Anyone Familiar With Prostate-Specific Antigen (PSA) Data

[JamLazyAss]

Just got a call from the doc about my blood test that I took last week.
He says I need to go to a specialist as my PSA number is too high.
My number is 4.23.

Below is a scale with legend that I copied from the www.cancer.gov web site.

0 to 2.5 ng/mL is low.
2.6 to 10 ng/mL is slightly to moderately elevated.
10 to 19.9 ng/mL is moderately elevated.
20 ng/mL or more is significantly elevated

Now my obvious questions are:
1) Is that really dangerously high? Probably is or I wouldn't have to go to a specialist, right?
2) What are the chances of it being cancer related?
3) If it is cancer related, how are these things treated?

Anyone been down this road yet?
I have the follow up with the specialist in a few weeks.
Until then, salute! 

[HroadhogD1]

  I have not had these problems, but if I did, I would go see the Doc.  He just want to be on the safe side and check you out to avoid other problems.  Try not to worry.  Just have it checked.

[BLM777]

More experience that I'd like to have had.  Actually, the PSA tests are extremely inconclusive of anything except measuring the change of one to the next.  Some doctors will admit this and some won't.  I've never seen a specialist who would be truthful on the shortfalls of the PSA tests as a great deal of their income depends upon biopsies ranging from 2-5k depending upon doing the procedure in the office or at a hospital.  I'm sure your upcoming appointment will result in the specialist suggesting a biopsy to determine if prostate cancer is present.  That, of course, is your call.  Should you elect to give it 6 months and take another one, I would suggest cutting out all caffeine, nicotine and spicy foods during that period.  You should also avoid being friendly with the opposite sex the week before the test.  If I were a betting man I would guess your next result would be 3 or less.

Worked for me in going from a 10+ to a 2.5 after falling for the biopsy trick twice.  Obviously, the call is yours on how to proceed, but don't worry yourself sick in the meanwhile.  Stress also elevates the PSA as does long, long bike rides without taking enough rest stops.

[Coyote]

I believe a number like that can easily be caused by an infection. I only know this because my Dad's was high for some time and they never found anything. Finally, a doc put him on antibiotics and poof it went away. Said that's what caused it to be elevated.

[V24me]

Definatey get the follow up.  There are alot of reasons for an elevated PSA result.  Of course cancer can be one of the many, but the sooner you have that diagnosed, the better.  The survival rate with early detection is very encouraging.

Many people simply have an enlarged prostate and then of course you'll be prescribed Proscar (finesteride) 5mg/daily, which in 1mg doses is called Propecia (which will help the thinning hair grow back)

Don't worry, but get checked out soon

[blk-betty]

JLA

I'm a Physician Assistant - been working for a Urology practice for 9.5 years.  What has been said above is accurate.  PSA Stands for prostate specific antigen - a protien produced by the prostate gland.   Normal range is 0-4 but then one's age also plays into what is normal.  Aside from one value point in time, the trend is more important, ie. if one's PSA has been slowly creeping up over the last 5 years from 3.5 to 4.5 it's probably no big deal but if one's value goes up more than 0.75 in a one year period it could be significant.

What causes the prostate to produce more of the protien (PSA) that is found in the blood?

  1. Prostate Cancer
  2. Prostate infection - asymptomatic or symptomatic
  3. Recent irritation/inflammation on the gland such as a colonoscopy or riding the bike for an extended period of time
  4. Prostate enlargement - which is a normal part of aging, as we get older our prostate gland gets bigger
  5. Who knows what else?

So someone has a PSA elevation  - what do you do?  Options are in no particular order.

  1.  Prostate biopsy - done in the office where I work
  2.  Take a 2 -4 week course of antibiotics and repeat the PSA blood test with a % Free PSA, if still elevated then recommend biopsy
  3.  Forget the antibiotics and just repeat the test 3-6 months later and see where it is at that time, is still elevatd recommend biopsy
  4.  New test called PCA-3 (insurance may not pay for it) that is more specific for prostate cancer.  Unlike the PSA it is urine test and results provide a
       probability of prostate cancer.  

PSA is neither very specific nor sensitive for prostate cancer but (excluding PCA-3) it is the only good screening test for Prostate Cancer.  Before the advent of the PSA in the 90s, cancer was only diagnosed after an abnormal prostate exam and typically by the time the prostate "feels" abnormal on exam the disease is more advanced and outcomes are not as good.  Since the PSA has been available, more Prostate Cancer has been diagnosed and mostly at earlier and less advanced stages.

So what do you do?  It all depends on your age, your family history, your other medical issues, ie, those things that will limit your life.  Most guys will die with Prostate Cancer if they live long enough but very few will die from Prostate Cancer.  If often becomes an issue of how concerned you as a patinet and how aggressive you would like to be in treating it if you found out you had Prostate Cancer.   We have diagnosed it in guys as young as 45 and as old as 85.  We do nothing for the 85 year old in most circumstances and recommend very aggeressive treatment for the guys less than 60 years old.

Without knowing your age or family history I can say that odds are likely your PSA elevation is NOT due to Prostate Cancer but the only way to know is with further testing and possible biopsy which is not 100% as you cannot sample the entire gland.  Yep it is confusing.  Go see the "specialist" who I assume is a Urologist, hear them out and decide what you think is in your best interest based on the information provided.  Good luck.  

 

[Sc00ter]

See the specialist - it is your health - nothing is more important.....  And if it is cancer, the earlier it is detected, the more treatment options you will have.  Two years ago, at age 48, I had a routine physical - and my doctor performed a PSA test.  The result of the PSA test was 4.3.  My doctor told me "I am sure it is nothing, but I want you to see a urologist.  So I did.  The urologist told me, "I am sure it is nothing, but to be sure, I think we should do a biopsy - so we did.  The results of the biopsy indicated I had prostate cancer.  Not only was it cancer, but the type of cancer cells found were rated as "aggressive".  But, because I was 48 and the cancer was detected early, all options were available to me - surgery, radiation treatment or placement of radioactive seeds.  After much research we decided to chose the option of radioactive seeds.  Given my circumstances, radioactive seeds carried the highest long term cure rate coupled with the fewest potential side effects and lowest percentage of likelihood of experiencing the side effects.  The procedure was not by no means comfortable, but it was not a big deal either.  The worst side effect I experienced was fatigue from the radiation while the seeds were active.  My PSA is now below one - two years out.  And, it all started with the same PSA result you now have.

[Jeffd]

get it checked out for sure.  My father had prostrate cancer and had his removed when he was in his early 70's and no ill side effects.  My psa number jumped almost a point so my doc had me go to a specialist and did the biopsy thing in the office and all came back fine.  Not a fun procedure by any means but the good news lessened the unpleasantness of the ordeal.

[Dennis The Menace]

Dr. Mark (blk-betty) gave some great insight.  Too many variables to rule it out, or to say its a definite.  I would go to the specialist to find out one way or another.  Better safe than sorry and too late.

I get a physical every year, I'm only 48 right now.  Been doing it since I had cancerous colon polyps removed 10 years ago.  I also get scoped on a regular basis.  Found GERD and Barretts esophagus year before last, so more tubal probing.  I just tell the doc not to use the same tube going down my throat that he just stuck up my azz.  Might be funny to you guys, but I think he probably hears it 20 times a day, so he isnt amused.  But, whatever helps me get thru it.

I have read a number of articles that speculate us men living well into our 100's, even if we dont have a family history of longevity--thanks to medical advances.  We have to remain somewhat healthy, and get regular medical attention to do so.  Sounds good, as long as I can still ride, make love and NOT wear a diaper.  Otherwise, I am outta here.  lol

Dennis

[Trolling10]

A friend of mine had a high PSA, went for check and later started to have urine leakage and went for another check.  Dr. found cancer doing a sonogram, nurse said tell all if having a check to do a sonogram(spelling?) Any thoughts on this?

[blk-betty]

JLA

Just to add a little more.  Like Sc00ter said everyone told him, probably nothing to worry about.  But just as in his case the unfortunate fact is if you develop prostate cancer early in life (less than 55-60 years old) the more likely it will be an aggressive form and moe often the younger the age the more aggressive.

Family history plays a pretty big role here as does race.  About 1 of every 10 white males with no family history will be diagnosed with it.  About 1in every 5 African American males with no family history will develop it.  If your white and have a positive family history, your odds go up to about 1 in 4.  Both my dad and my uncle (his brother) were diagnosed with it and both at age 67 so as far as I'm concerned it's a forgone conclusion that I will develop it too, just of matter of when.  I'll be 43 in about 8 weeks and started getting an annual PSA at 40, so far it's been very low.  I figure with my family history I will probably change to a 6 month screening schedule between 45 and 50.  

National guidelines recommend annual screening with PSA and digital rectal exam beginning at age 45-50 for white males with no family history and 40-45 with a postive family history 40-45 for black males regardless of family history.  As far as we know, there are no know risk factors predictors for developing the disease other than positive family history.  There are some suggestions that high-fat diet, sedentary lifestyle and being overweight may be risk factors just as those are for other cancers and heath conditions.

Dennis

Haven't had the colonoscopy yet, figure I have a few more years on that one but will definately start at age 50 as gandfather had colon CA.  I had my first upper endoscopy about 8 years ago and they thought there might be some Barretts but the biopsies were negative.  Had a second one done last December and again negative but I went ahead last week and had the surgery to correct the reflux so hopefully esophageal cancer will never be a concern for me.  That is a bad one with not many options - keep a close tab on those endoscopies.  Luckily for me we don't have any history of cardiac disease in my family but we do have a history of cancers.  Genes play a big role in how when enter and leave this life and no matter what we do as far as lifestyle choices are concerned, we can change our genes.  

Medicine and treatment survivals have come a long way in the last 20 years and the next will wihtout question bring more positive changes.  A cancer diagnosis today does not predict death like it did a generation ago as long as it is detected and treated early.          

[Trolling10]

blk-betty what is your opinion on a sonogram to detct prostate cancer?  He Was told by the nurse taht it was a sure way.  Dr is one of the beast urologist in the area

[blk-betty]

Trolling

Not exactly sure what your referring to but my guess is that your friend had a ultrasound and biopsy.  Older generation of Docs refer to an ultrasound as a sonogram, funny thing too they call a centimeter a sonometer.  Dad is a retired OB/GYN and he uses sonometer all the time when describing small distances.

Back on topic, the only way to diagnose prostate cancer is with a biopsy where a small sample of prostate tissue is collected and sent to a pathologist for microscopic evaluation.  An ultrasound or sonogram is used to take a picture of the prostate or any other internal body organ/tissue.  Certainly one could do a prostate ultrasound and visually see areas that look suspicous for cancer but you could not definitiely diagnose cancer without a biopsy and pathological evaluation.

Commom practice is to insert an ultrasound probe into the rear and through the probe the Doc is able to take several needle biopsies.  In our practice the Docs take 10-14 samples.  It's basically a hollow hyperdemic needle that very quickly under spring loaded pressure penetrates the prostate gland and immediately retracts back out bringing with it a very small sample of prostate tissue that is then sent for evaluation.  The procedure is done in the office under local anesthesia and takes about 15 minutes.   Most guys tolerate it without much pain and once you leave the office you go about you day normally as if nothing happened.

[Trolling10]

blk-betty Thanks am thinking of having it checked and was wondering. Maybe he did say ultrasound but sometime I get a case of CRS among other things all part of getting older(60) I guess

[blk-betty]

Regardless of whether one calls it an ultrasound or a sonogram (really the same thing) the key is to include a biopsy during the procedure if one's intent is to diagnose or rule out cancer.

Best of luck to ya.

[BART]

I take a complete physical at the Mayo Clinic every two years.  My PSA baseline was established early on at around 2.5.  At one physical the PSA was elevated and we decided to check it again soon.  It eventually moved up to the 6.0 - 7.0 range.  I did a biopsy and there was no sign of cancer as soon as the PSA started to elevate to around 4.0.  I did the biopsy three more times and we found the cancer.  By that time the PSA was at 10.4.  I elected to have the prostate removed and followed up with some radiation.  My PSA has been undetectable for seven years.  Once I discovered I had cancer I couldn't get the prostate out fast enough!  Fortunately the new surgery methods are less evasive.  It turned out the cancer was quite aggressive and it's a good thing the PSA test was available. 

When I was wheeled from the recovery room to my hospital room, the nurse asked me how I felt.  I told her, "Great - I've needed that hip repaired for a long time".  She raced out of the room and returned with a doctor (very serious) and I had to explain I was just kidding with them. 

BART 

[Scurvy]

blk-betty - just for the record I'm one of those guys that wouldn't tolerate it without mucho pain and would require major drugs.

[GC Super]

Trolling

Not exactly sure what your referring to but my guess is that your friend had a ultrasound and biopsy.  Older generation of Docs refer to an ultrasound as a sonogram, funny thing too they call a centimeter a sonometer.  Dad is a retired OB/GYN and he uses sonometer all the time when describing small distances.

Back on topic, the only way to diagnose prostate cancer is with a biopsy where a small sample of prostate tissue is collected and sent to a pathologist for microscopic evaluation.  An ultrasound or sonogram is used to take a picture of the prostate or any other internal body organ/tissue.  Certainly one could do a prostate ultrasound and visually see areas that look suspicous for cancer but you could not definitiely diagnose cancer without a biopsy and pathological evaluation.

Commom practice is to insert an ultrasound probe into the rear and through the probe the Doc is able to take several needle biopsies.  In our practice the Docs take 10-14 samples.  It's basically a hollow hyperdemic needle that very quickly under spring loaded pressure penetrates the prostate gland and immediately retracts back out bringing with it a very small sample of prostate tissue that is then sent for evaluation.  The procedure is done in the office under local anesthesia and takes about 15 minutes.   Most guys tolerate it without much pain and once you leave the office you go about you day normally as if nothing happened.

Glad to hear that as I'm having one done in a couple of weeks.  I'm 54 with a family history of prostate cancer, so they have been doing the finger ( I hate that ) check since I was 47, but this will be my first scope.

[wood02]

I went to our Doctor for hip pain.  Blood was taken and PSA was 7.4...it jumped from 4.1.  He suggested a specialist after he did the Digital Rectal Exam.  Biopsy was taken and prostate was cancerous.  I researched and with information given me by my specialist, I and my wife made a decision to have the thing removed.  I was 57 at the time.  The pathologist found that the cancer had spread outside of the prostate...the prostate was checked again along with some surrounding tissue while I was still on the operating table.  I think I missed a bullet.  I had all kinds of thoughts in my mind as to how I would have to live the rest of my life if I did not get the cancer out.  Most of which were not pleasant.  I had thirty-seven radiation treatments.  I am 61 now and doing well.  I created a file and at each juncture of the process I requested copies of report's of every thing that was done to me.  Doctor visits, pathology reports, MRI's, etc.  It made me at least feel better.  Good luck with making your choice and living with your decision because you are going to have to do both.  I wish you and your family all the best. 

What really helped mentally was riding my bike.  I had a "get my mind right" period before surgery was scheduled.  I could get on my bike and my thoughts were not of cancer.  I try not to take things for granted anymore.

[Upswept]

You need to have other checks done at about 4 month intervals.  If the PSA keeps increasing, then you might have a problem.  Also, age matters. A 4.5 PSA for a 75 year old man is great.  A 4.5 PSA for a 50 year old man is not too good.  When I was 55, my PSA went up slightly over the years, ending at 4.8.  They did a biopsy and found beginning stages of cancer in one sample and a suspect cancer in a second sample.  The word cancer scared me.  I elected to have my prostate removed.  My PSA is now less that .01.  Whatever you decide, don't ignore it. 

[IndyHarley]

I wholeheartedly agree with BLM777. It is a number that can be influenced by many things and also a number that has in recent years come under scrutiny. Nevertheless, it is a number that should cause your doctor to ask for further tests and until other tests are analyzed that PSA is just a number, a diagnostic tool if you will that has been shown to not be very reliable but get the other tests an don't jump to any conclusions of what may be the physical problem as there may not be any problem at all.

[JamLazyAss]

I went to our Doctor for hip pain.  Blood was taken and PSA was 7.4...it jumped from 4.1.  He suggested a specialist after he did the Digital Rectal Exam.  Biopsy was taken and prostate was cancerous.  I researched and with information given me by my specialist, I and my wife made a decision to have the thing removed.  I was 57 at the time.  The pathologist found that the cancer had spread outside of the prostate...the prostate was checked again along with some surrounding tissue while I was still on the operating table.  I think I missed a bullet.  I had all kinds of thoughts in my mind as to how I would have to live the rest of my life if I did not get the cancer out.  Most of which were not pleasant.  I had thirty-seven radiation treatments.  I am 61 now and doing well.  I created a file and at each juncture of the process I requested copies of report's of every thing that was done to me.  Doctor visits, pathology reports, MRI's, etc.  It made me at least feel better.  Good luck with making your choice and living with your decision because you are going to have to do both.  I wish you and your family all the best. 

What really helped mentally was riding my bike.  I had a "get my mind right" period before surgery was scheduled.  I could get on my bike and my thoughts were not of cancer.  I try not to take things for granted anymore.

Was the hip pain related to the prostate problem at all, or was it just the initial reason for going?

[72shovel]

My PSA was found to be too high, so the doc sent me to a urologist, who performed a DRE and found some abnormalities. I then had to have a biopsy. No, it wasn't fun; I'm a wimp when it comes to pain. Cancer was found in 5 out of 6 sections of the prostate, so I'm having surgery in 2 weeks to have my prostate removed. I agree with the others - have those tests done! I wish that I would have been tested at age 40 instead of waiting until almost 50.

[JamLazyAss]

72shovel,

Best of luck on your surgury. I'm sure you'll be fine.

Believe me, I'm no hero either when it comes to that stuff.

I have to see the urologist tomorrow morning. I'm 56 and never been tested. 

There's so many guys been through this here on HTT, that maybe we should start a frat or at least have a get together this summer!

Think spring my friend's. Guess it's better to get this stuff taken care of now before riding season.

[Deye76]

Jam, or ya have really good insurance.
I also have great insurance. At 50 I went in for a physical, doc did an EKG first. Read it and said Ohhh, looks like there was an episode. Ordered a thalium stress test and a echo-cardiogram. Then did sigmoidoscopy, said Ahhhhh looks like some pallups, ordered colonoscopy. By this time I'm more nervous than a hooker in the front pew. Passed all the tests and the Doc who did the colonoscopy said I was squeaky clean, and didn't want to see me for 8-10 years. (Although I get checked every 2) I chalked it up to fresh meat = this guys (me) got insurance that hasn't been used, so lets go for it. Lets hope yours is a false alarm.