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Q: tpsa increase
asked by: goggoga on September 22nd, 2009
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46 yr. old, white, no family history for PC. For the last few years, 2004-2008 my PSA was between .6 - .75 with the last values on June 2008 .61. Free ratio was .57. Annual check up on June 2009 said PSA 1.75 and frees ratio .27. Seeing the urologist on July 2009 he said that I should have a biopsy, which it is coming on October 5th, 2009. In the last six years, I had asymptomatic microhematuria in urine, which disappeared for a while and coming back. Always traces no small amount. The specialist performed cytoscopy on July 2005 and June 2009 and he did not found any reason for hematuria. I have a discomfort on my pelvis, no back pain, no joint pain only burning on urethra after urination. That happens when I drink a lot of water on short time and I need to go to washroom more often. Over night going out one time and not on every night. Starting with 2005, the specialist put me on Flomax which helped to remove the symptoms on the beginning but on 2007 the doctor said to take one in the morning and one in the afternoon. I am still on Flomax, once a day for now how the specialist prescribed. End of July 2009 the urologist performed DRE and he told to me NAD - supposed to means that nothing detected. I will go for transrectal ultrasound on next week. Now, on September 09, 2009 I ask my family doctor for one more PSA and free ratio to see the evolution over three months. The result scared me like crazy because PSA came back 2.25 and frees ratio .33 - this values bigger than June 09 does. The first result did not scared too much because I supposed that I was lucky to catch something pretty earlier, but the second one make me crazy. I am taking prescribed pills for sleep and also pills for days, so I can be able to concentrate at work. The DRE was done on July 25, 2009 and it was a hard one because the doctor used a lot of pressure to try to catch something on my prostate. As I already told you, NAD. Can the result from September 09, 2009 be not so accurate because of the DRE done on the end of July 25, 2009? Or the disease is aggressive? Also, can I have other symptoms? I asked urologist couple of years for a biopsy but his answer was NO because my entire test. This year, he asked me directly if I want to have a biopsy or I want to stay and watch. I choused biopsy but I am really scared. Can somebody tell me something from own experience and has an advice? I am dealing very hard with this situation. Thanks a lot
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Dr. Robert Wascher , MD
replied on September 26th, 2009
It is unlikely that a DRE more than a month earlier caused your September 2009 PSA level to be elevated. Chronic prostatitis can, however, cause an elevation of the PSA, although it doesn't sound as if you have the typical symptoms of prostatitis.

I am curious to know whether or not your Urologist performed a transrectal ultrasound of the prostate during any of your visits and, if so, what it revealed. In any case, a biopsy is probably the safest and most prudent approach, based upon the information that you have provided.

Sincerely/ Robert A. Wascher, MD, FACS

http://doctorwascher.com





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persiaxz
replied on September 29th, 2009
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Your PSA test results
PSA is not a very accurate test. It can vary more than 0.6 from Labratory to lab. But also the elevation can be caused by so many elements. Biopsy is kind of risky. There is a chance of trigering the sleeping cancer cells.

repeat PSA test for the next 18 months every six months and watch the variation. If it goes up more than 10% each time, then you should seek for second opinion. If the baseline remain around 1.8 or so donot worry. It is fine.
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goggoga
replied on October 7th, 2009
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Thanks everyone,
I had an transrectal ultrasound on 2005 not showing anything wrong and prostae volume 20.8 cc. The latest one, september 2009 coming out clear and prostate volume 29 cc. Is it almost 9 cc differnce too much for four years? Please, let me know.
Thanks,
Gog
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