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Cancer: Prostate Message Board

Cancer: Prostate Board Index

Hi cajunhandlebar,

I’m visualizing you in Louisiana with a long handlebar mustache.

Seeing those PSA results helps. You started with normal numbers for a younger man, and over the long term you have seen an overall increasing trend as you hit mid fifty, as happens to many of us, though not usually as high as the latest three scores. That suggests you are experiencing some BPH (Benign Prostatic Hypertrophy, aka benign growth of the prostate), which is typical. BPH does not need to be treated if it is causing no problems, but there are things you can do with diet/nutrition and some usually mild medications. However, it is very likely that at least one other thing is going on.

The clue is in the up and down pattern, which you noted. Neither BPH nor cancer is related to such a pattern, as both are associated with steady increases with no declines, but that up-down-up-down pattern is a telltale sign of an infection or inflammation. The increase can be rapid, and it can drive the PSA really high; I’ve read about multiple instances where PSA can be pushed into the 50s, for example, and the highest I heard about was about 200, with subsequent falls back to normal after effective treatment of the infection/inflammation. To my layman’s eye, you appear to have an infection – either a series of infections, or perhaps more likely a chronic infection that wanes and waxes. The usual medical strategy is to try to culture the bacteria causing the infection or to use trial and error with successive antibiotics to see if any work, starting with the drugs more likely to be successful. Sometimes it proves impossible to nail the cause and eliminate it.

However, I’m thinking that your urologist is seeing that this latest rise is double what you have seen in the past. That could easily still be due to infection, though not the gradual slow rise due to BPH. However, you are now at the level past the obsolete threshold of 4 that used to routinely trigger biopsies, and, at double the highest old level, there is a concern that cancer might be part of the reason for your current elevated level. On the other hand, even in your past three scores you have seen some up and down then up again movement that is likely beyond the day-to-day, test-to-test variation that is common, and this again points toward infection as a likely cause.

Here are some ideas in addition to the 4K test, just to give you some more good options. The main one is a “multiparametric MRI” (mpMRI) done at a facility (including the radiologist interpreter) that knows what it is doing. I described that MRI within the past few days elsewhere. This mpMRI technology has rapidly emerged as a pre-biopsy look to help determine whether a biopsy would be wise. Also, if it shows likely cancer, then its results can be used to guide the biopsy to sample the spots that look suspicious for cancer, while not wasting biopsy probes on areas that look perfectly normal. This approach has proven far superior in picking up meaningful cancer while avoiding insignificant cancer that experts feel hardly deserves the name. Another idea is to use one of the “5-alpha reductase inhibitor (5-ARI) drugs – either Avodart®/dutasteride or Proscar®/finasteride – to shrink the prostate and reduce its blood supply, which eliminates or at least decreases BPH tissue. This makes PSA trends and DRE results more efficient indicators for whether there is cancer. It also counters the milder forms of prostate cancer. A third idea is just to wait a bit and do another PSA test. That has the risk that you might not be countering an unlikely rapidly growing cancer as quickly as you could have, but in your circumstances, especially doing it in early October, would probably not risk much; another downward trend, perhaps a big one, would point toward an infection.

Biopsies are not huge deals for the vast majority of us. It’s important to get antibiotic protection before the biopsy and anesthetic just before the probing begins. If unusual side effects occur, prompt attention is needed. All in all, while there is a risk of bothersome burden on the patient from side effects, with very few patients experiencing long-term significant side effects, the risk is low and most significant side effects can be very well managed. The idea here, as you seem to already know, is not to jump to a biopsy if it is not time to get one, but to go ahead if the evidence so warrants.

Good luck with this.
Hi again,

You are welcome. I'm glad to help.

Regarding an infection causing elevated PSA, I'm almost certain that it is a prostate infection and not an infection elsewhere.

Free PSA is also influenced by infection, so it probably will not be much help. I believe the 4K score is not influenced by infection.

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