Hi. I posted earlier this month about my father's PSA results after he went for a yearly physical. The results were:
2011 - PSA 1.83
2013 - PSA 2.92
2017 - PSA 4.24
My father does have symptoms of BPH, and has for a couple years, but he was never definitely diagnosed with anything. I would hate to jump to the assumption that he has cancer, but it is definitely a worry of mine. He was placed on Flomax earlier this month from his GP and his symptoms have gotten better.
Anyways, he went to the urologist two days ago. The urologist was concerned with the rise in the PSA numbers. He placed him on three weeks of levofloxacin in case it is an infection or inflammation of some sort. If the numbers don't come down, he was considering doing a biopsy. The urologist also did a DRE and didn't notice anything remarkable.
I'm just nervous and was looking for input on this latest news. Thanks.
ALSO... my grandfather has had prostate problems and has a PSA of 9 (but he is also 83). He has had 4 prior biopsies within the past 10 years and all came back negative, so as far as we know, there is no history of prostate cancer in the family.
Those numbers are very low compared to many. My PSA has been around 8 for 10 years but has just come down to 6.7. I'm 66 now. Living with higher PSA scores is perfectly feasible. I have cancer but it isn't apparently growing or spreading. No treatment required. We are all individual cases, but I hope your mind can rest a bit easier to know your Dad's situation seems good to me!
Have him get a 3T parametric MRI and a 4K test. This will give a better idea of whether a biopsy is in order.
Good luck.
Is that usually covered by insurance or no? We live in the US.
I think your father and his doctors are proceeding in a reasonable manner. His numbers, while going up, are not alarming. I do not think it is time to jump to expensive tests such as MRI and I suspect with these symptoms and numbers that insurance would not pay.
If at a later date his urologist recommends biopsy then it would be time to talk about the MRI.
Good luck.
You say the urologist is concerned with the rising PSA. If the only figures he has are the three you mention then I don't see the PSA worrying anyone.
It is understood that a doubling of the PSA in a year may indicate a problem. The figures you offered don't indicate that.
But if in doubt, I suggest you follow scotth's recommendation of a MRI. Ideally 3T and ideally reported on by a radiologist that specialises in prostate images. You don't want a regular radiologist. If you can't find a facility with a 3T scanner, a 1.5 T, which is what I had reported on by a skilled prostate radiologist is good enough.
I live in Australia and can't say if such MRIs are covered by your insurance. What I can say is that a biopsy is an invasive procedure which is never 100% safe and if possible, a non invasive procedure like a MRI should initially be used instead. After the MRI is performed and a biopsy is recommended, the biopsy can be guided by the MRI to obtain far greater accuracy than an unguided biopsy, which is really a hit 'n miss procedure.
He mentioned to my dad that it doubled, which obviously worried my father, but I did explain to him that it doubled over 6 years. My dad hasn't looked into this stuff and it's really only been me researching options, so now hearing the concern of his urologist has him worried. I've read about the complications of a biopsy and I do believe that it may be too soon. I've mentioned the PCA3 test, free PSA test, and MRIs to my father as options he can ask about before a biopsy. His concern is more so the cost of these procedures at the moment.
I am not at my computer so difficult to type answers. Depends on your insurance as to whether it will be covered. Most do cover it now. If the doctor requests it then have them put in for a precertification to insure it is covered.
Depending on where you live I would suggest a major teaching institution for the 3T MRI so that a top notch radiologist familiar with prostate MRI's can read it. I would only have a 3T which has much higher resolution than a 1.5 T. Even the 3T can miss things so why risk it with anything else.
A 4K test is a much more specific blood test that measures four Prostate protein markers. It predicts the likelihood of finding a significant cancer if a biopsy were to be done. Many "local urologists" are not even aware the test exists so ask for it. If the test suggests a high likelihood of finding cancer then at least you go into it with peace of mind that it is needed.
If a lesion shows up on the MRI then a fusion guided biopsy is in order. They will typically take 4 cores from the lesion and then do 12 random biopsies along with it.
Prostate cancer is typically slow growing so have your father take his time and do plenty of research. This will arm him with the knowledge of the right questions to ask and how to proceed.
Hi
Karlee, I would request a PCA 3 test before agreeing to a biopsy
I have mentioned that to my father. Do you know if those are ever covered or partially covered by insurance? How specific and sensitive are they?
The PCA 3 is extremely specific to prostate cancer. I'm not sure about the sensitivity, would suggest reading up on it. I'm on Medicare with a Blue Shield supplement, and they have paid for two PCA 3 tests, 18 months apart
BPH can and will increase PSA, so before going through a painful biopsy get a PCA3 test done. He may have to ask for it, in my case I had to demand it. PCA3 is only sensative to prostate cancer, so it can be used to see if there is a problem. Now if that came back high I would then get a 3T MRI done as this alows the doctor to find the tumor and do a guided biopsy with less needle pokes. Don't let them fool you into traditional means. My urologist was all set to do a biopsy on me and I said no way. I will have a PCA3 done first to at least see if there is a need for a biopsy. If I hadn't said that I may have been biopsied for no reason as I have BPH and BPH runs in my family, but PC doesn't. So try not to worry and don't asume it is PC yet.
I would think you must check your plan I was only in the US long time ago, you may not get what they say in U.K. that's why the NHS is broke!
If his PSA keeps going up some form of further investigation is a MUST I had a biopsy at 5.5 and 4 weeks after Thad had the prostate removed I am fine now 3 years on Zero!
Don't mess around take action it's to late when it escapes and much more difficult to deal with, but I do hope it's all Neg!
This makes me feel a little better for now. My grandfather (his dad) has also been diagnosed with an enlarged prostate with 4 negative biopsies for prostate cancer, so I'm hoping enlarged prostate is the reason for my dad's numbers as well. I will definitely try and convince my dad to ask more about the PCA3 test, before jumping into a biopsy. Did you have a similar rise in numbers?
No. My urologist would not test me at the time, but I am going to get tested Saturday. Not going to worry about it because there is no pc in my family. Just bph.
karlee, A rising PSA needs investigation. Many experts say above 4 becomes an issue. My urologist said to me he has several patients with a PSA of less than 2, and aggressive prostate cancer. BUT, the average man who presents with a rising PSA is due to prostatitus and BPH and his prostate is increasing in size. I did not see your fathers age! If they did a detailed biopsy on your grandfather, (due to his age) they would most likely find cancer, and it will be the 'common' variety that is very little, and slow growing. Many 80+ year old men die with prostate cancer, but not from prostate cancer. It is just one of those things most men get.
The problem your Father has, as is common to us all, how to work out what the PSA test is saying. According to the inventor of the test, it is saying how healthy the prostate is. A PSA reading never says he has cancer, just how much the prostate is stressed and leaking PSA for some reason. There are many tests to try and help determine if cancer is present, some very invasive like a biopsy, others not so invasive like a 3TmpMRI. My PSA went from a 13 year average of 2.4 to 13 in 4 months. ( I doubled way too quick) A 3TmpMRI said no meaningful cancer found. My doctor said I could have had several negative biopsies looking for the cancer, and of course the complications it potentially brings on.
As for other blood tests, I had the PSA free and PHI. Both said I had a very high chance of cancer!! My urologist said while he trusts these tests, he also said my Prostatitus and BPH(seen on the MRI) was probably causing the false positive blood test results. So, while possibly very expensive for you, the MRI seems to be more definitive. If it finds something, then you get the targeted biopsy, rather than a blind fishing expedition. In summary, it is what your father can afford to do.
Geoff
My father is 57. Sorry for not including that. Thanks for your info. This is something we're definitely not ignoring. I was just looking to see what other people's thoughts are and to see if there was any way to put my mind at a little bit of ease as we go through this process of seeing what is definitively wrong.
Karlee, Prostate cancer diagnosis is a stressful time. But, 75% of rising PSA is usually not cancer, but prostatitus or BPH related. Maybe your dad had a UTI and this is the cause of the rising PSA. When I graphed your fathers PSA rise, it seemed a pretty consistant rise over 5 years.This is the dilemma we all face. I chose the 3TmpMRI because i could not see a urologist for 2 months. My general doctor said do not worry, prostate cancers are usually slow!! Not very helpful. Anyway, the MRI result allowed my blood pressure to settle before specialist visit, as no major PCa lesions were found. Here in Australia, 3TmpMRI cost about $AUD500-750. We have no Government or health insurance cover for prostate MRI. My specialist said the biopsy may need to be repeated a few times if PCa not found. The cost, time and illness risk for repeat biopsies convinced me to go the MRI route.
Karlee-
I realize this is a lot of information to absorb. It is like drinking from a fire house. But it is very important for you father to do his due diligence. He should be actively involved in this process and not just you.
Please be aware that the MRI and blood tests are merely tools. They help to indicate and predict if further investigation is warranted. They are also meant to minimize the number of men that have unnecessary biopsies. ( another issue altogether ). BUT...also realize that a biopsy is the only definitive way to diagnose prostate cancer.
It is not a perfect sceience and the field is still in its infancey. However, it is improving rapidly both with the means of testing and the means of treatment. A negative biopsy doesn't mean there might not still be cancer since it might have been missed. But a positive biopsy is a clear indication that cancer is present.
Then the question becomes what is the Gleason score of the positive biopsy and what is the volume within the core ( biopsy sample ). All these things influence what, if anything, has to be done. If treatment is indicated then you will be faced with the multiple choices of treatment options available.
My point is there is a lot that you AND YOUR DAD have to become educated about. It is essential that you both spend time researching everything you can about the disease process so that you can make educated choices. There is a specific order in which to do things in order to find out what is going on and what to do next.
At 57, your dad is young and has a rising PSA. Rather than sit around worrying if your dad has PCa it is in your dad's best interest to take the next step and have both a 3T MRI and either a 4K or PCA3. This will arm you and your urologist with additional information and guide you toward the next step
Your dad and only your dad can decide what is best for him but sitting around wondering seems to be the least productive option.