Rising PSA

[Lancelot]

Way back in 2005 I discovered that my PSA was 5.51 during a routine health check up. Doc treated me with antibiotics and my PSA was 2.78 two months later.

2006 I went for a PSA check at Phyathai BKK and it was 8.24! So the same day I went to Bangkok Nursing Hospital and my PSA there was 6.71, a variance of 1.53 at different labs and maybe four hours time. The doc also ordered a Free PSA test and thought cancer was unlikely because the Free PSA was greater than 30%. He treated me with antibiotics and one month later my PSA was 1.56.

2008 PSA was 2.0

2011 a VA (Veterans) doc back in the US detected a small nodule and my PSA was 4.42. Biopsy at VA hospital was negative.

2012 a doc at Chiang Mai could not find the nodule No PSA test because I had had sex three days prior...

2013 (June) PSA test 4.69

Today at Chiang Mai Siripat urologist could not find a nodule; however, my PSA was 6.27, quite an increase in five months.

The doc suggested a couple of options:

1 Recheck at a different lab

2 Consider another biopsy (Ouch!)

He did not suggest treatment with antibiotics.

My GF was with me last night and while we did not have sex, she does super excite me. Can mere arousal significantly impact PSA scores?

I think I will have my PSA rechecked at a different hospital.

Any thoughts or ideas?

PS- I was really impressed with Siripat and the doc that examined me. He called me personally with the PSA results, about two hours after my blood was drawn.

[Sheryl]

It is ejaculation which affects PSA arousal without it will have no effect. If you ejaculated then indeed this could have effected the PSA and test should be repeated.

I take it digital exam is normal -- no nodules, no enlargement? That is an important point.

I also take it no urinary symptoms? (frequency/difficulty/pain etc)?

Was a urinalysis also done? (From your history it is evident prior docs thought your mild PSA elevations were due to prostatitis. Urine and sometimes semen exam helpful in diagnosing this...though it would also usually be symptomatic).

And what is your age? (PSA levels normally rise with age)

[Lancelot]

Hi Sheryl,

No ejaculation for about a week prior to the PSA test.

Yes, digital exam normal, no nodules. The doc said my prostate was "big" for my age. I am 60. Doc at VA hospital, 2012, said it was slightly enlarged.

I do have some urinary frequency, but I also drink a lot of coffee. No coffee significantly decreases trips to the hong nam Never any pain on urination. When I visit the US I stock up on Saw Palmetto and herb dramatically decreases trips to the toilet. I have never found Saw Palmetto in Thailand. I wonder if there is local herbal equivalent?

No urinalysis testing.

My father had BNP issues and had his prostate removed at age 60. No cancer and he is doing fine now.

Again, thanks.

[Sheryl]

Sounds very much like BPH. And yes, Saw Palmetto can be found in Thailand, do a search for it on this forum, where to find it has been discussed several times.

With a slightly enlarged but smooth prostate and mildly elevated PSA most doctors would treat for BPH and monitor the PSA, especially given that you had a negative biopsy just 2 years ago. If PSA keeps rising significantly, or if any nodules are subsequently felt, then another biopsy.

That is what most docs in the West would do in the situation you describe and it is a conservative approach. To do another biopsy right now would be an aggressive approach....but no-one can guarantee it wouldn't detect cancer, though odds are not. The PSAlevel together with your age and clinical findings are consistent with BPH.

Ultimately you have to decide whether to get another biopsy now or not, but a "wait and see" approach would not be unreasonable, as long as you continue to have regular digital exams and PSAs (say every 6 months or so).

I don't think doing the PSA in another lab has any value added, more important to follow the PSA level over time and doing that at the same lab has its advantages.

[Lancelot]

I don't think doing the PSA in another lab has any value added, more important to follow the PSA level over time and doing that at the same lab has its advantages.

OK points taken

I was surprised that PSA scores between labs can vary so much, for tests on the same day, but yeah, establishing a base line is a good tool.

Thanks!