Elevated PSA Labs

Triathlon Forum
1

Ok, so had my yearly physical in July and labs came back with an elevated PSA of 5.46, Dr thought it was an anomaly as I did CDA70.3 three days prior, ordered another test 30 days after and said stay off the bike for a week prior to bloodwork, which I did. Came back 5.79 and he’s referred me to a Urologist. Getting a bit freaked out as all my other labs have been great over the years and I have never had any medical issues other than wear and tear, so now entering unknown territory.
Any thoughts or what to expect next?

I’m 56 / 162lbs / 6’1"

Thanks!

2

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%.

3

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?

4

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.

5

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?

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

6

Ok, so had my yearly physical in July and labs came back with an elevated PSA of 5.46, Dr thought it was an anomaly as I did CDA70.3 three days prior, ordered another test 30 days after and said stay off the bike for a week prior to bloodwork, which I did. Came back 5.79 and he’s referred me to a Urologist. Getting a bit freaked out as all my other labs have been great over the years and I have never had any medical issues other than wear and tear, so now entering unknown territory.
Any thoughts or what to expect next?

I’m 56 / 162lbs / 6’1"

Thanks!

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.

7

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.

8

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.

9

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.

10

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

11

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.

12

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.

http://www.thennt.com/nnt/psa-test-to-screen-for-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/article/when-evidence-says-no-but-doctors-say-yes

13

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?

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

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

14

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.

15

Hello Cornboy and All,

Thanks for posting …

16

Ok, so had my yearly physical in July and labs came back with an elevated PSA of 5.46, Dr thought it was an anomaly as I did CDA70.3 three days prior, ordered another test 30 days after and said stay off the bike for a week prior to bloodwork, which I did. Came back 5.79 and he’s referred me to a Urologist. Getting a bit freaked out as all my other labs have been great over the years and I have never had any medical issues other than wear and tear, so now entering unknown territory.
Any thoughts or what to expect next?

I’m 56 / 162lbs / 6’1"

Thanks!

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/articles/15-things-that-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.

17

Ok, so had my yearly physical in July and labs came back with an elevated PSA of 5.46, Dr thought it was an anomaly as I did CDA70.3 three days prior, ordered another test 30 days after and said stay off the bike for a week prior to bloodwork, which I did. Came back 5.79 and he’s referred me to a Urologist. Getting a bit freaked out as all my other labs have been great over the years and I have never had any medical issues other than wear and tear, so now entering unknown territory.
Any thoughts or what to expect next?

I’m 56 / 162lbs / 6’1"

Thanks!

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

18

Ok, so had my yearly physical in July and labs came back with an elevated PSA of 5.46, Dr thought it was an anomaly as I did CDA70.3 three days prior, ordered another test 30 days after and said stay off the bike for a week prior to bloodwork, which I did. Came back 5.79 and he’s referred me to a Urologist. Getting a bit freaked out as all my other labs have been great over the years and I have never had any medical issues other than wear and tear, so now entering unknown territory.
Any thoughts or what to expect next?

I’m 56 / 162lbs / 6’1"

Thanks!

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.

19

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?

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

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 … :frowning:

WD :slight_smile:

20

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” Ok, so had my yearly physical in July and labs came back with an elevated PSA of 5.46, Dr thought it was an anomaly as I did CDA70.3 three days prior, ordered another test 30 days after and said stay off the bike for a week prior to bloodwork, which I did. Came back 5.79 and he’s referred me to a Urologist. Getting a bit freaked out as all my other labs have been great over the years and I have never had any medical issues other than wear and tear, so now entering unknown territory.
Any thoughts or what to expect next?

I’m 56 / 162lbs / 6’1"

Thanks!

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.