PSA high but steady.... don't panic!

[simon43]

I'm in Thailand right now, but going back to Myanmar in a week or so.  Therefore, I decided to have a PSA and urine culture test.

 

I post these results to demonstrate that a high PSA number doesn't always mean that you have prostate cancer, although any increasing value or value above the norm needs to be investigated.

 

Here are my PSA numbers tested in the same lab since 2022.

 

October 2022 = 11.234 H ng/mL
September 2023 = 11.313
June 2024 = 8.927
February 2025 = 10.702

 

The October 2022 number prompted me to have a prostate MRI and then a 24-sample biopsy, to identify the cause of this high value.  2 benign prostate stones and a lot of ESBL (resistant to antibiotics) E.Coli bacteria were found, but no cancer cells.

 

Since 2022, the E.Coli UTI has been present throughout, and this, plus my mild BPH, plus the calcium stones, all result in what could be an alarmingly high PSA number.  However, you can see that the PSA number does not have an increasing trend, but fluctuates around a value of 11.

 

The UTI doesn't cause me too much discomfort.  I have previously discussed on this forum about getting the UTI treated with suitable (expensive) drugs, but unless there is a serious medical reason to do this, I guess I'll 'hang fire' on that 🙂

[Card]

25 minutes ago, simon43 said:

I'm in Thailand right now, but going back to Myanmar in a week or so.  Therefore, I decided to have a PSA and urine culture test.

 

I post these results to demonstrate that a high PSA number doesn't always mean that you have prostate cancer, although any increasing value or value above the norm needs to be investigated.

 

Here are my PSA numbers tested in the same lab since 2022.

 

October 2022 = 11.234 H ng/mL
September 2023 = 11.313
June 2024 = 8.927
February 2025 = 10.702

 

The October 2022 number prompted me to have a prostate MRI and then a 24-sample biopsy, to identify the cause of this high value.  2 benign prostate stones and a lot of ESBL (resistant to antibiotics) E.Coli bacteria were found, but no cancer cells.

 

Since 2022, the E.Coli UTI has been present throughout, and this, plus my mild BPH, plus the calcium stones, all result in what could be an alarmingly high PSA number.  However, you can see that the PSA number does not have an increasing trend, but fluctuates around a value of 11.

 

The UTI doesn't cause me too much discomfort.  I have previously discussed on this forum about getting the UTI treated with suitable (expensive) drugs, but unless there is a serious medical reason to do this, I guess I'll 'hang fire' on that 🙂

Why did u have a biopsy after your MRI? Was the MRI inconclusive. I've had 3 prostate MRI and none gave rise to a biopsy recommendation.

[John49]

Quote from my recent post on 5 Feb.:

 

"Recently, my PSA stated to creep up to 5, then 6, then 7.

I had a prostate MRI that was inconclusive.

This was a mistake, the wrong test, as this test lacks accuracy.

I followed up with the more accurate mpMRI – cancer indicated."

 

 This may be relevant here.

My first prostate MRI was done on the wrong kind of machine (I wish they had told me).

I waste several months of possible treatment, until I was tested on the more modern and expensive machine (Tesla 3).

 

Another quote:

"MRI scans produce pictures from angles all around the body and shows up soft tissues very clearly.

The multiparametric MRI (mpMRI) is a special type of MRI scan that produces a more detailed picture of your prostate gland than a standard MRI scan does."

[simon43]

3 hours ago, Card said:

Why did u have a biopsy after your MRI? Was the MRI inconclusive. I've had 3 prostate MRI and none gave rise to a biopsy recommendation.

I had the biopsy because the MRI that was performed at Bumrungrad showed 2 'lumps' still contained within my prostate.  The doctor suspected that these were cancerous growths and a biopsy was advised.  However, the biopsy found no cancer cells but 2 benign calcium stones, (which are not cancerous, but still do affect my PSA values, BPH, UTIs etc)

[Card]

8 minutes ago, simon43 said:

I had the biopsy because the MRI that was performed at Bumrungrad showed 2 'lumps' still contained within my prostate.  The doctor suspected that these were cancerous growths and a biopsy was advised.  However, the biopsy found no cancer cells but 2 benign calcium stones, (which are not cancerous, but still do affect my PSA values, BPH, UTIs etc)

My MRI showed various anomalies but the computer program (PI-RADS) that analyses the scans gives a score from 1-5 as to the probability of cancer, 1= very low, 2=low,3=intermediate,4=high and 5=very high. In all cases my score was 2 and since 2 docs did not recommend about a biopsy I assume they are clear. They were done on a 3T machine which I think means from 3 different angles.

What was your score?

 

 

[simon43]

2 hours ago, Card said:

What was your score?

 

 

T3a, but the Thai doctor wasn't sure if the lumps that the MRI found were absolutely likely to be cancerous and therefore advised a biopsy.  My UK doctor who performed the biopsy said - on first looking at the MRI scans provided by Bumrungrad, that he thought that they were not cancerous, and he was correct.

[Thailand J]

5 hours ago, John49 said:

My first prostate MRI was done on the wrong kind of machine (I wish they had told me).

I waste several months of possible treatment, until I was tested on the more modern and expensive machine (Tesla 3).

Using 3 Tesla MRI to investigate prostate cost 63,000B at Bumrungrad, 32,000B at bangkok Pattaya Hospital. Using 1.5T cost a lot less at Payathai Siriraj.

 

1.5 T with endorectal coil is good enough for prostate examination:

https://ajronline.org/doi/10.2214/AJR.04.1584

[Andyfez]

Interesting, and thank you for your article your PSA readings are very similar to my own. And they've only raised a couple of points in 20 years. 

I found regular sex, or regular exercise increased the PSA reading by up to five points. So I always have three or four days relaxation before I go for a test these days. I came to the same conclusion as you, although in my case I've never had a scan. But I've had three biopsies over the years, which are not a pleasant experience.

[Sevenomma]

Thank you for sharing this. I am in the same situation. But my PSA has been rising over one year from 6,5 to 9,9. I excercise every day so maybe this affect my PSA. In ultrasound doctor saw one stone?. Can it bee cancer?My urologist at goverment hospital advised a biopsy. 

I don want to have a rectal biopsy because of the risk of infections, pain and so on....

Someone gave me the advice to choose MRI (tesla3). This MRI machine they only have in private hospitals. I will go to Bangkok hospital Pattaya in july. Then I had insurance for 2 years and I dont have to pay and claim back myself. My insurance company will pay directly to hospital. Is it safe to wait until july/august to go for MRI?

[Expat68]

100% agree. It is the sudden increase in PSA that is a danger sign

[olongapo]

Hi I know it's off topic but can  anyone recommend a urologist for bph laser treatment I'm not suitable for rezum, the Dr in bnh informed me. had aquablation in UK  7 years ago now need something else.

[simon43]

[quote]

...

I don want to have a rectal biopsy because of the risk of infections, pain and so on....

...

[/quote]

 

My biopsy was between the scrotum and anus (perineum?), with an ultrasound wand stuck up my bum... 24 samples and the whole experience was relatively painless (slight prick from the local anesthetic needle, then no pain when the samples were taken).  I understand that perineum biopsies carry a lower risk of infection.

 

(In fact, my doctor waited 2 weeks to try to clear up my long-term UTI with antibiotics without success, so finally decided -with my agreement - to go ahead with the biopsy, and there were no post-biopsy infections. I mean I still had my UTIs, but nothing extra as a result of the 24 needles stuck into my prostate...)

[John49]

My Prostate MRI on the 1.5 T gave a result of PI –RADS 3, with categories as follows:

PI‐RADS v2.1 Assessment Categories

PI-RADS 1 – Very low (clinically significant cancer is highly unlikely to be present)

PI-RADS 2 – Low (clinically significant cancer is unlikely to be present)

PI-RADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)

PI-RADS 4 – High (clinically significant cancer is likely to be present)

PI-RADS 5 – Very high (clinically significant cancer is highly likely to be present.

 

An inconclusive result - not really "good enough" in my case - I decided that I would monitor my PSA.

It showed continual slight movements upwards, I decided I would wait until my next visit to Australia.

In Australia (with a PSA of 7), my Prostate mpMRI showed a “large area of signal abnormality, categorised as PI-RADS 5”.

 

This Australian mpMRI was done some 6 months after the Bangkok MRI – could explain the difference in results (from a 3 to a 5).

However, the MRI in Bangkok – unfortunately me was a waste of time as basically inconclusive – ok just my bad luck.

BTW the Prostate MRI was done at an Imaging Center that advertises widely and was about 10,000 Baht, plus extra for dye. No problems there, the service and expertise seemed good.

 

One interesting point, I asked my urologist in Australia why he was not giving the obligatory DRE, he said ‘we don’t do that anymore’.

 

I sense a reason way – on my prostate journey – looking for a suitable Thai doctor- probably 5 doctors put their finger up my bum and it seemed ok – prostate ‘firm and round’, despite this being the easily reachable part of the peripheral prostate area where I had cancer.

Seems to me like you need a really bad case of prostate cancer for the DRE to be useful?

[Sheryl]

1 hour ago, John49 said:

My Prostate MRI on the 1.5 T gave a result of PI –RADS 3, with categories as follows:

PI‐RADS v2.1 Assessment Categories

PI-RADS 1 – Very low (clinically significant cancer is highly unlikely to be present)

PI-RADS 2 – Low (clinically significant cancer is unlikely to be present)

PI-RADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)

PI-RADS 4 – High (clinically significant cancer is likely to be present)

PI-RADS 5 – Very high (clinically significant cancer is highly likely to be present.

 

An inconclusive result - not really "good enough" in my case - I decided that I would monitor my PSA.

It showed continual slight movements upwards, I decided I would wait until my next visit to Australia.

In Australia (with a PSA of 7), my Prostate mpMRI showed a “large area of signal abnormality, categorised as PI-RADS 5”.

 

This Australian mpMRI was done some 6 months after the Bangkok MRI – could explain the difference in results (from a 3 to a 5).

However, the MRI in Bangkok – unfortunately me was a waste of time as basically inconclusive – ok just my bad luck.

BTW the Prostate MRI was done at an Imaging Center that advertises widely and was about 10,000 Baht, plus extra for dye. No problems there, the service and expertise seemed good.

 

One interesting point, I asked my urologist in Australia why he was not giving the obligatory DRE, he said ‘we don’t do that anymore’.

 

I sense a reason way – on my prostate journey – looking for a suitable Thai doctor- probably 5 doctors put their finger up my bum and it seemed ok – prostate ‘firm and round’, despite this being the easily reachable part of the peripheral prostate area where I had cancer.

Seems to me like you need a really bad case of prostate cancer for the DRE to be useful?

I am not aware of any private imaging places that do an mpMRI. You may have just regular MRI with contrast which is not reliable for assessing likelihood of prostate cancer.

 

DRE can be useful if there is cancer present where it can readily be felt.  Dometmes it is, sometimes it isn't.