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Medical Forum / Diseases and Disorders / Prostate Cancer / August 2006Just had first PSA test at age 59, yikes. Am new to this group.
The result: 23, not 2.3, but 23, which is abnormally high? Am now wondering if my specialist who I'll be seeing in two weeks for the first time will want a new PSA test before deciding anything about a biopsy, since this test result is so high. I imagine he'll do a digital exam. My last digital exam about 2 yrs. ago was perfect in every way. I think I'd insist on a PSA re-test - in case this high result is a false reading, since I have no prostate symptoms and my brother had a totally false liver function test that had him buried with end stage liver failure one day, perfect retest results the next. Anyone else have such a high first PSA test? My primary doctor seemed quite alarmed. Not that I'm in denial about it all, since my 85 yr. old father, who I am relatively out of touch with being far out of town, has a high PSA result and diagnosis of PC as far as I know. Could certain diets, etc. raise it so high? I have a low-animal-fat diet, but high-peanut-butter-fat diet, and huge quantities of broccoli, spinach, horseradish, curry, and mustard daily. I drink about 8 cups of decaf and 2 caffinated daily. I have cardiac arythmia, but no longer take beta blockers for it as it has stabilized and a recent EKG looked fine. I've had colon resectionings (large and small colons) due to emergency diverticulitis surgery where gangrene also destroyed my appendix), and have resultant muscle and nerve damage at the scars in the abdominal wall. I have permanent diverticulosis so I eat a water-soluable diet only, no nuts, seeds, vegetables like corn, beans, etc., to protect the parts of my colons that were not removed. Most suspiciously, I have a rare blood disease - allergy to sunlight UV - that killed my twin sister at age 36 due to the crystals formed by UV in the blood destroying her liver where they can deposit. Obviously, with a potentially terminal allergy to radiation as 'weak' as sunlight, I'd be wary of any radiation treatments/chemo, due to this blood disease and its already stressing my liver. I've had colon polyps removed during colonosopies, and had a heart catheterization following a corony thrombosis 15 yrs. ago (no damage to heart and no plaque, yet a cholestoral of 340 - possibly caused by rare blood disease making my liver outputs wacky?). I have no disc number one, between the tailbone and the spine, in the region of the prostate, which creates major events involving disablement, pain, numbness in legs/feet, etc., and occasional use of muscle relaxants and vicadin. Also near the prostate, but outside on the skin, I had a major shingles outbreak ten years ago and now have some post herpetic neuralgia occasionally. Other than that, I'm in great shape, really! Thanks for any info on this high PSA test result - I'm very new to the PC worry. Tim, Easton PA The result: 23, not 2.3, but 23, which is abnormally high? Am now wondering if my specialist who I'll be seeing in two weeks for the first time will want a new PSA test before deciding anything about a biopsy, since this test result is so high. I imagine he'll do a digital exam. My last digital exam about 2 yrs. ago was perfect in every way. I think I'd insist on a PSA re-test - in case this high result is a false reading, since I have no prostate symptoms and my brother had a totally false liver function test that had him buried with end stage liver failure one day, perfect retest results the next. Not that I'm in denial about it all, since my 85 yr. old father, who I am relatively out of touch with being far out of town, has a high PSA result and diagnosis of PC as far as I know. ========> sorry to have you join the club you didn't want to join. having a father with pca, automatically moves you up on the risk factor chart. yes, psa of 23 is high, and no, you don't feel any different, and yes, a digital exam can feel perfect in every way, while having pca. (mine did, and it was performed just hours before surgery and i had confirmed pca in both lobes) they should probably put you on a two week treatment of some form of antibiotics such as cipro or levaquin to rule out prostatitis, then, do another psa test. also, you can have a psa II test done that measures the amount of free psa in your body. that number should be higher than 25. and yes, the waiting period of standing around sucks..... best of luck, ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc > ... < long list of maladies > ... > Other than that, I'm in great shape, really! Well, I don't know if your body is in great shape, but your attitude is terrific. > Thanks for any info on this high PSA test result - I'm very new to the > PC worry. Tim, I'm not a doctor and my advice may be worth even less than you're paying for it, but here goes ... A PSA of 23 gives you a high probability of having prostate cancer. It could be caused by prostatitis, but it would be unusual for the PSA to be that high due to prostatitis alone. If you don't feel any pain at all, for example during ejaculation, then that too seems to me a more likely symptom of cancer than prostatitis, which is often painful. PCa is only painful in late stages, after it has metastasized to other parts of the body. I am personally not a fan of taking antibiotics to find out if you have prostatitis because most cases of prostatitis are not caused by bacterial infection, and even among those that are, it may take a lot of antibiotics over an extended period to treat it. My first choice to find out if you have a bacterial infection would be to get a urine culture - which is non-invasive and should show whether antibiotics will likely do any good. By all means, do get another PSA test. Be sure not to have sex or a digital rectal exam for at least 3 days before the test since both can elevate the readings somewhat - though not to anywhere near 23. It is conceivable that the lab totally screwed up and confused your PSA with someone else (God help the other guy!), or got the decimal point wrong, or whatever. But that kind of error is probably pretty rare. Unless the next PSA is _way_ down, then if I were you, my next step would be to schedule a biopsy. A PSA of 23 is a serious warning sign and I'd want to know right now whether cancer is involved. I wouldn't wait. Any PSA over 20 is considered "high risk". If you had a normal PSA two years ago, that's all the more reason to treat this seriously since the rise is rapid. As I recall, some men in this newsgroup have had successful, curative treatment with PSA in the 30's. So, although you should be concerned, you have a chance of killing the cancer even with a PSA of 23. And if that fails, you have a good chance of living with it for a long, long time before it brings you down, possibly long enough for new treatments to save you. A friend of mine had a physical exam last year and it showed a PSA of 300!. Curative treatment was out of the question. However they put him on hormone therapy and now, a year later, his PSA is almost undetectable and he's living the same full life that he had been living. If the biopsy is positive, start looking for the best, smartest, most experienced, most committed prostate surgeon you can find. Good luck. Alan > The result: 23, not 2.3, but 23, which is abnormally high? > Yes, it is. The medic should know the gland volume (GV) after the DRE. To determine how much PSA is normally expressed by prostate gland tissue, multiply GV x 0.066. The result will be the amount of PSA from "benign" cells. Anything in excess of that is suspicious and requires further investigation. *Do not* permit a PSA blood draw within 48 hours of the DRE. The gland will be stressed and the test result therefore unreliable. Other stressors are sex within 48 hours, infection, prostatitis, even riding a bike. > Am now wondering if my specialist who I'll be seeing in two weeks for > the first time will want a new PSA test before deciding anything about > a biopsy, since this test result is so high. Is the "specialist" a urologist? (snip) > I think I'd insist on a PSA re-test - in case this high result is a > false reading, since I have no prostate symptoms and my brother had a > totally false liver function test that had him buried with end stage > liver failure one day, perfect retest results the next. > Lab errors do in fact occur; it has happened to me and others. (snip) > Could certain diets, etc. raise it so high? (snip) I am not a medic, but I doubt it. (snip info on comorbidities) They'll have to be taken into consideration. But I recommend intensive studies only if the dx is adverse. Contingency planning is prudent, though. In that regard, I recommend exploration of the authoritative website of the Prostate Cancer Research Institute at: http://prostate-cancer.org/index.html Regards, Steve J "What does not kill me, makes me stronger." --Friedrich Nietzsche > I've had colon resectionings (large and small colons) due to emergency > diverticulitis surgery where gangrene also destroyed my appendix), and [quoted text clipped - 10 lines] > as sunlight, I'd be wary of any radiation treatments/chemo, due to this > blood disease and its already stressing my liver. Pardon me, for butting in here, Tim. Is the rare blood disorder one of the porphyrias? If so, there are two (radiation) oncologists on sci.med.diseases.cancer who might have treated or know whether radiation therapy is contraindicated for such and/or how to treat such a patient effectively but safely. As to hormone therapies and/or chemos, your oncologist would have to work closely with your blood specialist. Chemo is not usually in the picture early, unless it has spread and it's used palliatively to shrink tumours or unless it's a different (rarer) type of prostate cancer Quite a few chemos are listed in a booket issued by the Porphyria Centre Sweden. My copy's dated year 2000 and the list is regularly updated as to which medicines are safe and which are contraindicated. Your national association or blood specialist could probably provide you with the updated booklet for a nonimal fee. But we're getting ahead of ourselves, since you haven't been diagnosed yet. If you do (on both), please come over and tell them which blood disorder and maybe they'll have some input. Good luck. J > The result: 23, not 2.3, but 23, which is abnormally high? Yes, 23 is high, but less than 4,900 which is the highest I've seen recorded here. The average in the last five years, or so, is 45.4. I hope that helps. > Am now wondering if my specialist who I'll be seeing in two weeks for > the first time will want a new PSA test before deciding anything about > a biopsy, since this test result is so high. I imagine he'll do a > digital exam. My last digital exam about 2 yrs. ago was perfect in > every way. Seriously, 23 is awful high to have hopes of a benign condition. > I think I'd insist on a PSA re-test - in case this high result is a > false reading, since I have no prostate symptoms I imagine 70 to 80 percent of those here were asymptomatic at diagnosis. The greatest precursor to a diagnosis of prostate cancer seems to be a life insurance policy examination. > Anyone else have such a high first PSA test? My primary doctor seemed > quite alarmed. Out of 600+ members in the last few years, 54 had PSAs of 23 or higher. > Not that I'm in denial about it all, since my 85 yr. old father, who I > am relatively out of touch with being far out of town, has a high PSA > result and diagnosis of PC as far as I know. Sons of 85 year old men with prostate cancer are no more or less susceptible to prostate cancer at 59. However, men who are diagnosed at 42 (like my dad) ARE more likely to have sons with prostate cancer. And, I was in the same denial that you're... well... denying. > Could certain diets, etc. raise it so high? I have a low-animal-fat > diet, but high-peanut-butter-fat diet, and huge quantities of broccoli, > spinach, horseradish, curry, and mustard daily. I drink about 8 cups of > decaf and 2 caffinated daily. I have cardiac arythmia, but no longer > take beta blockers for it as it has stabilized and a recent EKG looked > fine. Nope, sorry. > Most suspiciously, I have a rare blood disease - allergy to sunlight UV > - that killed my twin sister at age 36 due to the crystals formed by UV > in the blood destroying her liver where they can deposit. That is interesting. Sunlight activated Vitamin D is good for the prostate. [horrid medical history redacted] > Other than that, I'm in great shape, really! My God, Tim! You're a human medical lab. I guess with all you've entered into the equation, you could have some condition that elevates your PSA to 23. I sincerely hope that is the case.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 Non Illegitimi Carborundum > cardiac arythmia > colon resectionings (large and small colons) [quoted text clipped - 11 lines] > shingles > post herpetic neuralgia "Yikes" is right, Tim . . . and you're concerned about a little thing like PC? ;-) Your cool-headed approach to adversity will serve you well in this potential new skirmish. I'd question carefully any oncologist who says your other problems do not affect your treatment options if your PSA follow-up verifies PC. I.P. Tim, I had my first DRE and PSA at 50 - DRE was positive and PSA was 30. I was put on Cipro for 30 days and retested at 33. This was about a week after my 4-year younger brother told me he had been diagnosed w/ PCa. G.S. 3+3. I had a bone scan and MRI and they were clear. Despite the high PSA I had RP along w/ my bother on the same day, same hospital, same team. G.S. 3+4 w/ seminal vesicle involvement. I had 2 undetectable PSAs and then it started to rise. Due chiefly to the high pre-op PSA and SVI, I have assumed systemic disease and foregone salvage radiation. You probably do have PCa but it may still be local and curable despite your 23. Good luck and keep us updated. Bill Denton RP 2/12/02 PSA .93 Memphis Gee, I know exactly where Easton is - I grew up not far from you, Lower Moreland school district. I'm now in Virginia. The Fox Chase cancer center has a good reputation. Yes, you can have a high PSA such as yours without having PC but it is rare. You may ask to have your PSA tested prior to your visit with the specialist and also consider a fPSA. Sometimes the fPSA can be the best indicator at this point because anything below 25% usually spells cancer. Just call your regular doctor's office and ask for a retest of the PSA with a fPSA. Do it now so those results will be available for the specialist when you see him/her. Just remember if it is prostate cancer, this is a treatable cancer. Take some time and do some reading. From Walsh to Strum and everything else you can find. Being educated will help you to ask the right questions of your doctor and to understand what he tells you. Expect a DRE (digital rectal exam) and that will probably be followed by a biopsy. Biopsy is not fun but not terrible either. It's done as an outpatient procedure. Some times the guys are knocked out for it and sometimes they forget to give them something for it prior to the biopsy and do it anyway. They say finding the cancer is like looking for a few BB's in an orange. Maybe they will get lucky and hit one. I know that sounds terrible but that is about the best a man can hope for at the present time. They do use a Doppler thingy to guide them so they do have some idea where to aim. After the biopsy you will notice a bloody often ketchup-like ejaculate. That's normal. They will also give you a round of antibiotics. It is possible if the fPSA come back high (good thing) that you might just have an inflamed prostate. That means a round of antibiotics and another PSA test in a few weeks. Don't worry about your diet. Diet might play a role but so far no one as ever found diet to due much of anything positive or negative when it comes to PC. Your blood disease sounds like autoimmune to me and I haven't looked that on e up. So it is possible that could be playing a role in your high PSA test score. Also the UV from the sun is not that same as the radiation used for treatment of PC. But it is something that needs to be discussed with a radiation oncologist. If it you have joined the club and it is PC then consider all your options. Bev > The result: 23, not 2.3, but 23, which is abnormally high? > [quoted text clipped - 56 lines] > > Tim, Easton PA |
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