The same thing happened to me last April. Elevated PSA after a lot of biking. The urologist scheduled an MRI which showed a lesion in the transitional zone. Next step was a biopsy of the lesion and sectional biopsy of the rest of the prostate. 18 core samples of the prostate in total. All came back negative for cancer. Like you, all my blood work over the years (lipids, etc) has been excellent. Elevated PSA could be due to many things. I have friends and acquaintances whose PSA levels have been as high as 8.5. With no cancer.

I'm guessing your urologist will schedule an MRI for you. Then, biopsy if needed. You did the right thing. If detected early, prostate cancer is utterly treatable and survival rates are near 100%.

At 56, why in the world you have your PSA checked? This is what you get: concern over nothing. Were you sexually active the night before the tests?

Hello Petrarch and All,

While unlikely to have prostate cancer before age 40 ...

I had a friend (about age 50) that was going on a trip and and in the process of getting some life insurance had a required physical. He was found (to his surprise) to have advanced agressive prostate cancer ...... and with all available treatment he was dead in about 1 year.

That said, most all of my friends that have had prostate cancer (and there have been several) and treatment have survived.

My doctors have stated the rate of change over time is what they watch on PSA, in addition to numeric value ... so save your previous results.

Early diagnosis and treatment is key. Knowledge is power. Lack of knowledge is weakness.

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Cheers, Neal

+1 mph Faster

This is a horribly irresponsible post. You have no idea if it is "concern over nothing" or not.

i'm 61. here's my history over the past 5 years;

"high velocity" PSA, from 3.5 to 4.x to 5.x to right around 6. high velocity means the PSA is escalating at a fairly rapid rate.

2yr or so ago, had an MRI, showed a mass, "75 percent likely to be cancer" my urological oncologist said, took, a biopsy, which turned out to be 15 biopsies, peed blood for a week. result? benign.

then, a PSA a couple of months ago, 4.6. my PSA went down a point or more, but my ratio of something to something, which was very good, got a little bit less good. go figure.

i have a talented urological oncologist - and i searched for this guy, asked around - and every year or so he sticks is finger up my ass and extols the virtues of my prostate, as palpated by his finger.

i have no advice for you. i can only tell you that i rely on the one-two punch of a PSA every 6mo and a date with my urologist once a year. i don't worry about it.

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Dan Empfield
aka Slowman

Unfortunately, I can speak authoritatively on this subject as I had my cancerous prostate removed nearly 2 years ago. Diagnosed in '14 after a biopsy following an elevated PSA of around what you are reporting. Came back with a low gleason score which allowed me many options, one of which is watchful waiting. Fast forward to '16 and the 3D radioscopic xray says it's growing close to the edge and that's not good because you don't want that cancer to escape outside the organ. I looked long and hard at all the options and ended up going with surgery to have it removed. Looking back on that time I'm now perfectly happy with my choice. If you end up getting a positive diagnosis and need some information from someone whose been there and done that feel free to message me.

When I was 42 I needed a physical and my doctor had me get a PSA along with the other tests. It was kind of elevated, so he had me take another one, which came back a little high as well. So I was in a similar situation as you are now in. Next step is ultrasound and biopsy; not pleasant, but not a big deal either. My biopsy came back "inconclusive" so we kept up the PSA every 6 months. Two years later it popped higher, so another round of biopsies. This time they came back positive. After exploring the alternatives, I went with robotic surgery. I was back at work in a few days and "back to normal" riding the bike, running etc. in a month. Now, 10 years later, I don't even think about it.
I was very lucky that i got that early PSA test. If i didn't need the physical for my SCCA race car license, I never would have seen the doctor, and most likely I wouldn't be alive right now. My friend Mark wasn't so lucky; he passed away last week from Prostate Cancer at age 58 after a horrible last 3 years.
This is why you get your PSA tested early and often.

I forgot to mention that my Dad had Prostate issues in his late 50s, not cancer just enlarged that we know of. Dr thought it was about time to keeping track of mine.

Thank you! I may take you up on that depending on what this journey looks like!

So, there is a lot of debate about PSA levels and treating prostate cancer. For the majority of men, we will all at some point develop prostate cancer. A small percentage of those men will develop an aggressive form of the cancer that will metastasize and kill them. For the rest, for those that decide to treat the cancer, many will undergo unnecessarily aggressive treatment that could very well leave them impotent and incontenint for the rest of their lives. Also, there is some question as to whether repeated invasive biopsies will actually induce cancer that wasn’t there in the first place. It’s a very difficult decision and personal to make, and really, at the end of the day, it’s a roll of the dice, because nobody has yet found a test that can accurately diagnose a slow growing prostate cancer that is unlikely to kill you from an aggressive cancer that will spread to other parts of your body. My father had prostate cancer and elected to treat it with radioactive seeds, and are always trying to get me to constantly get my PSA checked. On the other hand, he also has friends and family that have aggressively treated prostate cancer and ended up unable to have sex anymore and/or incontinent. I’ve elected to not worry about my PSA levels (age 53) for right now, but again, that is a very personal decision. I should note that there is a general move towards not screening PSA levels anymore because there is no data that supports doing so increases life expectancy (IIRC what I’ve read). I highly recommend you do some due diligence and read up on what the latest research shows regarding treating prostate cancer.

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___________________________________________________
Taco cat spelled backwards is....taco cat.

http://www.thennt.com/...r-prostate-cancer-2/

The evidence suggests that you need to screen about 1000 men with a psa test to prevent one death from prostate cancer. But screening with a psa test doesn't reduce your risk of dying in general just dying of prostate cancer. About one in ten men who have a psa test will have an elevated level. About thirty percent of those men have prostate cancer. Seventy percent do not. So if you screen one thousand men you will likely have one hundred men who will likely get biopsies to save one man from dying from prostate cancer. I guess that means that 99 men get biopsies that don't save their lives. Some may have increased quality of life from treatment I don't know the answer how many and who. Some may have worse quality of life from treatment. Incontinence or impotence.

By the way I never had encountered this thennt site until I was looking for link to attach to this post. It is golden.

The article that lead me to it is also thought provoking.

https://www.propublica.org/...-but-doctors-say-yes

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They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

It actually isn't that irresponsible. It is a very legitimate question to ask if a psa test has any value.

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They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

My background - I'm a physician assistant in Urology and have been for over 20 years. I have also facilitated a support group for men with prostate cancer called Us Too and have been working with this group for 20 years come January 2019. Teamheadwind, I would suggest you check out the UsToo.org website for a local chapter near you as having the opportunity to talk with guys who've been in the same situation can be enlightening. At 56, a psa of 5.6 is considered high and worth evaluation. Historically, it was felt that a psa over 4 was abnormal but for men in their 50s, psa over 2.5 is actually concerning, particularly if you're African-American or if you have a family history as both increase the risk of prostate cancer.

Most men with prostate cancer don't have symptoms unless the cancer has already metastasized to other locations (therefore not curable). And it doesn't really matter how healthy you think you may be, the clear risk factors are those mentioned above. Obesity, physical activity, diabetes, hypertension, hypercholesterolemia, etc. don't seem to have a big impact on who gets it.

It's true that we have to screen, biopsy, and treat a lot of men to save a life from prostate cancer, but the data is clear - men with advanced cancer may require some pretty aggressive treatments (chemotherapy and hormone blockade) that can lead to miserable side effects. The AUA (American Urologic Association) does not recommend screening before age 40. Recommends high risk men (family history, African American) discuss screening with doc until the age of 55 and that all men from 55-69 review the pros/cons of screening with their docs.

As far as treatments, localized cancer can be treated a number of ways including active surveillance (watchful waiting), surgery (robotic or open), radiation (external beam or seeds), or cryotherapy (freezing). Even if diagnosed, there should be a lot of research and discussion with your urologist about what's best to do. Not all prostate cancer is the same - there are very aggressive forms that can metastasize quickly and other forms that are very slow growing and may never cause harm. Unfortunately, psa testing, alone, can't differentiate. Further workup with MRI and biopsy and then close follow up gives a much better picture of what really is going on. There are newer genetic tests and other, older, psa tests (psa velocity, free psa, etc) that can be useful, as well.

Diagnosis and management of prostate cancer is rather complex and I think it's a bit naive to lump the screening, diagnosis, and treatment of the disease into a simple good/bad argument. No different than arguing the benefits of screening for any of the other cancers we might face. Some are generally more aggressive, for sure (pancreatic and lung come to mind). But I wouldn't blow off screening or a recommended evaluation for an elevated psa because of the perceived odds or worry of possible side effects. We do have treatments for erectile dysfunction and urinary incontinence. And I'll bet your wife would rather have you alive and impotent than dead. Bottom line, advocate for yourself and be as informed as you can be.

Hello Cornboy and All,

Thanks for posting ....

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Cheers, Neal

+1 mph Faster

Last year I was in a very similar situation that you are in now. My entire life I have never had any abnormality in my blood work until I was 62 years old. Sure enough it was a PSA score of 5.6. A fairly large jump from the previous year. Absolutely convinced I had prostate cancer off to the Urologist I go. He examines me and then schedules a specific PSA blood test that breaks the PSA into "free" and "bound" fractions to further assess my levels. New PSA blood work still indicated a problem so a biopsy is scheduled. While the procedure did not sound too appealing it really wasn't that bad. All of my concerns were focused on what the biopsy results would show. After holding my breath for a week it came back negative. My next examine is scheduled six months down the road.

This whole procedure started me thinking as to what else would have caused a high PSA score if I did not have any cancer. Could it have been high volumes of riding my tri bike in an aggressive position causing micro trauma to my prostate gland and elevating my PSA (https://prostate.net/...t-increase-your-psa/)? So I decided to just ride my road bike (which also happens to have a saddle with a very large center cutout) for 6 months prior to my new blood work. I also added pomegranate juice to my daily diet. This juice is supposedly prostate friendly so why not. I go back for my 6 month PSA blood work and now my score is 1.8. Urologist looks at me, smiles and says, " What ever you're doing keep doing it and I'll see you in a year".

My advice to you is go for your examination knowing a high PSA score is not a guarantee you have cancer. If a biopsy is ordered don't sweat it. Nobody is a bigger baby than me and if I tell you the procedure is really not that bad believe me. Good luck and keep us informed as to how everything goes.

So not sure about the juice thing, but a high PSA itself does not -cause- prostate cancer. So not sure if there was any reason to change your riding habits.
My father also had PC, with a gleason score of 9 & 10 in biopsy samples. Given the aggressiveness, he was incredibly lucky that it was confined to the gland and close seminal vesicles, and they actually managed to cure him with ADT, IMRT and low dose taxotere (cure as in, its been about 8 years now, still PSA of zero). It was a hell of a ride for him though, due to the size of the tumor and the associated side effects of having a bleeding lump that big down there...

For me, at age 45, I'm not sure what I should do. As others have said above, family members say I should be tested. My Primary care doc says no. SHe did a few baseline tests like 6 years ago, but since then, she has said that if no symptoms and staying healthy, the recommendation (at least here in Canada) is to not test. I can honestly see both sides of the argument, and agree that there is no easy answer...
To the OP, if mine were elevated that high, I would want further testing to confirm what was (or wasn't) going on, hopefully its nothing.
Cheers

I didn't mean to imply that a high PSA score causes cancer (I know it doesn't). I just wanted to prove to myself that riding a bike (at least a tri bike up front on the nose of the saddle) can increase the PSA score. At least it did for me.

I agree, a guy at work got caught in his late 40's and it was advanced when they found it. Hormone, chemo and radio followed very shortly after - he's due back in work anytime now after recovery from the radio but at this moment in time there is still a big question mark over his long term well being ... :-(

WD :-)

The "finger up my ass" comment made me laugh! Last two times my doc did his finger wave up my ass he was impressed that it felt smooth and smaller than most men my age and seemed dumfounded on my PSA levels based on how it "felt"

Thank you all for your thoughts and info on this, it really is invaluable to make good informed decisions on this moving forward! from what most of you have stated the research seems to be all over the place, but very treatable if caught early.
Take care all! and I'll update on how this plays out
Greg

Except that's not what he said. He is taking a definitive stand that it is "concern over nothing" when it very well could be something bad.

Actually, the research is pretty clear. The USPSTF looked at 300,000 men in 9 countries and decided in 2012 to recommend completely against routine screening of PSA, as you were far likelier to be harmed by aggressive treatment than gaining a benefit. Not unsuprisingly, the American Urological Assocation vehemently disagreed with that finding, but the data was pretty clear. The USPSTF have recently changed their recommendations to considering screening after discussing it with your doctor, and perhaps going with active surveillance of any cancer as opposed to aggressive treatment. There are some facts that you should be aware of:

"
"The USPSTF evidence review shows that out of every 1,000 men who receive PSA screening:

• 240 will get a positive result, but only 100 will have cancer confirmed.
• 80 of those 100 with confirmed prostate cancer will have surgery or radiation treatment, either immediately or after a period of active surveillance.
• Of those 80 who receive treatment, 50 will suffer erectile dysfunction and 15 will suffer urinary incontinence."

From: https://www.cbsnews.com/...s-on-patient-choice/

The fact is, you have a more than 50% chance of being impotent after treatment. And yes, impotent is better than dead, but it's not even remotely a binary choice, as the likelihood you are treating an aggressive prostate cancer is relatively small.

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___________________________________________________
Taco cat spelled backwards is....taco cat.

Wow, I can't believe some of the responses on this thread. How can it be any easier to keep this in check? A simple blood test and a finger in the butt once a year. Compare that to your wife, mom, or sister that have to get their tits smashed annually to check for breast cancer. Or should they just ignore that test and take their chances? I never read a statistic where you have a greater than 50% chance of impotency after treatment and believe me I read a lot on the subject. You get the right surgeon with the right tools and he can precisely remove the prostate without impacting the erection nerves. You do lose one of the sphincters in your ureter but that is why God gave you two. I've talked to several other guys that had the robotic surgery like I did and none of us are suffering from impotence or incontinence. And best of all, we have a 95% chance of being around in another 10 years. Unlike these guys that didn't make it: https://www.ranker.com/...ate-cancer/reference

Nobody is saying people don’t die of prostate cancer; of course they do. But just because it worked out well for you doesn’t mean that many folks aggressively treating prostate cancer haven’t had very harmful side effects. My dad has several friends who had their prostates removed and are now completely impotent. Now, YOU may have never read a statistic stating that you have a greater than 50% chance of being impotent, but the data are the data.

Here is a website if you want read further: https://screeningforprostatecancer.org/get-the-facts/

Bottom line: Out of 80 men who choose to treat their prostate cancer, 50 will end up impotent and 15 of those 80 will become incontinent, and some both.

Look, as I said earlier, and what the USPSTF says, is that it is a very personal decision.

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___________________________________________________
Taco cat spelled backwards is....taco cat.

If you have a low or intermediate risk prostate cancer your risk of dying from the prostate cancer without treatment is about three percent at ten year followup. Aggressive tumors are rare. But devastating. I still remember a 48 year old patient of mine who died of prostate cancer within a year of diagnosis.

https://www.reuters.com/...dUSTRE65H5MP20100618


Actually one can also make the argument that mammograms have their drawbacks too. Before ordering one it probably merits a discussion of risks and benefits.

https://www.ncbi.nlm.nih.gov/pubmed/17054145

https://www.nejm.org/...0.1056/NEJMms1409003

The current estimate is you have to screen about 2000 women for ten years for one woman to have her life prolonged by screening. In addition to that about ten of those 2000 women will be diagnosed as breast cancer patients and have unnecessary treatment. Although the estimates depend on who you ask. They may be as good as One in 800 for the 50-69 year age group. I'd bet if you ask the average person on the street what the chances of a mammogram saving their life is you would get a wildly lower number. We don't have very many good screening tests for cancer.

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They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

It is true that most men will have erectile dysfunction and incontinence after surgery whether it's performed robotically or via an open incision. The USPSTF does not state when or how long men will have those side effects. All men have some degree of both immediately after the procedure but with time and intervention, those can and often do improve. The USPSTF does not indicate when these men were questioned regarding their ED or incontinence. And many men who undergo surgery already experience some degree of ED - as we get older the risk increases due to other medical conditions.

Screening is a personal choice just as making the decision as to which, if any, treatment should be performed if you are diagnosed. Every time I order a psa or counsel a man who was referred to me for an elevated psa, I review the potentially confusing path he may be headed down should that psa be elevated. With the USPSTF recommendation to stop all prostate cancer screening in 2012, many primary care physicians stopped ordering the psa. And we are now seeing more men in the last five years coming to us with advanced cases where there is no cure. I can't quote you stats on this yet, as this shift has been too recent but my urology group (and most others) are fearful that we are just now starting to see a significantly greater number of men with metastatic disease than we had prior to 2012. The trick is treating the more aggressive cancers and following those that do not appear to have a greater malignant potential. But that is not an easy science.

Thanks for the thoughtful post, I appreciate the data on what you're seeing now. I think this is much more helpful than asking whether or not somebody would rather be impotent or dead, which to me smacks of fear mongering (not claiming you were doing that, but that's how kind of came out to me reading a forum post).

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___________________________________________________
Taco cat spelled backwards is....taco cat.

My apologies - not trying to instill fear. Just letting these guys know that it's not quite as straightforward as some resources might suggest. That quote actually came from one of the wives of a survivor and I thought it kind of cut through some of the BS that newly diagnosed men were hearing from non-medical sources.

Update:
Had my appointment with my Urologist about a month ago. He said to be sedentary for the next week then get another PSA test, no running, no bike and no sex. Did that and came bake at 5.81 which was slightly higher than the other two PSAs. Scheduled a biopsy, took 16 core samples and three came back showing small amounts of cancer that is grade 1 with a Gleason score of 6 (3+3) which surprised and shocked me. He recommends that we do Active Surveillance and test PSA every four months along with the DRE to see what the trend is. He emphasized that I shouldn't worry and that whatever I have going on can be treated when and if that time comes. At this point I'm going to get on with my life and not let it consume me and my family, and just grateful it was caught early.
Thanks All!

That phone call when they tell you you're positive for cancer is a shocker! Good news is that they caught it early and you got lots of options (sometimes I thought too many). Take care and whatever you do don't let that beast out of the capsule!

Are you a urologist or practicing health care provider in the know? If not, probably not worth making uneducated comments like this, as prostate cancer incidence start to creep up by mid 40s.

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Colorado Triathlon Company, CO2UT 2021, Crooked Gravel 2022, Steamboat Gravel 2022

Glad it has worked out for you. I went through this dance earlier this year when my PSA shot up. I am 63. Was referred to Urologist and had a biopsy. Fortunately for me the enlargement of my prostate is benign. The naysayers out there would say that I went through an unnecessary procedure. But my brother, just 14 months older, had high Gleason score cancer and elected radiation (Tomotherapy followed by radioactive seed implantation in the last year). He is for the time being cancer free.

They say most men that live to old age die with prostate cancer. Not of it, but with it. This illustrates the fact that for all but the unlucky few, it is a slow growing cancer that stays put. That said, it can spread and kill you if it is the more virulent type, as indicated by a high Gleason score on your biopsy samples.

PSA is quite effective for tracking the progression of prostate cancer and how a treatment plan is affecting it once a person is already diagnosed. eg, the number going up or down

PSA can be helpful for men with family predisposition towards prostate cancer and for men over 50 years old to identify early suspicion and decide on possible treatment (or non-treatment) plans.

PSA is very sketchy for everyone else. It is not a very effective diagnostic tool.

I write this with the personal experience of being without any family history, before any previous problems "down there" and before any previous prostate exam, and only being 46 years old, now diagnosed with advanced, Stage 4 (already metasticized) prostate cancer. Might an earlier PSA have helped to catch the cancer earlier (before it got out into more of the body) so as to provide more chances for longer survival?

I say PSA is an affordable, non-invasive blood test even if paying out of pocket.

Thank you for sharing, My thoughts and prayers are with you as you fight this!
Take care

Hello markvoss and All,

Bummer!

As you likely know ... there are clinical trials for stage 4 prostate cancer.

Are there any clinical trials you can enter in Columbia?

If not .... are you an expatriate from another country that might be having clinical trials?

https://www.everydayhealth.com/...our-prostate-cancer/

Because new drugs are being developed all the time, you might also want to talk to your doctor about the possibility of joining a clinical trial for treatment with an experimental medication or other therapy.

https://www.pcf.org/...cer-clinical-trials/


Clinical trials bring life extending and curative new treatments to cancer patients. Clinical drug trials play a vital role in moving new treatments to patients who need them most, securing data so regulatory approvals can be obtained and new drugs can move into widespread clinical practice. Patients who participate in clinical trials provide an invaluable service both to treatment science and fellow patients.

There are currently over 130 Phase III drug trials and more than 600 Phase I/II trials in process for prostate cancer in North America and Europe. Those that are approved will join the eight new drugs that have been approved for men with advanced metastatic disease since 2010 and further improve outcomes for patients.

Good luck!

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Cheers, Neal

+1 mph Faster

Interesting thread. Like Cornboy, I too worked as a health professional (RN) in a large urology center. Some interesting stories and opinions came forth from years in the trenches. There are a number of men who WOULD rather die than be impotent. Saw several take their chances and did die. Prostate cancer bone mets are not a pretty way to go. Trust me on that one. Did a prostate biopsy on a twin that was grossly positive. The Urologist told the guy that maybe his brother needed a Urologist consult. Sure enough bro #2 had bad cancer too. Both had their prostates taken out on opposite sides of the country at the same time. 10 years both were doing great.

There is a lot of controversy over PSA testing, in my opinion if you can afford the blood test or a digital rectal exam, it don't hurt anything and may help save your life. Yea, getting a needle biopsy is no fun and the biopsy may miss all the cancer cells. I have seen some biopsy prostates look very normal on ultrasound and came back very positive, and some prostates with palpable lumps, and bad looking ultrasound images that were not positive by biopsy at all.

We have a long way to go with prostate cancer, but in my thoughts getting regular Urology visits, skin screens for cancer, working on the diet, not drinking and driving, regular checkups and eye/ dental exams seem like a reasonable and prudent thing to do in life. Be careful out there kids.