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Cancer: Prostate Message Board


Cancer: Prostate Board Index


Re: Psa increasing
Jun 21, 2008
Bob,

daff has already made some key points. Regarding intercourse, Dr. Gary Onik wrote that intercourse too close to a PSA test can elevate it by 10% (much higher if within an hour or so afterward - hard to imagine - LOL, also hard to picture how they got that figure - LOL; hope a little humor helps ;)). Here are a few more things to consider.

To your bottom line question: "... does anyone know of this sort of situation where there isn't cancer and the prognosis is inflammation or just enlargement?" - yes, that's a clear possibility. :cool:

With a 51 cc prostate (I'm assuming the grams equate to cc - think that's so), using the rule-of-thumb of .066 PSA units X cc = explained PSA from healthy cells, you can explain about 3.4 PSA units. Of course this is a rule-of-thumb and varies somewhat among patients. It's based on research referenced in the book "A Primer on Prostate Cancer - The Empowered Patient's Guide," page F4. It seems to me as a layman that even being generous there is a fair amount of PSA left to explain in your case, plus the variation and sudden increase in PSA don't stem just from the size of the prostate. Therefore, at least one other factor than size of the prostate is likely affecting the PSA count.

Prostatitis could well be the culprit, even if tests for it are negative. My impression is that it can be impossible to pin down, even when it is there. Sometimes the doctor tries a medication or a test that is right for the cause, but sometimes the right medication or test is not found despite repeated attempts. As new patients, we often think that one test will rule infection in or out, but that's so only if we have some luck; with prostatitis, you can't reliably say that my test for infection was negative, therefore I don't have an infection. I've read that prostatitis can boost PSA as high as 50, and I've heard of one case where the PSA approached 200 before dropping to the normal range when the right medication was found.

Again, as a layman, the rapid jump from 5.5 to 9.9 in just two months seems more like mostly or all prostatitis. If prostate cancer were causing the jump, the short doubling time would indicate a case where the cancer had suddenly taken a very aggressive turn. That's possible, but in another month you would expect the PSA to again increase by roughly 2.5 or so as cancer has a fairly constant rate of doubling; much more or much less PSA in a month, or a stabilization, or a drop would, to me, suggest something other than cancer. I've heard that a PSA that jumps around is more likely to affected by prostatitis than cancer.

There have been posts on this board about the PSA3Plus test that has evolved from the upm3 test that emerged only a few years ago. It is supposed to be especially helpful for indicating the likelihood of cancer for men with some signs of the disease but negative biopsies. Do you know about it? Has your doctor discussed it? To me, getting that test is the logical, key next step.

You could also try finasteride (formerly Proscar) or Avodart for several months and see how your PSA responds. Some leading doctors like to have their patients on it for six months to see if they can cut their PSAs by 50%, an encouraging sign that cancer is less likely, and vice versa. However, these drugs seem especially suited to situations where the size of the prostate is influencing the PSA count, and I don't see that they would help clarify the situation much where the PSA was being driven mainly by prostatitis. (It's now being recognized by many doctors - not just leading doctors - that finasteride is safe, that it does NOT foster increased high grade disease, just makes it easier to detect. That view of it's safety is now, finally, even making it to our media, where some stories treat it as fresh news; it isn't fresh, but better very late than never!) However, in view of the limited time docs have to keep up with developments, some no doubt still are unwilling to prescribe finasteride, and you may find that your doctor is in that group, or he may have a good reason why he does not want to try it, such as disrupting the data line from your PSA tests at this time; finasteride should cut the PSA about in half, and I believe that Avodart will do that too.)

About that falling free PSA - the current level and the fall are of course not favorable signs. However, there are circumstances where the free PSA is unreliable as a clue to prostate cancer, and you might be one of those patients. Also, even in the best circumstances it is far from a perfect indicator of cancer, as you already know.

If it were me in your circumstances, I would want to get that PCA3Plus test done. If it indicated that cancer was likely, in view of those two previous negative biopsies, I would want something more definitive done next, such as a color Doppler ultrasound guided biopsy by one of the few experts or the kind of saturation biopsy under a general anesthetic where 40 to 70 cores are taken, depending on the size of the prostate.

I've also just learned about an imaging practice that touts its "3 Tesla" powered special MRI plus spectroscopy scanner for detecting prostate cancer. I don't know what to think about that. That technology has been developing for well over a decade, and it may now be mature, with the boost to 3 Tesla no doubt improving resolution. However, the practice that described it used alarmist and hard-sell language that set off my alarm for baloney. On the other hand, the main doctor involved, in Florida, has specialized in prostate cancer for years. Of course, that is a non-invasive approach, which makes it attractive. I hope it pans out.

But it's easy to offer advice when you are not the one who has to actually make and follow through on a decision. I wish you a good outcome whatever you choose to do.

Take care,

Jim

PS - an anti-prostate cancer program of nutrition, diet, supplements, exercise and stress reduction could help your cause.





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