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Cancer: Prostate Message Board

Cancer: Prostate Board Index

Re: Elevated PSA
Jun 17, 2009
[COLOR="DarkGreen"]Welcome to the board! :)

You've already had some excellent comment from kcon and daff, so I'll just add a few additional points.[/COLOR]

[QUOTE=babette1;4012803]I just got a full compliment of blood work done by my primary doc and the report shows a PSA of 4.7, up from 3.6 six months ago. Six months prior to that it was 3.9 so it has been going up and down.

[COLOR="darkgreen"]One sign that PSA changes are due or partly due to infection is a set of PSA scores that go up and down. That is not a conclusive sign, but it does underline the possibility that the changes you have seen are at least partly due to infection.[/COLOR]

I have yet to discuss this with my doctor or a urologist but when I got a digital exam six months ago he said the prostate was "smooth" and only slightly enlarged, (1 out of 4?). I am 62 and also am being treated for low testosterone (currently 199) with Androgel.

[COLOR="darkgreen"]Just a thought - since testosterone is needed as fuel by both healthy and cancerous prostate cells, it's possible that the Androgel accounted for the rise in PSA. When did you start using the Androgel, and how does that relate to the PSA scores?

If you do have prostate cancer, the doctor will most likely want you to stop the Androgel treatment, but that's down the road.[/COLOR]

I would be interested in hearing what guys out there think is a sensible approach for me to take at this juncture. Thanks in advance![/QUOTE]

[COLOR="darkgreen"]I too think a "free PSA test" would be worth a try, but it too can be influenced by infection: both infection and cancer lower the % free number. Another alternative to a biopsy at this point, which is a decent choice, is a fairly recent test known as the PCA3Plus test. It complements PSA tests nicely, being strong ("specificity") where they are weak, and vice versa (PSAs being much more "sensitive").

If I had to make this call for myself, but with your case characteristics and not mine, I think I would go for another PSA (from the same lab with the same test version) in three months. If the PSA level increased substantially, I would want a biopsy. If it increased only slightly or stayed the same, I think I would want a PCA3Plus test. If it decreased, I think I would go for another PSA test in another three months, maybe six months. All this assumes a DRE that is about the same as the last one in three months. I've thrown in some "I think"s in here because it's easy to speculate when you are not actually in the hot seat. ;)

One other technique is to do a "challenge" with either of the drugs finasteride" or Avodart (both drugs in the same class). A man's PSA should drop by about 50% on these drugs in about six months. If it does not, that is an added clue that prostate cancer may be present.

As you probably know, both drugs are used to treat BPH. Finasteride has been proven to have some activity against prostate cancer, based on results of a massive, long-term, gold-standard type of clinical trial, and diligent, talented analysis of the results has proven it to be safe (meaning that it does not foster the growth of more aggressive prostate cancer). Two similar trials using Avodart for PC prevention are due to report this spring, but I've got a feeling we may have to wait a few more months. By "prevention" I mean help in achieving partial prevention; neither drug is going to come close to preventing all prostate cancer.

Now would also be a good time to start learning about the lifestyle tactics that can help win the fight against prostate cancer. The tactics include nutrition/diet/supplements, exercise (aerobic and strength), and stress reduction. Mild drugs, such as a statin drug, and either finasteride or Avodart, can also be part of the program.

Take care and good luck,

Jim[/COLOR] :wave:

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