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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 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

 
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