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Rapid PSA velocity

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User
Posted 04 Oct 2023 at 06:42

I was born 1975 (48 years old), I'm 5'11" and weigh 165 pounds with no medical issues. Never smoked or drank alcohol.

I started testing my prostate since 2016, and these are my PSA levels (ng/ml) with DRE findings:

May 31, 2016: PSA (0.54) %Free PSA (35%)

Jan 29, 2018: PSA (0.58)

Mar 18, 2019: PSA (0.64)

May 15, 2020: PSA (0.62)

Aug 17, 2021: PSA (0.68) DRE (30g, smooth, no nodules)

Aug 23, 2022: PSA (0.75) DRE (30g, smooth, no nodules)

Aug 29, 2023: PSA (1.53) DRE (40g, smooth, no nodules, no pain felt when doctor pressed on prostate checking for infection)

My only symptoms happen (occasionally) in the mornings ONLY (right after waking up): weak, but uninterrupted, urine flow that lacks force, preceded by brief hesitancy. I empty the bladder fine without voiding again for another 2-3 hours later.

Can cancer enlarge the prostate gland size (from 30g to 40g) within a year? 

I'd love to hear your thoughts on my latest test result (psa 1.53).

User
Posted 04 Oct 2023 at 10:18

Measuring prostate size from DRE is a bit of a guess. I don't doubt it is getting bigger, but that last jump was probably from 33cc to 36cc which, if you are reporting to the nearest 10, is from 30 to 40. ( by the same argument it could have been from 26 to 44, which also would be reported as 30 to 40).

The PSA figures would not attract the slightest concern in the UK. What is really good is the long history of results. The last one is a bit of an anomaly I hope the next one goes down back to a figure more normal for you. If it doesn't in a year or two it will get to about 3 and that would start to look suspicious.

My main advice to you would be start smoking and drinking. The good lord only gives us three score years and ten, and it sounds like you have wasted the first 48; have a blow out for the next 22.

Dave

User
Posted 04 Oct 2023 at 10:20

There are two separate conditions, Benign Prostatic Hyperplaisia (BPH, enlarged prostate), and prostate cancer. They are not related to each other (although it is possible to have both conditions). BPH causes urinary flow issues in some men. Prostate Cancer usually has no symptoms.

You don't say how the prostate volume (I presume, although it's not measured in grams) was measured. If it's an estimate from a DRE, 30-40g is within likely measurement inaccuracy. It might even be for ultrasound too.

PSA doubling in a year is concerning. That should probably result in a urine test for infection, and a retest in about 6 weeks. Some things can push it up temporarily, such as ejaculating in previous last day or two, having COVID or a COVID vaccination, possibly cycle riding.

I don't know what the referral protocols are where you are, but not many places include rate of change of PSA in the criteria. Research on this suggests that if you ignore rate of change, those patients who need referring soon cross over the referral threshold anyway, which would be between 2.0 and 2.7 in the UK depending which recommendations you look at for someone under 50.

Also, the US hasn't widely adopted MRI before biopsy and still significantly uses TRUS biopsies, which does mean the risk of referral is higher, as in going though an unnecessary invasive procedure.

So I think the first thing I would do is rule out any temporary effects by having a urine test and if clear, another PSA test.

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User
Posted 04 Oct 2023 at 10:18

Measuring prostate size from DRE is a bit of a guess. I don't doubt it is getting bigger, but that last jump was probably from 33cc to 36cc which, if you are reporting to the nearest 10, is from 30 to 40. ( by the same argument it could have been from 26 to 44, which also would be reported as 30 to 40).

The PSA figures would not attract the slightest concern in the UK. What is really good is the long history of results. The last one is a bit of an anomaly I hope the next one goes down back to a figure more normal for you. If it doesn't in a year or two it will get to about 3 and that would start to look suspicious.

My main advice to you would be start smoking and drinking. The good lord only gives us three score years and ten, and it sounds like you have wasted the first 48; have a blow out for the next 22.

Dave

User
Posted 04 Oct 2023 at 10:20

There are two separate conditions, Benign Prostatic Hyperplaisia (BPH, enlarged prostate), and prostate cancer. They are not related to each other (although it is possible to have both conditions). BPH causes urinary flow issues in some men. Prostate Cancer usually has no symptoms.

You don't say how the prostate volume (I presume, although it's not measured in grams) was measured. If it's an estimate from a DRE, 30-40g is within likely measurement inaccuracy. It might even be for ultrasound too.

PSA doubling in a year is concerning. That should probably result in a urine test for infection, and a retest in about 6 weeks. Some things can push it up temporarily, such as ejaculating in previous last day or two, having COVID or a COVID vaccination, possibly cycle riding.

I don't know what the referral protocols are where you are, but not many places include rate of change of PSA in the criteria. Research on this suggests that if you ignore rate of change, those patients who need referring soon cross over the referral threshold anyway, which would be between 2.0 and 2.7 in the UK depending which recommendations you look at for someone under 50.

Also, the US hasn't widely adopted MRI before biopsy and still significantly uses TRUS biopsies, which does mean the risk of referral is higher, as in going though an unnecessary invasive procedure.

So I think the first thing I would do is rule out any temporary effects by having a urine test and if clear, another PSA test.

User
Posted 04 Oct 2023 at 18:38

Thank you for the feedback. Just to add few more details, 

I live in Austin, Texas, USA, and a specialist (Urologist) has been overseeing my prostate health since 2016, and the way I understood it the prostate size was just an estimate (in grams) based on DRE.

My first COVID vaccination: Moderna, on Sept 4, 2021.

My second COVID vaccination: Moderna, on October 16. 2021. 

Urinalysis result was clear, and NO culture was done.

Never tested positive for COVID, but I remember feeling a little under-the-weather in Summer 2023 and didn't take COVID test because my symptoms back then weren't too bad (slight throat discomfort for a couple-of-days only). On the other hand, the couple-of-weeks just before my last PSA test (1.53 ng/ml) on Aug 29, 2023, I had constipation, and my first ever urinary flow issues started on Sept 8, 2023 - or maybe I started to scrutinize my urine flow after my last PSA spike. Again, my urinary flow issues (occasional hesitancy and weaker flow only after waking up in the morning).

So I'd like to rephrase my original question: can prostate carcinoma in its early stages enlarge the prostate size; ie,

does prostate size get bigger under these 3-conditions only?

- Inflammation or/and,

- BPH or/and,

- ONLY advanced prostate cancerous cells?

Thank you for your feedback.

User
Posted 10 Oct 2023 at 05:29

My urologist put me on Doxycycline 100mg for 30-days: August 30 - September 29, to rule-out prostatitis as cause of elevation. My new Free/Total PSA came out October 4:

PSA (1.12) %Free PSA (33%)

So my PSA dropped from 1.53 to 1.12 in 5-weeks, but still considerably higher from my 2022 baseline 0.75.

Your thoughts on this - is this a reasonable PSA response over a 5-week period?

Thanks,

Omar 

 
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