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PSA & METS

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User
Posted 05 Feb 2023 at 07:42

Hi folks, looking for any words of wisdom regarding my situation. I am a 57 year old and just had a PSA of 4.5. Due to have a Urology appointment on Tuesday but in the meantime freaking out and finding it difficult to focus on anything.

I started having PSA checks in 2016 as I was running to the loo frequently and had occasional nocturnia. Also had an Uncle on Mother's side diagnosed in his 60's - still alive today.

PSA history was as follows: 

Mar 2016 0.48

Nov 2017 0.77

Feb 2019 1.33

Oct 2020 0.57

Jan 2023 4.5

Normal PSA's generally had DRE's which were normal other than the comment that the prostate was slightly enlarged but synonymous with age. Recent DRE was reported as enlarged with central sulcus and no cragginess. 2/3rd of the prostate was able to be felt. Incidentally I went for my recent PSA as my Nocturia had developed to the point where I was getting up once a night every night. Interestingly this has changed again in the last week where I am only getting up some nights. 

What really worries me is the significant PSA increase and whilst I understand it can be caused by other conditions I haven't really seen many stories where this turned out to be the case. Furthermore I have to assume that it didn't increase linearly since Oct 2020. As a result I think I am almost resigned to the fact that I will end in a positive diagnosis. Furthermore I'm also now worried that the symptoms in 2016 were the beginning of prostate cancer despite the PSA results and I will now be diagnosed with advanced disease as it has progressed over 7 years. I notice I now have a painful/tender point on my right hip (no bigger than a fingernail) and wonder if this could be bone mets?

Should also say that semen quality has been poor more recently - less quantity and more watery. Might have had one instance with blood in semen a couple of months back - difficult to tell as it was extremely faint pink. Not sure if it was lighting.

Apologies for the long email but as you might be able to tell I am currently in some distress. Appreciate any thoughts that might help.

-Alex

Edited by member 05 Feb 2023 at 09:05  | Reason: Additional info

User
Posted 05 Feb 2023 at 20:14

Thanks for your feedback - much appreciated. To quote GP comments on prostate were “enlarged prostate with central sulcus, only able to palpate lower 2/3rds but no cragginess/masses”.

interested to hear any thoughts on whether I might have had PCa for last 7 years, despite lower PSA’s, and the possibility it is now advanced with Mets given pain to touch at top outside of leg?

User
Posted 30 Apr 2023 at 07:41

Thought I would provide an update on my earlier situation in the event that it provides a perspective for others that might be in a similar situation. PSA went from 0.57 to 4.5 in 27 months. Had an MRI with a PI RADS 2 result. Rather than have an immediate biopsy I decided to retest PSA after 3 months and have just had the results back with PSA now at 0.7. Clearly relieved and although I haven't spoken with my Dr yet about results it seems that my levels have returned to around where they were historically. Assuming I might be asked to retake in another 3-6 months however massively relieved at the moment. 

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User
Posted 05 Feb 2023 at 09:58

You should have been referred to Urology for investigation with a PSA >=3.1.

My brother has a PSA of 4.5, he has a MRI every 6 months. No signs of cancer yet.

User
Posted 05 Feb 2023 at 10:00
Thanks Jim - I have been referred to see a Urologist on Tuesday.

-Alex

User
Posted 05 Feb 2023 at 15:54

Push for an MRI, better to be safe than sorry!

 

User
Posted 05 Feb 2023 at 17:53

Hi Mellick, I can understand you thinking the worst but chances of you having advanced PCa must be pretty slim. It would be worth repeating the the PSA to check whether the abnormal reading was for some other reason such as infection (and a MRI as already suggested). The fact you have an enlarged prostate tends to count in your favour. Statistics show they are less likely to turn cancerous. A larger prostate will also produce more PSA

User
Posted 05 Feb 2023 at 18:02

Chris, 

Thanks for the reassuring words. The one thing I’m trying to get my head around is if I have had an enlarged prostate for a number of years why the sudden jump in PSA now?

-Alex

User
Posted 05 Feb 2023 at 20:02
You said it was described as 'slightly enlarged' which is not the same as have an enlarged prostate - if they thought it was enlarged, they would likely have offered you tablets. A sharp rise in PSA coupled with symptoms which appear quite suddenly and then seem to improve is more indicative of a urine infection or prostatitis than cancer. The change in semen is more concerning than the PSA but could also be a sign of prostatitis.

There are plenty of men who have passed through this forum with raised PSA who subsequently got the all clear - it is just not so easy to find their threads because they are not actively posting (no need for a PCa forum once you are told you don't have PCa!)

It is possible to have two things at the same time - a UTI and early prostate cancer. Once you have seen a urologist and a scan has been arranged, you will feel better, I think.

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

User
Posted 05 Feb 2023 at 20:14

Thanks for your feedback - much appreciated. To quote GP comments on prostate were “enlarged prostate with central sulcus, only able to palpate lower 2/3rds but no cragginess/masses”.

interested to hear any thoughts on whether I might have had PCa for last 7 years, despite lower PSA’s, and the possibility it is now advanced with Mets given pain to touch at top outside of leg?

User
Posted 05 Feb 2023 at 22:47
Bone mets tend not to hurt when you press the skin. I think the likelihood of you having advanced prostate cancer while having years of normal PSA is almost zero.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 05 Feb 2023 at 23:23

I seem to recall about 2/3rds of men referred for raised PSA turn out not to have prostate cancer.
Only about 14% of men referred for blood in semen have prostate cancer.
Prostate cancer very rarely causes urinary symptoms - those are almost always caused by an enlarged prostate. (There's now a move going on to stop talking about prostate cancer symptoms, as for the most part, it doesn't have any and talking about symptoms is misleading.)

You should really have been referred in Feb 2019 because of PSA doubling in 2 years, but your PSA reading in Oct 2020 shows this would have been a false alarm and not due to cancer. Besides the other things mentioned, having COVID or a COVID jab in the preceding month can temporarily push up PSA quite considerably.

Obviously, we can't make any guarantees, so you do need to be checked out.

User
Posted 06 Feb 2023 at 09:03

Thanks all for the encouraging words. Appreciate no one can give an answer - only tests can do that however it has taken the edge off of my anxiety a little. 

Urology appointment tomorrow. Will update afterwards although assume I won't learn much tomorrow.

User
Posted 07 Feb 2023 at 13:29

Quick update - had my consultation with urologist today. DRE examination was slightly enlarged but otherwise normal. Suggested it could be prostate inflammation but no guarantees. Basically gave me the option of waiting 3 months and repeating the PSA in the hope that it reduces or continuing to MRI (and most likely biopsy). I asked for his advice and he said if I decided to wait 3 months he wouldn't tell me that he strongly recommends against that course of action however MRI and biopsy is the only thing to give some certainty one way or the other. He said he personally would choose that route especially with family history of cancer.

Back tomorrow for MRI - still extremely anxious!

User
Posted 07 Feb 2023 at 16:18
Good decision, Mellick - fingers crossed for you.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 13 Feb 2023 at 18:48

Still waiting on the results from my mpMRI scan last Wednesday and after initially calming down some I seem to be getting myself in a panic again as each day passes. 

I'm having some pain in and around the trochanter on my right leg and can't seem to dispel the worry that if I have a PCa diagnosis from my MRI it has already spread. I also have similar cramping/deadleg feeling on left leg when lying on my side in bed at night. What is troubling me is the fact that my PSA went from 0.5 to 4.5 in 27 months. Everything I read seems to point to this rate of increase in PSA being associated with an aggressive cancer. What I'm trying to understand is how quickly an aggressive cancer might metastasise? Assuming I was clear of any cancer when my PSA was 0.55 could it have metastasised in 27 months?

User
Posted 13 Feb 2023 at 22:40
Yes it is possible but highly unlikely.

You won't get a diagnosis from the MRI - it will simply help the urologist decide whether to go ahead with a biopsy.

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

User
Posted 14 Feb 2023 at 07:12

Thanks for taking the time to reply again - really appreciated. 

Understand the MRI will not provide diagnosis  but an indication of likelihood of PCa and whether there are signs of spread. 

just had another terrible night with little sleep and woke up on side with hip pain. Interestingly it seems to be at the same point on both sides. Hoping it is something completely unconnected but don’t recall doing anything that would have brought this on. Seems to be getting slightly worse over last 2 months. Finding it difficult to look beyond worst case scenarios. Hopefully results will come soon.

User
Posted 15 Feb 2023 at 12:38

Just wanted to provide an update following my MRI results which I received by telephone earlier today. 

MRI showed nothing of significance and was rated as PI-RADS 2. PSA density was 0.11. Only remaining concern was PSA doubling time (0.57 to 4.5 in 27 months) and family history (maternal Uncle). Decided to recheck PSA in 3 months and see if it has moved significantly. Consultant reassured me with respect to my fears of Advanced Prostate Cancer noting that if there was something there it would likely be small and localised hence missed on MRI. 

Appreciate I'm not necessarily completely out of the woods at this point but certainly came as a big relief when I was anticipating worst case scenario. Thanks to all for the words of support in the last few weeks. Will report back when I get my PSA in 3 months!

User
Posted 30 Apr 2023 at 07:41

Thought I would provide an update on my earlier situation in the event that it provides a perspective for others that might be in a similar situation. PSA went from 0.57 to 4.5 in 27 months. Had an MRI with a PI RADS 2 result. Rather than have an immediate biopsy I decided to retest PSA after 3 months and have just had the results back with PSA now at 0.7. Clearly relieved and although I haven't spoken with my Dr yet about results it seems that my levels have returned to around where they were historically. Assuming I might be asked to retake in another 3-6 months however massively relieved at the moment. 

User
Posted 30 Apr 2023 at 18:56

Hi Mellick,

That's great news.  Time for a celebration, I think?

Good luck.

JedSee.

 
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