Re: PSA Questions
- From: Leonard Evens <len@xxxxxxxxxxxxxxxxxxxxx>
- Date: Tue, 13 Jun 2006 14:00:59 -0500
ptoppo@xxxxxxxxx wrote:
I'm 47 and in good health
No first degree relatives with PCa. but an uncle got it at age 67.
On 8/2001 I had my first DRE which was negative, and my first PSA which
was .9 On 9/2004 my DRE was again negative, and my PSA was .5 Last
week, my blood panel showed a PSA of 1.8 (DRE was again negative),
The last two tests were done at the same lab. The first one was done
somewhere else.
I didn't think too much about it until I started reading about the new
PSA and PSAV guidelines. Now I'm not so sure it's OK:
As I understand it, a PSA reading <2.5 in my age group is considered
normal, but the .75 rise for two years in a row is not. On the other
hand, if the PSA is <2, then testing can be done every two years
instead of annually.
In your case, you don't have evidence yet of a consistent rise over 0.75 per year for two years. Also, as you suggest below, it is possible you have some prostatitis. Prostatitis is very common, and is the mostly likely explanation for a sudden increase in PSA. It also may appear without any other obvious symptoms. It might be wise to discuss this with your doctor who might decide to check for prostatits and/or to order addtional PSA tests further down the line, say in 3 to 6 months.
I'm also skeptcial about applying these indicators with only three data
points, since PSAV and DT are statistical models which depend on
regression techniques.
I think it goes something like this. Men with prostate cancer tend to have higher PSAV, but of course in any individual man, the actual time series of values will show considerable variation rather than a smoothly increasing value. There is experimental error in measuring it, the fact that other factors such as prostatitis, BPH, and even situmlation of the prostate can raise the value. So detecting the signal of an increase in PSAV in the noise can be tricky. In your case, there are not even three data points since the first two just indicate a constant value with typical variation. That is why they recommend a clear progression of 0.75 mg/ml per year over a two year period before recommending a biopsy. Even so, most such biopsies would come up negative.
But let me note that a more recent study suggests that men with particularly aggressive PSA were likely to show an increase of more than 2.0 mg/ml in the year before diagonosis. Of course a large increase is still much more likely to be due to prostatitis than to prosate cancer, but it still might be grounds for a biopsy.
What do you think? Am I making too much of this or should I be
concerned?
You should be concerned enough to discuss it with your doctor. Further testing seems appropriate, but otherwise I don't think you should start thinking you have prostate cancer. The odds are still strongly against it.
I do have on and off slight groin and testicular tenderness/pain, which
I
have attributed to exercise but wonder if ot may be a touch of
prostatitis.
I am not a physician, but I don't think that what you describe is typical of prostatitis. And it certainly isn't an indication of prostate cancer.
Also, I had been taking Wellbutrin for about two months
when the PSA was taken. An interesting question would be whether
dopamine agonists raise PSA.
Sorry. I haven't seen anything like that, but I don't really know.
.
Any ideas?
Thanks!
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