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High PSA -> Active Surveillance

User
Posted 21 Jan 2021 at 13:43

Hi, I've just been diagnosed with a Gleason score of 6 and Stage T1a. The consultant is recommending Active Surveillance. I suppose I should be mightily relieved but the fly in the ointment is a PSA of 17.5 (Oct 2020). The doc  assures me that there are guys walking around naturally with PSA's > 20 who will never go on to have PCa. Because of the biopsy I won't be able to have another PSA test for 4 months.

Are there any others on here is a similar situation and how do you cope with the added stress of knowing the PSA is high?

User
Posted 21 Jan 2021 at 15:29

I can't answer your question but over treatment used to be a problem.  You're asking Is yours under-treatment.   After a biopsy and an MRI there isn't much more to do.   Do you know how many pins the biopsy used and how many had bad cells?  

Your prostate seems large as well which might be why your psa is high.

There's often a worry between psa tests even when you've been treated.  You're in that position, although six months gap is quite a while at this stage I'd think.  Three months could be more normal but there must be a minimum period after your biopsy which was in January which makes 6 months gap seem reasonable, since your October biopsy.

It looks like you will have to hang on and establish a psa trend with 3 monthly tests from April.  Unless someone knows a case to have earlier psa test.   Regards Peter

 

User
Posted 21 Jan 2021 at 16:23
Assume your urine has been checked for UTI?
Barry
User
Posted 22 Jan 2021 at 01:16

A friend with G3+4=7 has been on AS for five years and is doing great.

He has annual consultations with his urologist, annual MRI’s and quarterly PSA tests.

I hope your AS is as successful and you carry on enjoying a normal life.

Cheers, John.

User
Posted 19 Dec 2022 at 15:01
Hello Folks , I have just found and signed on to the forum

I have had a higher end PSA that has been relatively stable for several years at 3 and bits , I had a test in April which measured 4.11 and mainly due to my age 62 underwent a MRI which showed an enlarged gland at 72 ml but scored T2 in all areas.

I had may last bloods a week ago and my PSA has shot up to 7.4 and so I am quite concerned at the velocity of the increase as well as the number , usual symptoms when urinating and I am on Tamsulosin.

I have a phone consultation with a Urologist later this week.

I am rather concerned at the rate of change ;0{

Jasper.

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User
Posted 21 Jan 2021 at 15:29

I can't answer your question but over treatment used to be a problem.  You're asking Is yours under-treatment.   After a biopsy and an MRI there isn't much more to do.   Do you know how many pins the biopsy used and how many had bad cells?  

Your prostate seems large as well which might be why your psa is high.

There's often a worry between psa tests even when you've been treated.  You're in that position, although six months gap is quite a while at this stage I'd think.  Three months could be more normal but there must be a minimum period after your biopsy which was in January which makes 6 months gap seem reasonable, since your October biopsy.

It looks like you will have to hang on and establish a psa trend with 3 monthly tests from April.  Unless someone knows a case to have earlier psa test.   Regards Peter

 

User
Posted 21 Jan 2021 at 16:23
Assume your urine has been checked for UTI?
Barry
User
Posted 21 Jan 2021 at 22:53

Originally Posted by: Online Community Member
Assume your urine has been checked for UTI?

Actually, no it wasn't. I didn't have any symptoms though...

User
Posted 21 Jan 2021 at 22:59

Originally Posted by: Online Community Member

 Do you know how many pins the biopsy used and how many had bad cells ?Regards Peter

I had a targeted TP Biopsy. 9 pins in left side, 6 pins in right. All targeted pins were negative. Of remaining random pins, one pin on left and right side had < 5% Gleason 3.

 

 

 

User
Posted 22 Jan 2021 at 01:16

A friend with G3+4=7 has been on AS for five years and is doing great.

He has annual consultations with his urologist, annual MRI’s and quarterly PSA tests.

I hope your AS is as successful and you carry on enjoying a normal life.

Cheers, John.

User
Posted 22 Jan 2021 at 14:09

Originally Posted by: Online Community Member

A friend with G3+4=7 has been on AS for five years and is doing great.

He has annual consultations with his urologist, annual MRI’s and quarterly PSA tests.

I hope your AS is as successful and you carry on enjoying a normal life.

Cheers, John.

Thank you so much John. That has cheered me up no end! All the very best to you.

BTW, where did you have your mpMRI?

Edited by member 22 Jan 2021 at 14:17  | Reason: Not specified

User
Posted 23 Jan 2021 at 01:17

Originally Posted by: Online Community Member

Thank you so much John. That has cheered me up no end! All the very best to you.

BTW, where did you have your mpMRI?


At my local billion pound (PFI financed) super-hospital in Coventry, which we call Walsgrave Hospital, but that was not grandiose enough, so it’s now called University Hospital Coventry and Warwickshire. 

They have a tie up with the ‘new’ medical school at Warwick University, which is also in Coventry and nowhere near Warwick. ‘Coventry’ was thought too low-brow to call the university, although we also now have a Coventry University (formerly Lanchester Polytechnic), together with about 30,000 students at each, pre-covid.

Cheers, John.

Edited by member 23 Jan 2021 at 01:20  | Reason: Not specified

User
Posted 23 Jan 2021 at 01:58

There is an Active Surveillance online support group, managed by Prostate Cancer UK.

 

User
Posted 19 Dec 2022 at 15:01
Hello Folks , I have just found and signed on to the forum

I have had a higher end PSA that has been relatively stable for several years at 3 and bits , I had a test in April which measured 4.11 and mainly due to my age 62 underwent a MRI which showed an enlarged gland at 72 ml but scored T2 in all areas.

I had may last bloods a week ago and my PSA has shot up to 7.4 and so I am quite concerned at the velocity of the increase as well as the number , usual symptoms when urinating and I am on Tamsulosin.

I have a phone consultation with a Urologist later this week.

I am rather concerned at the rate of change ;0{

Jasper.

User
Posted 19 Dec 2022 at 16:17

T2 has two possible meanings. One is a parameter on an MRI scan. Comparing T1 and T2 images helps clarify the image. The T stands for relaxation time, of nuclear spin. The other possible meaning is Tumour stage 2, I doubt that is what "T2 in all areas" means for you.

As your prostate volume is 72 which is over twice normal size, your PSA of over 4 is not very alarming.

An increase in PSA is of some concern but can be caused by many things, most notably infection. If the MRI showed anything of concern then a biopsy will be next on the list. If not, then they may suggest a repeat PSA in a few months. Until you get more information, there is not much point in getting worried. The fact you are 62 means you have more chance of having prostate cancer than not having it, but as of yet there is no evidence that you have a troublesome version of it.

Dave

User
Posted 20 Dec 2022 at 10:48
Hi Dave , thank you for taking the time to reply.

My apologies as I seem to have expressed myself poorly when describing my condition.

My PSA was 3.3 when the MRI was performed in May and reviled an enlarged prostate measuring 74 ml volume.

My most recent blood test in November measured my PSA at 7.6 whereas it has never been higher than 3.4 over several years .

It is the velocity spike since May that has caused me such alarm.

I have attached an extract from the Radiologists report :

Dimensions: AP:

4.7

TR:

6.2

CC:

49

PSA:

Vol (mI): Referrer:

74

Radiologist

Scanning Site

Report:

3.3

PSAD.

0.04

Indication:

PSA 3.3. DRE - slightly firm right lobe.

Technique:

T2, diffusion-weighted & dynamic contrast-enhanced images of the prostate

Findings:

74 ml prostate. PSA density = 0.04.

No significant median lobe. Membranous urethral length = 20 mm.

Some stranded / wedge-shaped T2 changes in the peripheral zone bilaterally,

with mild enhancement and only minimal restriction of diffusion - the

morphology is reassuring and scores 2/5.

No suspicious PZ or TZ lesions (2/5 at most)

No seminal vesicle, bony or nodal disease.

Unremarkable appearances of the remainder of the visualised pelvis.

Conclusion:

No suspicious prostatic lesions. The PSA density is reassuring.

Please see page 2 of this report for diagrams & representative images.

User
Posted 20 Dec 2022 at 12:24

The MRI is very good. As you say the only thing of any concern is the rise in PSA. PSA on its own is a very poor diagnostic tool, however a history of PSA tests makes it more useful, and a rise like that needs investigation. 

Such a sudden rise is more likely prostatitis, cancer is not usually that fast. I guess there might be some variety of prostate cancer which could start from nothing and in six months cause that rise in PSA but it is not one I have seen discussed on this forum.

Your just going to have to see what urologist says.

Dave

User
Posted 20 Dec 2022 at 16:29
The scan results are very reassuring and, critically, your free PSA % is also great news. Whatever is causing the PSA rise, I don't think the urologist will be concerned about cancer.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

 
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