Rapid PSA rise in 6 months

User

Posted 24 Jul 2021 at 16:51

For the past 5 yrs, including six months ago, my PSA was level with readings around 1.8/1.9. Urologist was not concerned because they have been stable, but he checks me every 6 months. Last week, I got a result of 19.1. So, I went from 1.8 to 19.1 in six months. They repeated the test on the same sample the next day and got the same result. I had another blood draw the next day and waiting on that result now, but it seems to me it is unlikely to be different. He has always said that I have a slightly enlarged prostate, but to me that would in no way account for this level and rapid rise. I do not have any noticeable signs of an effective.

Obviously, this scares me to death. I have always heard prostate cancer is slow growing, so the 10X increase in just six months all the sudden has me convinced this is a aggressive cancer that has already progressed. On a side note, I need to find a good DR who actually has the time to see me. I cannot wait 3 months.

User

Posted 25 Jul 2021 at 08:41

Originally Posted by: Online Community Member

What do you mean when you say "I do not have any noticeable signs of an effective"? An effective what?

Best wishes,

Chris

I think he means infection not effective.

Thanks Chris

User

Posted 14 Jan 2022 at 00:37

Yes - it was interesting in the context of posts we have had on here debating the same thing. Tthank you for sharing it.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 31 Dec 2023 at 01:52

We have definitely had similar posts, do not be too worried.

Having a history of PSA results is really useful. They have not indicated a slow steady rise, so this probably is not cancer. To go from a PSA of 3 to 12 in six months would imply a doubling time of three months. It is true that, that is possible for prostate cancer but usually that is only in the later stages of the disease.

It is plausible that your PSA reached 50 in October and is now heading down. I am inclined to say that another PSA test four weeks after the 12.54 would provide a lot of information, a rise to about 16 would be entirely consistent with a PSA doubling time of 3 months, that would be worrying. A fall would be very good news, staying close to 12.54 would be reasonably good news as it would suggest there is no pattern of doubling.

I assume the urologist will do tests for infection and may prescribe antibiotics to try and rule out infection. There isn't much point in worrying, because worrying is not going to change anything.

Dave

Show Most Thanked Posts

User

Posted 24 Jul 2021 at 20:10

A sharp rise like that is almost always down to infection - prostatitis doesn't always have symptoms. Your GP should refer you to urology on the cancer pathway for further tests- urology may just say to take antibiotics for a couple of weeks and then redo the PSA test

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 24 Jul 2021 at 23:05

Hi and thanks for the reply. Can I ask if you have had some experience with that. I thought the same. A huge increase like that is unusual.

User

Posted 25 Jul 2021 at 00:25

Lyn usually comes up with the most logical explanation.

We have had at least one case of a blood sample mix up.

A ten fold error is mentioned if you look into PSA testing.

Thanks Chris

User

Posted 25 Jul 2021 at 08:16

What do you mean when you say "I do not have any noticeable signs of an effective"? An effective what?

Best wishes,

Chris

User

Posted 25 Jul 2021 at 08:41

Originally Posted by: Online Community Member

What do you mean when you say "I do not have any noticeable signs of an effective"? An effective what?

Best wishes,

Chris

I think he means infection not effective.

Thanks Chris

User

Posted 25 Jul 2021 at 12:48

Sorry guys. Yes I meant to say I have no symptoms of an infection. It is hard for me to wrap my head around such a huge increase 1.8 to 19.1 in 6 months. I have no experience with this which is why I was wondering if this is typical of an infection or aggressive cancer. I know I need to see the urologist and I am trying to get an appointment.

User

Posted 26 Jul 2021 at 18:25

Thank you all for being so kind to reply. This PSA number has floored me. Going from stable 1.8 for 4 years to 19.1 in six months has me obviously thinking the worst.

I have an appointment tomorrow with the doctor's Physician Assistant, best they could give me.

I am trying to figure out what to ask during the appointment. To me, I want to know if the doctors have experience with seeing this kind of a spike (10X over 6 months), and is it aggressive cancer normally behaving this way or asymptomatic prostatitis. From what I have read it is doubtful it is due to an enlarged prostate, which I do have but not big enough to produce this level, I think.

Also, I kind of feel they will want to go straight to a biopsy. But should I insist on an MRI first. At this point I am concerned about an explosive cancer that has gone beyond the prostate.

User

Posted 26 Jul 2021 at 19:10

I see that you are in the US so it might be a bit different to the UK. These days, in the UK, most men have a multi-parametric MRI first and then a biopsy if necessary. However, mpMRI can only see suspicious areas - it can't always tell the difference between cancer, bruising and infection / inflammation so you may still be advised to have a couple of weeks of antibiotics before they scan.

Generally speaking, prostate cancer is not explosive and does not cause PSA to rise so sharply. There are a couple of particularly aggressive prostate cancer types which don't cause the PSA to rise at all.

Edited by member 26 Jul 2021 at 19:11 | Reason: Typo

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 26 Jul 2021 at 20:02

From being normal 1.9 to being 19 in 6 months is amazing. Seems like a decimal point is in the wrong place. They might have calibrated the machine wrongly.

That's what I'd be pressing the physician about although failing that I'd want to know what investigative work they propose.

I also wondered why you have 6 monthly psa tests. Even suspect people like me only have annual tests. Six monthly is a good precaution although they say once you're on the testing treadmill you're vulnerable to calls for treatment that sometimes would never be needed.

All the best, Peter

User

Posted 26 Jul 2021 at 20:11

Thanks Peter. As for the test, the repeated it the next day so I am fairly certain now that my PSA is 19 now. As for the frequency of the checks he gave me the option of coming once per year or every six months and I picked the latter. I think for my age (54) that 1.8 is a bit elevated but not high enough to go for any further tests. So we has been watching it to make sure it stays stable as my baseline. It has for 4 years now every six months until last weeks check. So it has increased nearly 10 times in 6 months! Hope this is not a cancer that has already broken through in 6 months time before they could catch it. Hoping some other thing like infection as Lyn has mention could be the cause. Yet I have no symptoms really.

User

Posted 26 Jul 2021 at 21:11

Have you had the result from the second blood sample you gave.

Thanks Chris

User

Posted 26 Jul 2021 at 22:14

Yes, the second blood sample produced the same result.

User

Posted 26 Jul 2021 at 22:57

I would have thought the first thing would be to do comprehensive test for an infection or any other thing to explain such a rise followed by a biopsy if one can't be found. Incidentally, many men who are diagnosed with PCa do not experience symptoms.

Barry

User

Posted 27 Jul 2021 at 18:09

Hi,

Ah yes, I missed the repeat test bit in your original post. I like the term 'blood draw', it's not one I've heard before although it's obvious what it means.

Actually you don't know when the increase in psa started. It would be surprising if it was immediately after your last test, it could have been just a few weeks ago. That's what makes it seem improbable that it's Prostate Cancer in my opinion. The rise is so fast.

From a quick search Prostatitis seems to be more probable. Diagnosis is often based on probability. Putting together different tests to get a picture. I'm just a patient, keep rooting for it to be a good outturn. Good luck, Peter

Edited by member 27 Jul 2021 at 18:11 | Reason: Not specified

User

Posted 27 Jul 2021 at 19:28

Thank you. Met with the PA today. Here is the summary:
Overall it was more of a positive experience than negative. They are going to do an mri and then a guided biopsy. PA said the doctor said it is most likely inflammation, they do not think it is an infection. But because cancer is always possible, even though not the most likely, they want to do the mri to rule it out. She also said that if it is cancer that 6 months is catching it early Also the finger exam of the prostate was normal. She said in most cases of advanced cancer she can feel something and she did not.

User

Posted 27 Jul 2021 at 19:44

You must have some kind of special Personal Assistant to go to those lengths for you!

😂😂😂😂😂

Best of luck,

Cheers, John.

User

Posted 27 Jul 2021 at 21:40

Tah0476

Keep us posted please. I did work with a guy who had a fluctuating PSA, at one point I think it went above 100, possibly higher, despite three biopsies including a template biopsy they never found any cancer. He did have colitis bit not sure if that had an effect on the prostate/ PSA.

Hope all goes well.

Thanks Chris

User

Posted 12 Aug 2021 at 14:15

Update: I had a Prostate MRI (3T) last Friday and the results showed No targetable lesion, and the radiologist's impression was chronic prostatitis (not sure if that is just by default). No capsular disruption, normal bladder wall thickness, no inflammation seen in the lymph nodes. He did make this comment which my urologist said was not concerning...."Whispy intermediate T2 signal in the peripheral zone that can be seen with chronic protatitis". So overall I took the MRI results as good news.

Urologist wanted to hold on the TRUS biopsy scheduled for 8/17. I guess because he seems like it is more likely prostatitis. He ordered another PSA test today, at my request, and the results came back as 12.71 (a 35% drop from the level of 19.66 on 7/23). Remember, he wanted to hold on the biopsy even before he knew it dropped 35% in 3 weeks.

Now I don't know what to do. Is it atypical of cancer to fluctuate that much with PSA? It certainly moved in the right direction. So, should I wait a few more weeks and test it before I jump into the biopsy (that is what the DR recommends).

User

Posted 12 Aug 2021 at 14:40

My advice to you is to eschew the now largely-discredited TRUS biopsy (particularly in indeterminate cases like yours) and hang out for a more accurate transperineal biopsy, where they will take multiple samples.

I have seen guys here who have had three risky TRUS biopsies, which were inconclusive, only to have to endure a fourth transperineal biopsy, which confirmed or denied cancer.

If you have to wait a month or two to get a more definitive diagnosis, it will be worth it!

Best of luck.

Cheers, John.

User

Posted 12 Aug 2021 at 15:20

Noone has mentioned a transperineal biopsy yet to me. They seem to be leaning toward this be inflammation/infection due to the negative MRI and recent downward movement of the PSA. So, I am not sure what you meant by "hold out" for the other biopsy. I guess if the PSA does not return to my baseline, then I will have to move forward with the biopsy and I should ask for the transperineal biopsy?

I suppose the three main pieces of information (sharp PSA rise in short period of time, good MRI, and now seemingly decreasing PSA) is leading them toward prostatitis and not wanting to jump into the risk of the biopsy.

User

Posted 13 Aug 2021 at 14:56

On the advice of a family friend, I sought a second opinion from another urologist regarding the path forward. These are both very experienced urologists. I mainly did this because it was difficult for me to arrange a conversation with my primary urologist. They both agree that my condition is likely, pointing to prostatitis, and both agree that considering the clear MRI and 7 point drop in the PSA over 3 weeks, that the biopsy should be put on hold. One urologist (1 second opinion) wants to put me on antibiotics and retest in a few weeks, the other (2 my primary urologist) gave me a choice to proceed with the biopsy next week (not what he recommends) or wait and retest in 4 months! Heck, I don't want to wait 4 months. Considering the dramatic drop in the past 3 weeks without the antibiotic, I would want to know what it does in 3 or 4 more weeks while on the antibiotic.

Interesting the urologist 1 has offered to call urologist 2 and discuss it with him.

User

Posted 13 Aug 2021 at 18:37

Tah

Great news on the reduced PSA, hopefully Lyn was right with her prediction. My 3 pre cancer treatment PSA tests over a three year period each had a steady increase.

Thanks Chris

Edited by member 13 Aug 2021 at 19:16 | Reason: Not specified

User

Posted 13 Jan 2022 at 16:21

Update after 4 months:

Well, my PSA has been on a wild ride. See results below. Went from a normal baseline of 1.8 in Jan '21 to 19 in Jul '21 back to baseline of 1.8 in Nov '21 and now at 3.09 in Jan '22. Urologist ordered an MRI in Aug which showed no targeted lesions, but did mentioned something about possible chronic prostatitis (that may have been a default response, not sure). After the consistent downward trend from July and the MRI results the urologist recommended to hold on a biopsy. Everything was looking good through Nov, then I got the spike back to 3.09 yesterday.

1/7/21 - 1.8
7/22/21 - 19.10
8/11/21 - 12.71
8/23/21 - 6.3
9/22/21 - 3.43
11/16/21 - 1.8
1/12/22 - 3.09

I have been thinking about what could be causing this. In Feb and March I had my first and second dose of the Covid vaccine, then the spike to 19 was identified in July, followed by the consistent downward trend. I returned to baseline 1.8 on 11/16, then I had my Covid booster shot on 11/23. Now PSA is back to 3.09 on 1/12. Maybe this is just coincidence and I am guessing the DR will not feel the vaccine had anything to do with it. I see him next Wed 1/19.

Any comments or thoughts on the COVID vaccine doing this?

User

Posted 13 Jan 2022 at 16:48

https://cbs12.com/news/local/palm-beach-county-urologist-seeing-false-psa-levels-in-men-due-to-vaccines

User

Posted 13 Jan 2022 at 18:32

Based on anecdotal evidence on this forum (which appears to be no more or less reliable than the anecdotal evidence of a doctor in Palm beach) the vaccine might cause a small temporary rise in PSA but it is very small and very temporary. There is no way the vaccine could make PSA rise 10 fold! If that was feasible we would have seen thousands of men more than usual being sent for unnecessary biopsies over the last year.

What is very common is to see someone susceptible to prostatitis getting rollercoaster PSA readings as episodes of prostatitis are treated, abate and then recur.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 13 Jan 2022 at 18:51

I deliberately timed my last PSA to be two days after my third COVID jab (the things I do for science) my PSA went down a fraction, so no evidence of a correlation here.

Dave

User

Posted 13 Jan 2022 at 19:31

I understand LynEyre's comments very well. I told my wife if the vaccine was responsible for this, then we would be hearing much more about it. My bet is my urologist at my appointment next week will say the same.

So, what to do now? I wonder if I am just in for a biopsy here.

I had the MRI in Aug which showed no targeted lesions. Radiologist wrote the following and my Urologist did not say much about it:

"Peripheral zone: No targetable lesion is seen. Whispy intermediate T2 signal is present within the peripheral zone that can be seen with chronic prostatitis"

Radiologist also wrote the following:

Prostate dimensions: 5.6 x 3.8 x 4.0 cm (calculated via Invivo DynaCad software). Prostate volume: 39.76 cc
Peripheral zone: No targetable lesion is seen. Whispy intermediate T2 signal is present within the peripheral zone that can be seen with chronic prostatitis. .
Extraprostatic extension: None.
Transitional zone: Stromal BPH is minimal.
Extraprostatic extension: None.
Anterior fibromuscular zone: No abnormal enhancement.
Capsular disruption: None.
Neurovascular bundle region: Intact.
Bladder: No bladder wall thickening.
Pelvic lymph node enlargement: None seen.
Free fluid: None seen.
Bony metastatic disease: No sclerotic lesion seen. Fatty marrow changes are seen

User

Posted 13 Jan 2022 at 23:16

I was merely pointing out that there are some folk out there claiming that CV jabs could have, however small, an effect on PSA levels

User

Posted 14 Jan 2022 at 00:37

Yes - it was interesting in the context of posts we have had on here debating the same thing. Tthank you for sharing it.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 14 Jan 2022 at 00:40

Originally Posted by: Online Community Member

So, what to do now? I wonder if I am just in for a biopsy here.

Hopefully Andy will post a response but my instinct would be to see a urologist with proper expertise in prostatitis and ideally, an antibiotic massaged into the prostate.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 28 Dec 2022 at 10:17

Enzalutamide without a prescription - https://specialmedassortment.com Enzalutamide immediately halted the doubling of my PSA level and has, in 3+ months, reduced the PSA from approximately 400 to 5.7! I am feeling MUCH better and functioning MUCH more normally.

Edited by member 30 Jul 2023 at 05:21 | Reason: Not specified

User

Posted 31 Dec 2023 at 00:19

Ok, I just stumbled onto this thread while researching my own issue. I too am in the same boat as tah0476.

For the past 3 years, I have had my PSA tracked every 6 months because my father died of prostate cancer and my brother had his prostate removed because of cancer when he was 47 (he’s younger than me, but was on testosterone replacement that was not exactly monitored well). My PSA has always been about 3.0 every six months (even a 2.85 4K PSA blood test) up to 6 months ago (3.07 on 7/25). I even had a negative MRI in Dec 2022. Then I had a PSA yesterday and the results came back 12.54. A head spinning shock to say the least. I have an appointment with my urologist next week, but like tah0476, I have quite a bit of anxiety right now. I will say this though, I came down with COVID in mid October and I haven’t been quite the same since (other issues). I’ve read that the widespread inflammation caused by COVID can cause a ton of problems that are related to infection. Has anyone else read this? Also, does anyone other than tah0476 know of a situation similar to this that resulted in prostatitis? I’m strongly leaning towards prostatitis, but hearing about others in the same boat calms my anxiety.

User

Posted 31 Dec 2023 at 01:52

We have definitely had similar posts, do not be too worried.

I assume the urologist will do tests for infection and may prescribe antibiotics to try and rule out infection. There isn't much point in worrying, because worrying is not going to change anything.

Dave

User

Posted 31 Dec 2023 at 03:56

Dave, I greatly appreciate your reply. I’m inclined to believe this is prostatitis, but obviously with my family history, my mind goes off the rails. Indeed, it is entirely plausible that my PSA was 50 five or six weeks ago and this 12.54 is a result on my PSA’s way back down to normal.

On a comical side note, why do we, as patients, always seem to get bad test results or symptoms right before the weekend or before a holiday? I mean…come on! Why couldn’t these results come on a Tuesday or Wednesday? At least I could call the office and feel like I was getting something done.

Oh well, just gotta wait until next Tuesday. I’ll keep everyone posted.

User

Posted 13 Jan 2024 at 03:17

Ok, back with an update.

I had an appointment with my urologist, who strongly recommended an MRI. I had an MRI which revealed the following:

PROSTATE:
Size (AP x TRV x CC): 4.1 x 5.3 x 4.6 cm = 52 mL.
Central gland enlargement (BPH): Moderate.
There is multiple areas of mild T2 hypointensity throughout the peripheral zone
which appear mildly wedge-shaped, with a single more focal area of signal
abnormality as described:

Lesion: 1
Size: 0.7 cm, series 5/20 and 4/18.
Location: Left lateral peripheral zone near the mid gland.
T2-weighted images: Score 4: Circumscribed, homogeneous moderate
hypointense focus/mass confined to prostate and less than 1.5 cm in greatest
dimension.
Diffusion-weighted images: Score 3: Focal (discrete and different from
background) hypointense on ADC and/or focal hyperintense on high b-value DWI;
may be markedly hypointense on ADC or markedly hyperintense on high b-value DWI, but not both.
Dynamic post-contrast images: (+) Focal, and earlier than or
contemporaneous with enhancement of adjacent normal prostatic tissues, and,
corresponds to a finding on T2-weighted and/or DWI.
PI-RADS Assessment Category: 3, Intermediate (presence of clinically significant
cancer equivocal.
Extra-prostatic extension (EPE): Abuts capsule without visualized EPE.
Seminal vesicles: Normal.
URINARY BLADDER: Unremarkable.
LYMPH NODES: No pelvic lymphadenopathy.
BONES: No suspicious osseous lesion.

IMPRESSION:
1. PI-RADSv2 Category 3 - Intermediate (the presence of clinically significant
cancer is equivocal). Multiple areas of wedge-shaped mild signal abnormality
throughout the prostate gland, suspected related to sequela prostatitis. Single
more focal area of more moderate signal abnormality within the left lateral
peripheral zone, may also reflect sequela prostatitis versus a a small focus of
neoplasm. Follow-up MRI recommended.
2. Calculated prostate volume of 52 mL.

I haven't had any follow up PSA, but that is scheduled for Feb 9th. I am sure my urologist will recommend a biopsy, but it seems that one of the guidelines now for recommending a biopsy is PSA Density. Mine right now is 0.24 (using the PSA from 12/29/23 of 12.54). If my PSA decreases on Feb 9th to anything lower than 5.2, guidelines seem to indicate that you might need to hold off on a biopsy. Anyone have experience with this?

Notification

Join the online community now.