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Brutal increase in PSA level in 3 months

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User
Posted 04 Oct 2024 at 10:58

Hello  i get my last control psa result and is 35.80 mg/ml!!.

30/05/2022: 4.14 ng/ml
25/09/2023: 5.33 ng/ml
12/06/2024: 5.85 ng/ml

27/09/2024: 35.80 ng/ml

I am in Shock. To say that at the beginning of August for 2 weeks I had somewhat dark semen and I feel some slight discomfort in the perineal area. At the beginning of August my semen was somewhat dark for 2 weeks and then it returned to normal and for a few days now the semen has had a somewhat yellowish color. :(

What do you think of this sharp increase in the PSA level in just 3 months and diagnosed with Gleason 6 (3+3) on active surveillance?

Possibly this is a rare mutation or could it be something else?

Quite scared and distressed until the appointment with my urologist arrives :(

Thank u

User
Posted 11 Nov 2024 at 09:00

My understanding is that there is strong evidence that Gleason 6 hardly ever (and possibly never) becomes metastatic.

The main problem is that, although tests and MRIs are getting more accurate, it remains the case that it is not possible to be certain that a Gleason 6 diagnosis is accurate - the only way to verify this is with a post-prostatectomy pathology which obviously defeats the object of AS. Another problem is that there is nothing to stop a man with a Gleason 6 from subsequently developing another more aggressive cancer.

That is why it is so important to remain vigilant when on AS (e.g. with regular PSA tests and MRIs) so that you are ready to act if there are signs that the cancer is progressing.

My hope is that in the future men will not face such a dilemma because the diagnostics will become more and more accurate at identifying the dangerous cancers.

User
Posted 04 Oct 2024 at 12:16

Well, it definitely needs raising quickly with urology.

Did you have a biopsy during this period?

It might be prostatitis (inflammation of the prostate), and the discomfort might also suggest this. PSA results are invalid if you have prostatitis.

User
Posted 04 Oct 2024 at 13:18

Hi mate.

I'm not medically trained but like Andy says it's unlikely to be cancer related, more like another prostate condition. It should be picked up by urology if you're on AS, but you might have to have to nudge them.

Years ago I had the snotty coloured semen, again it was nothing to do with cancer.

Best of luck buddy.

 

Edited by member 04 Oct 2024 at 14:01  | Reason: Typo

User
Posted 08 Nov 2024 at 10:18

Hello again mate.

I've reread your first conversation.

https://community.prostatecanceruk.org/posts/t29873-completely-terrified-and-distraught#post289783

Am I right that your biopsy a year ago revealed Gleason 6 (3+3), T2 disease that was close to the capsule wall, and at that time your PSA was 5.85 and you selected active surveillance?

Your big rise in PSA has been drastically reduced by antibiotics, which obviously indicates much of it was caused by a non cancerous condition. However, during your AS, prior to the big increase, your PSA levels had shown a gradual rise. 

I understand your anxiety in the PSA  not returning to its former levels and it seems very wise to have a follow MRI and possible biopsy to check if there has been any disease progression.

I wish your the best of luck with your results.

 

 

 

User
Posted 09 Nov 2024 at 03:09

Originally Posted by: Online Community Member

Well, actually, at the time of diagnosis the PSA was 5.33 and 8 months later it was 5.85.

In outright terms that's not a startling PSA level and the difference between 5.33 and 5.85 isn't huge, though there's definitely a slow upward trend. PSAs can commonly get up to 40+ and sometimes even go past the 1,000 mark, so a 5.85 isn't extreme.

Jules

 

 

User
Posted 09 Nov 2024 at 20:52

Hi Murdock,

I'm not medically qualified, but could it be that, although you've finished the antibiotics, and there is now no evidence of current infection, that it might take some time for that to be registered in the PSA level returning to previous levels?  There has already been a dramatic fall in your PSA levels after one month of treatment, so there could be room for a further, more gradual decline in PSA levels.

Just my two-penny-worth.

Best wishes,

JedSee.

User
Posted 09 Nov 2024 at 23:00

Hi,

The hospital I use told me they don't do tests less than 6 weeks apart.  It's always worrying but I'd think it's got further to drop and might take time.

User
Posted 10 Nov 2024 at 20:20
Murdock, I suspect the urologist put you straight on antibiotics because s/he knew that a sixfold increase in PSA over 3 months was due to something other than cancer and most likely an infection. As a benchmark, doubling in 3 months would be an extremely fast growing cancer.

I don't know how long it takes for inflammation of the prostate to die down completely, but a threefold decrease in just 3 weeks strongly suggests that was the main cause. I don't think you have too much to worry in waiting another few months to see if it returns all the eway to baseline.

I sympathise with your anxiety over treatment, but you may one day have to recognise it will be necessary and you will have to decide what of the suggested options to accept. Let's hope that day is still a very long way away.

User
Posted 11 Nov 2024 at 13:30

This forum is a place where people with bad stories come. There are the 1 in 1000 events.  There are or were around 12,000 ops done every year and many more having other treatments. So the numbers on here aren't that big.

I think your doctor did your psa test early to check the tablets were having an effect.  They are so that's good. If he'd waited until when he thought your psa would be right down you might have waited until December when it might have been too late. Your estimate of 6.5ish sounds about right.

I was 67 when I had the op and was worried, I can understand that it's more worrying if you're younger. I thought that at 67 I'd put up with any side effects the priority being to remain curable. 

As my lesion was said to be near the edge and gleason 4+4 I was very keen to get the op done. I think the nurses must have thought me odd as I was over the moon to get onto the table and they dashed over as I leapt aboard. I had visions of multiple possible delays including the surgeon being ill or a road accident so being there and sleeping for 2hrs to wake up likely cured was job done whatever side effects may occur. I didn't feel a thing and left hospital after 2 nights. It would have been one night but my pelvic drain seemed to be draining more than I thought good and asked to stay. Not everyone has such a drain I believe.

6.5 isn't that high but I wonder if you've a point when you think you'll decide.  The MRI might make it clearer.

 

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User
Posted 04 Oct 2024 at 12:16

Well, it definitely needs raising quickly with urology.

Did you have a biopsy during this period?

It might be prostatitis (inflammation of the prostate), and the discomfort might also suggest this. PSA results are invalid if you have prostatitis.

User
Posted 04 Oct 2024 at 12:21

hello mate, i dont have biopsy in the last time. The last biopsy is a year ago.

so u think is some infection/inflammation? 

The truth is that apart from being scared, I am quite confused...
I was always informed that prostate cancer is a gradual disease...
even in cases of more aggressive tumors.
I didn't think that a Gleason 6 tumor classified as low risk
was going to increase the PSA value sixfold in just over 3 months...
User
Posted 04 Oct 2024 at 13:18

Hi mate.

I'm not medically trained but like Andy says it's unlikely to be cancer related, more like another prostate condition. It should be picked up by urology if you're on AS, but you might have to have to nudge them.

Years ago I had the snotty coloured semen, again it was nothing to do with cancer.

Best of luck buddy.

 

Edited by member 04 Oct 2024 at 14:01  | Reason: Typo

User
Posted 08 Nov 2024 at 08:20

Hello again i have update news with last test.

30/05/2022: 4.14 ng/ml
25/09/2023: 5.33 ng/ml
12/06/2024: 5.85 ng/ml
27/09/2024: 35.80 ng/ml
31/10/2024: 11.70 ng/ml

Well, after the value of 35.80 ng/ml, the urologist prescribed me to take ciprofloxacin antibiotics
for 14 days and permixon for 1 month and do some urine and semen cultures.
The PSA has dropped from 35.80 ng/ml to 11.70 ng/ml in 1 month
and now the cultures have all come back negative.
Yesterday I had a consultation with the urologist and he prescribed a Multiparametric MRI
and very possibly a new biopsy later since it will be a year since the diagnosis.
Now I am quite distressed and very stressed because I expected at least the PSA
to return to a value similar to the control on 12/06/2024.
The uncertainty now is much greater because we do not know
what amount of PSA is attributable to probable tumor progression
or what amount is attributable to inflammation.

Tonight I barely managed to sleep with tremendous worry. :(

Edited by member 08 Nov 2024 at 09:47  | Reason: Not specified

User
Posted 08 Nov 2024 at 10:18

Hello again mate.

I've reread your first conversation.

https://community.prostatecanceruk.org/posts/t29873-completely-terrified-and-distraught#post289783

Am I right that your biopsy a year ago revealed Gleason 6 (3+3), T2 disease that was close to the capsule wall, and at that time your PSA was 5.85 and you selected active surveillance?

Your big rise in PSA has been drastically reduced by antibiotics, which obviously indicates much of it was caused by a non cancerous condition. However, during your AS, prior to the big increase, your PSA levels had shown a gradual rise. 

I understand your anxiety in the PSA  not returning to its former levels and it seems very wise to have a follow MRI and possible biopsy to check if there has been any disease progression.

I wish your the best of luck with your results.

 

 

 

User
Posted 08 Nov 2024 at 11:40

"Am I right that your biopsy a year ago revealed Gleason 6 (3+3), T2 disease that was close to the capsule wall, and at that time your PSA was 5.85 and you selected active surveillance?"

Well, actually, at the time of diagnosis the PSA was 5.33 and 8 months later it was 5.85.

Edited by member 08 Nov 2024 at 11:41  | Reason: Not specified

User
Posted 09 Nov 2024 at 03:09

Originally Posted by: Online Community Member

Well, actually, at the time of diagnosis the PSA was 5.33 and 8 months later it was 5.85.

In outright terms that's not a startling PSA level and the difference between 5.33 and 5.85 isn't huge, though there's definitely a slow upward trend. PSAs can commonly get up to 40+ and sometimes even go past the 1,000 mark, so a 5.85 isn't extreme.

Jules

 

 

User
Posted 09 Nov 2024 at 11:16
I expected the PSA value to be around 6 or 6.5 following that slow upward trend,

but after the antibiotics it has dropped from 35.80 to 11.70, which still seems quite high to me.

I have a horrible fear that something catastrophic is happening inside my prostate.

B.R.

User
Posted 09 Nov 2024 at 20:52

Hi Murdock,

I'm not medically qualified, but could it be that, although you've finished the antibiotics, and there is now no evidence of current infection, that it might take some time for that to be registered in the PSA level returning to previous levels?  There has already been a dramatic fall in your PSA levels after one month of treatment, so there could be room for a further, more gradual decline in PSA levels.

Just my two-penny-worth.

Best wishes,

JedSee.

User
Posted 09 Nov 2024 at 23:00

Hi,

The hospital I use told me they don't do tests less than 6 weeks apart.  It's always worrying but I'd think it's got further to drop and might take time.

User
Posted 10 Nov 2024 at 09:09
Thank you very much for your opinion, which helps calm my tremendous anxiety a little.

The antibiotic treatment was for 14 days and the PSA test was performed

10 days after finishing the antibiotic treatment.

I expected the urologist to culture bacteria from semen and urine before prescribing antibiotics,

but I don't understand why he did it the other way around.

Now we do not know if the possible inflammation was due to an infection or not :(

I am tremendously anxious and very afraid that something aggressive has appeared

again in my prostate and I will have to leave AS.

I am truly terrified of surgery and its unpleasant side effects since I am still very young.

B.R.

User
Posted 10 Nov 2024 at 20:20
Murdock, I suspect the urologist put you straight on antibiotics because s/he knew that a sixfold increase in PSA over 3 months was due to something other than cancer and most likely an infection. As a benchmark, doubling in 3 months would be an extremely fast growing cancer.

I don't know how long it takes for inflammation of the prostate to die down completely, but a threefold decrease in just 3 weeks strongly suggests that was the main cause. I don't think you have too much to worry in waiting another few months to see if it returns all the eway to baseline.

I sympathise with your anxiety over treatment, but you may one day have to recognise it will be necessary and you will have to decide what of the suggested options to accept. Let's hope that day is still a very long way away.

User
Posted 11 Nov 2024 at 08:45
Hello amd thank you very much for yours comments.

I am scheduled for an MRI on December 17th and then discuss the results on December 27th.

I hope this gleason 6 tumor has not suffered a mutation of such magnitude.

I am aware that in medicine 0% and 100% do not exist, but there are several cases

in this forum of members with an initial Gleason 6 tumor that progressed

to much more aggressive forms in not much time, unfortunately.

All of this contrasts with the large number of articles in the literature

in which some go so far as to state that Gleason 6 is indolent/harmless.

B.R.

User
Posted 11 Nov 2024 at 09:00

My understanding is that there is strong evidence that Gleason 6 hardly ever (and possibly never) becomes metastatic.

The main problem is that, although tests and MRIs are getting more accurate, it remains the case that it is not possible to be certain that a Gleason 6 diagnosis is accurate - the only way to verify this is with a post-prostatectomy pathology which obviously defeats the object of AS. Another problem is that there is nothing to stop a man with a Gleason 6 from subsequently developing another more aggressive cancer.

That is why it is so important to remain vigilant when on AS (e.g. with regular PSA tests and MRIs) so that you are ready to act if there are signs that the cancer is progressing.

My hope is that in the future men will not face such a dilemma because the diagnostics will become more and more accurate at identifying the dangerous cancers.

User
Posted 11 Nov 2024 at 13:30

This forum is a place where people with bad stories come. There are the 1 in 1000 events.  There are or were around 12,000 ops done every year and many more having other treatments. So the numbers on here aren't that big.

I think your doctor did your psa test early to check the tablets were having an effect.  They are so that's good. If he'd waited until when he thought your psa would be right down you might have waited until December when it might have been too late. Your estimate of 6.5ish sounds about right.

I was 67 when I had the op and was worried, I can understand that it's more worrying if you're younger. I thought that at 67 I'd put up with any side effects the priority being to remain curable. 

As my lesion was said to be near the edge and gleason 4+4 I was very keen to get the op done. I think the nurses must have thought me odd as I was over the moon to get onto the table and they dashed over as I leapt aboard. I had visions of multiple possible delays including the surgeon being ill or a road accident so being there and sleeping for 2hrs to wake up likely cured was job done whatever side effects may occur. I didn't feel a thing and left hospital after 2 nights. It would have been one night but my pelvic drain seemed to be draining more than I thought good and asked to stay. Not everyone has such a drain I believe.

6.5 isn't that high but I wonder if you've a point when you think you'll decide.  The MRI might make it clearer.

 

User
Posted 11 Nov 2024 at 13:46
I hoped that the day of making the decision on what treatment to choose would be still far away,

suffering from a relatively small tumor (10x11 mm) and Gleason 6

but observing the upward trend of my PSA (regardless of this rise and fall

so abrupt that I even think that There is no infection as such but rather

the tumor itself may be irritating my prostate) makes me think that something

is happening faster than expected.

B.R.

 
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