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PSA Spike / MRI PIRAD 2 / 46 Years Old

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User
Posted 16 Feb 2023 at 21:15

I am 46 and began getting my PSA tested at 39 as my father was diagnosed at 63 with advanced prostate cancer that ultimately killed him.

My PSA has always been under 1.0.

Last January ('22) I tested at 0.6.

This January ('23) I was shocked to see that my PSA had rocketed to 7.55. I went to the urologist and he did a DRE, as he does every year. He said "It's completely normal"

One week later I tested my PSA again and it had gone done to 5.6. The urologist sent me for a 3T prostate MRI and I received the results today which took place two weeks after my PSA test of 7.55.

Size: 4.0 x 4.5 x 2.0 L x W × H cm, prostatic volume 18.72 ml, PSA density 0.403 ng/mL/mL Quality: Mild geometric distortion on diffusion-weighted imaging from rectal distention does not compromise diagnostic confidence.

Hemorrhage: Not present.

Peripheral zone: Slightly heterogeneous high signal with no focal findings, category 2/5.

Transition zone: Moderate heterogeneity with no focal lesions, category 1/5.

DCE: Not present

Prostate margin: No extra prostatic extension.

Overall PI-RADS category: 2/5

Neurovascular bundles: Not involved.

Seminal vesicles: Not involved.

Lymph nodes: No lymphadenopathy.

Bones: No osseous metastases suggested.

Other pelvic organs: Normal.

The urologist is recommending that I go in for a biopsy. It's only been 17 days since I tested at 7.55 and part of me wants to wait a few more weeks and test again in order to rule out infection or any other prostate issue that might have caused 1258% increase in PSA in one year.

Has anyone had any experience like this?

User
Posted 16 Feb 2023 at 23:28

We have had people on here with high and low PSA and everything in between. With the MRI showing so little signs of concern, and a falling PSA I'm surprised a biopsy is on the cards. Having said that a biopsy technology has improved in the last five years so it isn't a big deal.

Personally I would want to wait a month and have another PSA test. It has already fell 30% from the last test, and who knows how high or low it has been throughout the previous year. I would probably want monthly or at most three monthly PSA tests, and if it was constantly falling and got below 1.0 fairly soon I wouldn't be worried, but if it isn't showing signs of a rapid fall then yes go for a biopsy. Don't forget I'm not a medic and what chances I'm prepared to take with my health may be different to your preferences.

Dave

User
Posted 17 Feb 2023 at 09:53

Did you have COVID or a COVID vaccination before the PSA test?
This can temporarily push PSA up for a month.

Usual practice after a once-off increased PSA would be to check for a UTI, treat if necessary, and retest in 6 weeks.

User
Posted 17 Feb 2023 at 14:20

I agree with you and was surprised that he recommended a biopsy right away. 

I went in today to see another urologist who specializes in prostate cancer and he said the most prudent course of action would be additional PSA testing over the next few months to see what happens. He said the MRI is far from conclusive, but the dramatic PSA spike for someone my age is more consistent with with an infection or another benign cause and we should investigate that before I jump to getting the needle. So I am going to wait a month and test again. 

User
Posted 17 Feb 2023 at 14:21

I had COVID about six months ago... so I imagine I'm out of the woods on that. 

User
Posted 04 Mar 2023 at 20:31

05 Jan 2022 - PSA 0.66

28 Jan 2023 - PSA 7.55

4 Feb 2023 - PSA 5.65

23 Feb 2023 - PSA 1.20

Although I haven't been back to see the urologist yet (I'll go at the end of next week), I did re-rest again a little less than a month after my massive spike to 7.55 and my PSA has fallen quite a bit... now at 1.20. Still elevated for my age (46) and about double my baseline, but it has been moving in the right direction over the month of Feb.

With a negative DRE, an unremarkable MRI and a rapidly declining PSA,  I'm feeling a little bit better that this is probably due to an infection or a cause other than cancer.

User
Posted 05 Mar 2023 at 01:08

Thanks for the update. Seeing a PSA profile like this may help someone in a similar position in the future.

Dave

User
Posted 06 Mar 2023 at 16:38

I'm 42 and have just undergone a TP Biopsy under LA after 3 PSA's of 7.5, 5.4 and 3.5. The TP Biopsy was awful to go through. I know it had to be done but jeez, it was just horrible. Had an MRI the week before so all is going big guns - now just waiting for the results and next steps. Past few months have been a whirlwind but I find it easier being open and honest, talking about it as that is what helps me cope. I can see that your PSA's are on the decrease, mine did the same but still had an area of concern that needed investigating. The next 3 weeks will be long ones that's for sure! 

User
Posted 06 Mar 2023 at 16:58

I am hoping to avoid the biopsy, but it’s probably good that you got it done. 

Why did you start getting the PSA test at such a young age? Family history?

I am curious as to what they saw in your MRI? What were your PIRAD scores?

User
Posted 15 Mar 2023 at 01:04

Final test was on March 10th. PSA down to 1.05. Urologist at the Cleveland Clinic canceled the biopsy appointment and said to test again in six months. Case closed, at least for now and I hope for good. 

Good luck to everyone out there.

 
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