be retested in 3 months before referral.


CHAPS uses the following thresholds, which have been worked out by Chris Booth from his research into screening using PSA testing, and are roughly between NICE and BAUS levels:
Under 50: 2-3 retest in 3 months and refer if >2. Refer immediately if >3.
50-59: 3-4 retest in 3 months and refer if >3 Refer immediately if >4.
60-69: 4-5 retest in 3 months and refer if >4. Refer immediately if >5.
Over 69: 5-6 retest in 3 months and refer if >5. Refer immediately if >6.
CHAPS also recommends retest intervals depending on the last test result.


The NICE and BAUS figures are specified as for men with symptoms (pretty meaningless given current research shows most men diagnosed have no symptoms). The CHAPS figures are for screening men, and hence for men without symptoms.

Edited by member 29 Aug 2023 at 00:32  | Reason: Not specified

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User
Posted 26 Aug 2023 at 13:02

Hi Richard, those first tests are really just initial markers that lead to further investigation. There are people on here who've had low PSA which turned out to be cancer and high which haven't. My first one was 5.1 which eventually led to a T2 diagnosis. No symptoms or family history.


I would imagine your next step is an MRI. If that shows any suspicious areas, then onto a biopsy.


My consultant explained everyone has a different baseline, and high readings can be for all sorts of reasons. The PSA trend becomes more useful after positive diagnosis and treatment. For example if you have an enlarged prostate but no cancer, the figure might not be as bad as it seems. Mine is 29cc at 5.1/5.6 in initial 2 tests.


 


 

Edited by member 26 Aug 2023 at 13:09  | Reason: Not specified

User
Posted 26 Aug 2023 at 16:48
The threshold for the start of investigations is PSA > 4 - given that 12% of men will get prostate cancer in their lifetimes then it's quite common and in most cases there are no symptoms whatsoever. The good news is that IF it is PCa then it will have been caught early and there are lots of treatment options.

Typically the process goes as follows

PSA blood test - repeat every 3 months if > 4
Urine test to check for infection
DRE to check for surface abnormalities
Echo if needed to check for size
MRI to investigate for lesions
Bone scintigraphy to look for any bone mets
Biopsy to remove cores from the prostate to estimate how far the cancer has developed

Then it comes down to the 4 main treatment options

Active Surveillance - basically keeping an eye on it to see if/how it progresses
Brachytherapy - inserting 60 radioactive seeds into the prostate to kill the cancer cells
Radical Prostatectomy - if the cancer is fairly well contained then cut it out
Hormone Therapy/Radiation Therapy - if cancer has spread outside the prostate then hit it with radiation and reduce testosterone with drugs.
User
Posted 28 Aug 2023 at 15:50

Hi Steve86, regarding your statement of threshold for start of investigations is PSA >4. This is not true. My PSA was 2.7 but the DRE was a concern so sent for MRI then biopsy and diagnosed T2c Gleason 3+4. I am now 10 months post RALP and a PSA 0.01. 

User
Posted 28 Aug 2023 at 23:29

The next step will be to get an MRI scan in the hospital.


You'll be called in for an appointment when they have the scan result (that's supposed to be within 2 weeks of the GP referral, but often isn't, and isn't actually that urgent for prostate cancer, which usually moves very slowly). The scan can't normally diagnose prostate cancer, so you will either need more tests if the scan shows any abnormal areas (which still might not be cancer), or they'll give you the all-clear.

Edited by member 28 Aug 2023 at 23:29  | Reason: Not specified

User
Posted 29 Aug 2023 at 00:11

There's no one agreed set of PSA thresholds.


NICE gives:
Below 40 Use clinical judgement
40 to 49 More than 2.5
50 to 59 More than 3.5
60 to 69 More than 4.5
70 to 79 More than 6.5
Above 79 Use clinical judgement


ICBs, Cancer Alliances, and individual hospital urology departments can override these on regional and local basis.


Urologists sometimes use the BAUS recommendations:
40-49 2.7
50-59 3.9
60-69 5.0
70-79 7.2
80-84 10
85+ 20
Borderline results should be retested in 3 months before referral.


CHAPS uses the following thresholds, which have been worked out by Chris Booth from his research into screening using PSA testing, and are roughly between NICE and BAUS levels:
Under 50: 2-3 retest in 3 months and refer if >2. Refer immediately if >3.
50-59: 3-4 retest in 3 months and refer if >3 Refer immediately if >4.
60-69: 4-5 retest in 3 months and refer if >4. Refer immediately if >5.
Over 69: 5-6 retest in 3 months and refer if >5. Refer immediately if >6.
CHAPS also recommends retest intervals depending on the last test result.


The NICE and BAUS figures are specified as for men with symptoms (pretty meaningless given current research shows most men diagnosed have no symptoms). The CHAPS figures are for screening men, and hence for men without symptoms.

Edited by member 29 Aug 2023 at 00:32  | Reason: Not specified

 
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