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Cancer: Prostate Message Board


Cancer: Prostate Board Index


My husband's psa has been steadily rising for the past 4 years or so. He has had 3 -12 sample biopsies and one 6 sample biopsy after a finding of HGPIN. His last 4 psa tests the past two years are as follows: 4.2, 6.2. 4.6 and his most recent, an 8.2! His free psa has now dropped from 17 to 13. I am terrified at the sudden large jump in PSA. He saw his urologist today and he said my husband does not have an infection because the exam would have hurt, so he wouldn't give him any antibiotics. He does not have any symptoms of an infection either. The urologist also mentioned that other than slight enlargement, his prostate felt normal. He is scheduled to get, yet again, another biopsy next Friday. I am so scared that he now has aggressive cancer.
I have been reading that a jump of more than 2 points in psa in one year usually leads to a bad outcome. I am scared and confused and don't know what to think. Thanks for reading.
[COLOR="DarkGreen"]Hi Looney,

Welcome to the board! :)

That's a scary ride that you and your husband have been on these last two years. :eek: :dizzy: You are certainly getting more than your money's worth of anxiety. I'll insert some thoughts in green. Jim[/COLOR]

[QUOTE=Looney1;4071506]My husband's psa has been steadily rising for the past 4 years or so. He has had 3 -12 sample biopsies and one 6 sample biopsy after a finding of HGPIN. His last 4 psa tests the past two years are as follows: 4.2, 6.2. 4.6 and his most recent, an 8.2!

[COLOR="darkgreen"]Actually, there are some important clues in that pattern, and if you think about it, your husband has [U]not[/U] experienced a steady rise, and that could be important: after increasing [U]by 2.0[/U] from 4.2 to 6.2, it dropped by almost the same amount before the recent increase. One of the reasons that's important is because cancer, all by itself - uninfluenced by benign enlargement, infection or inflammation - results in a steady increase; cancer alone does not cause a PSA to go up and down, nor does benign enlargement. For cancer alone, 1,000 cells become 2,000; 2,000 split into 4,000; 4,000 divide into 8,000, and so on, with each doubling taking about the same amount of time, though that "PSA doubling time" is particular to each man's case. If you are into mathematics, that is an "exponential" pattern of increase. Benign enlargement causes, by itself, a gruadual increase in PSA, but not an exponential doubling. However, infection and/or inflammation often causes an up and down pattern in PSA as the disease waxes and wanes. The bottom line: just based on the PSA, your husband's pattern sure looks like infection or inflammation rather than the other two. :) (But keep in mind that, like most of us, I've spent a lot of time in the School of Hard Knocks for prostate cancer, but have had no enrolled medical education.)
[/COLOR]

His free psa has now dropped from 17 to 13.

[COLOR="darkgreen"]Of course, that is a concern, both the drop and the level. However, unfortunately for free PSA as a test, it is not as selective for cancer as we would like; in fact, infection often causes free PSA to drop. Therefore, in light of your husband's see-saw PSA pattern that is typical of infection, you could probably notch down your worry level a bit - not all the way, but down a little. :)[/COLOR]

I am terrified at the sudden large jump in PSA.

[COLOR="darkgreen"]The PSA test dates are important here. While a sudden large jump - short period of time - could indicate a very aggressive cancer, that is quite unusual in this era of regular PSA screening. On the other hand, an on-and-off chronic infection could easily account for a big jump. :) My hunch is that a jump from a PSA from 4.6 to 8.2 in a short (how short?) period is more likely to be due to an infection, especially in view of the history of a previous substantial jump, followed by a decline.[/COLOR]

He saw his urologist today and he said my husband does not have an infection because the exam would have hurt, so he wouldn't give him any antibiotics. He does not have any symptoms of an infection either.

[COLOR="darkgreen"]This is where I wish I knew more about diagnosing prostatitis (infection or inflammation of the prostate gland). My impression is that some infections do act like what your husband is experiencing: no symptoms, and not painful on examination, but I'm not that sure. I do know that urology experts concur that some cases of prostatitis are very hard and sometimes impossible to diagnose, and that challenging the condition or tissue culture with various medications is a common tactic. Maybe one of our other board participants knows more about diagnosing prostatitis, especially in the absence of pain during an exam.[/COLOR]

The urologist also mentioned that other than slight enlargement, his prostate felt normal. He is scheduled to get, yet again, another biopsy next Friday.

[COLOR="darkgreen"]There is a fairly new test that can help rule prostate cancer pretty much in or out in conjunction with PSA tests, and unlike the PSA and free PSA tests, it is not thrown off by prostatitis. The latest version is known as the PCA3Plus test; it is based on a urine sample, collected shortly after an "attentive" DRE that causes some prostate cells to be shed into the urine. It is strong (specificity) where the PSA test is weaker, and to some extent vice versa (weaker on sensitivity - it takes a stronger "signal" to indicate prostate cancer). Bostwick Laboratories, run by one of the world leaders in prostate cancer pathology, is one of the labs that can do this test, with samples shipped in from anywhere.

If it were me, after four negative biopsies, I would want to give this test a try before having a fifth biopsy, but that is a highly individual call to make. Many doctors do not yet know about this test (used to be known as the uPM3 test), or have not used it, but the number is growing. It has been discussed on this board.

Also, rather than going down the same biopsy road again, if the PCA3Plus test resulted in a substantial likelihood of prostate cancer, your husband could consider either a color Doppler ultrasound (CDU) guided biopsy or a saturation biopsy, even the "3D mapping" type of saturation biopsy favored by Dr. Gary Onik of Celebration, Florida. There are, unfortunately, only a handful of sites with the expertise to do a good CDU biopsy, but I think it would be worth it to get the added precision and information that biopsy affords. It's big advantage is that it can determine and display where new blood vessels are growing in the prostate, and the resulting sites ar where there is likely to be prostate cancer.[/COLOR]

I am so scared that he now has aggressive cancer.
I have been reading that a jump of more than 2 points in psa in one year usually leads to a bad outcome.

[COLOR="darkgreen"]That's true, and it's good that you are aware of it, but, if the increase is due a little to BPH and a lot to infection, it seems quite possible that none of it is attributable to prostate cancer.[/COLOR]

I am scared and confused and don't know what to think. Thanks for reading.[/QUOTE]

[COLOR="darkgreen"]You're welcome. Please followup if you have additional questions. I hope you can keep your spirits up during this scarry time.

Take care,

Jim :wave:[/COLOR]
Update: My husband went to our family doctor and he put him on a sulfa drug for 30 days. We hoped that would lower his psa, but that is not the case. My husband got his psa retaken, and unfortunately, it was still 8.2. I am really disappointed, I thought for sure he had an infection, but it seems it is not the case. He has an appointment with a new urologist tomorrow, who I assume will want to do yet another biopsy. It is very frightening thinking he may have cancer and have a nearly 4 point rise in his psa in a year, which may mean it is very aggressive.
[COLOR="DarkGreen"]Hi Lonney - good to see you back!

I'll insert some thoughts in green. Jim[/COLOR]

[QUOTE=Looney1;4099723]Update: My husband went to our family doctor and he put him on a sulfa drug for 30 days. We hoped that would lower his psa, but that is not the case. My husband got his psa retaken, and unfortunately, it was still 8.2. I am really disappointed, I thought for sure he had an infection, but it seems it is not the case.

[COLOR="darkgreen"]It is much too early to conclude there is no infection based solely on a stabilized PSA after one month of sulfa. Prostatitis can be caused by a number of disease agents, and sulfa may simply be the wrong drug! Prostatitis is also slippery; sometimes the cause is never found; doctors often use a trial and error approach, trying a number of drugs until hopefully they find one that eliminates the infection.

I just searched www.pubmed.gov, a source we can use on this board because it is Government sponsored, for " prostatitis AND sulfa ", which yielded three hits. The second seemed most relevant, and here's a key quote from the abstract: "Prostatic tissues are best penetrated by drugs with a high pKa and high lipid solubility, such as quinolones, macrolides, tetracyclines, and sulfa drugs. Ciprofloxacin has been shown to be effective in the treatment of chronic bacterial prostatitis caused by Escherichia coli. The older quinolones demonstrate superiority against chronic bacterial prostatitis caused by gram-negative pathogens; the newer quinolones may be more effective against gram-positive pathogens and anaerobes." I'm pretty shaky on some of these details, often the way it is when we check PubMed, but I can see clearly that different causes of prostatitis are involved and that each is best treated by certain drugs and not others.

Here's another "glass half full" (vice "glass half empty") kind of point: your husband's PSA over the past month has been stable. Now the time is quite short for saying that his PSA is not increasing; for instance, his PSA may be increasing so slowly that you cannot see a change in just a month. On the other hand, his PSA may truly have stabilized, and that would [U][I]not be characteristic of prostate cancer[/I][/U]! If his PSA is increasing due to cancer, it appears the increase may be happening quite slowly, suggesting a slow-growing cancer. [/COLOR]

He has an appointment with a new urologist tomorrow, who I assume will want to do yet another biopsy.

[COLOR="darkgreen"]I wouldn't be surprised if the doctor instead wanted to try another drug agent to again try to smoke out an infection, instead of going for the biopsy. [/COLOR]

It is very frightening thinking he may have cancer and have a nearly 4 point rise in his psa in a year, which may mean it is very aggressive.

[COLOR="darkgreen"]Consider this: if your husband's PSA velocity is 4 points per year, that suggests, roughly, an average increase of .33 per month (and actually the increase would be "exponential" so at this point the monthly increase would be somewhat greater than .33 - that's why I wrote "roughly"). That would mean your husband's PSA should have been 8.2 + at least .3 = at least 8.5 after a month, but it was not! :) That clue is certainly not the whole ball game, but it is encouraging.

It's possible your husband may have an infection and also cancer, with both boosting the PSA, but my hunch is that he just has an infection.

Does all this make sense to you?

Please keep the board posted.

Good luck to you both and hang in there,

Jim :wave:[/COLOR]

[COLOR="DarkGreen"]PS - I realize that you and your husband are eager to join our exclusive club, and just having prostatitis is not good enough to qualify. However, if you really want to get in the clubhouse, knock three times on the door and tell them that Jim sent you![/COLOR]
[/QUOTE]
[QUOTE=Looney1;4071506]My husband's psa has been steadily rising for the past 4 years or so. He has had 3 -12 sample biopsies and one 6 sample biopsy after a finding of HGPIN. His last 4 psa tests the past two years are as follows: 4.2, 6.2. 4.6 and his most recent, an 8.2! His free psa has now dropped from 17 to 13. I am terrified at the sudden large jump in PSA. He saw his urologist today and he said my husband does not have an infection because the exam would have hurt, so he wouldn't give him any antibiotics. He does not have any symptoms of an infection either. The urologist also mentioned that other than slight enlargement, his prostate felt normal. He is scheduled to get, yet again, another biopsy next Friday. I am so scared that he now has aggressive cancer.
I have been reading that a jump of more than 2 points in psa in one year usually leads to a bad outcome. I am scared and confused and don't know what to think. Thanks for reading.[/QUOTE]
Not always is there a bad out come. My PSA jumped more
than 2 pts. in a year. I had a biopsy, found early cancer, had RPS at U.W. Madison Hosp., Madison, WI and am now fine. Last PSA was zero. Hope all goes well.
[QUOTE=ldskier;4101891]Not always is there a bad out come. My PSA jumped more
than 2 pts. in a year. I had a biopsy, found early cancer, had RPS at U.W. Madison Hosp., Madison, WI and am now fine. Last PSA was zero. Hope all goes well.[/QUOTE]

Thanks so much for your reply. It helps a lot to hear about other people's good outcomes.

My husband visited a new uro a few days ago. He thinks he has an infection of some kind and we are waiting for the results of a urine culture. If that is negative, they will do more tests. While I was thrilled that the uro thinks my husband has an infection, I am sort of alarmed that he did find a "small bump", however, that could be from an infection too. I guess we will just hurry up and wait.

I hope you continue to have low psa readings, and thanks again for the encouraging reply.
[QUOTE=Nassau one;4123070]I hope your husband's rising PSA is something other than prostate cancer...have there been any further developments?

In 1998, my husband PSA rose steadily and finally reached 12. He was put on antibiotics from the beginning and that brought the levels down a bit but not enough. When the PSA reached 12, he had a biopsy and ultrasound and it showed Benign Prostatic Hyperplasia...that was a relief! Then in 2003, while in surgery for rectal cancer, it was found that his prostate was very large and almost a year after the cancer surgery, he had a TURP operation to reduce the size of the prostate. That surgery was very successful, there was no malignancy and the PSA came down to, I think, around 1. For the next couple of years, the PSA remained low until six weeks ago when he had his annual test and it was 8 and now is 9. He is to see the urologist on the 24th and we are of course concerned. I am of course hoping it is just a return of the BPH but the numbers seem to be going up so quickly.

Alison[/QUOTE]

We don't know anything new at this time. His next appointment is 11/19, and we will hopefully know more then. The doctor seems to think it is an infection, but the discovery of a "small bump" has me alarmed.

From everything I have heard and read, and admittedly I am far from being an expert, but when the psa rises that quickly like your husband's has, it is usually the result of an infection or inflammation. If it rises more than 4 points in one year, it is almost always the result of an infection, I read somewhere. It is really a roller coaster, which sometimes seems never-ending. Best of luck to you, it sounds like you and your husband have been through enough.





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