Welcome to Cancer-Forums.net!   

Advertisments:



Useful Links:

American Cancer Society
National Cancer Institute
Cancer Definition

Changes In Psa

Kidney Cancer Discussions

Changes In Psa

Postby Naaman » Thu Jun 02, 2016 7:14 pm

Hello, I am a 57 year old male. In the past 5 years my PSA has been below 0.5. Last year I went to a Urologist in April because of a frequent and urgent need to urinate and he checked me out. He ran a camera into my blatter and said that my prostate was closing in at the opening of my blatter. He had me try uroxatral for a month and it seemed to work fine. He did a PSA and it was 0.35. He suggested a microwave procedure to shrink my prostate. After considering it, I decided to just take the uroxatral. This past June,2009. I had a PSA done by my regular doctor and it was 1.41. He said that when it goes up 0.75 higher than my last PSA that we should try Septra DS for 10 days and repeat the PSA test. Five days after finishing the Septra DS, the PSA was 0.91 What do you recommend I should do now. Should biopsies still be done? When the Urologist did the digital exam in April 2008, he said that I had a small prostate. My regular doctor hasn't ever done a digital exam. He goes soley on the PSA. I still am using the uroxatral but still have an urgent need to urinate. When it hits, I have to go immediately. Your expert advice will be sincerely appreciated.  Stephen
Naaman
 
Posts: 60
Joined: Fri Mar 14, 2014 11:44 am

Changes In Psa

Postby aoidh66 » Fri Jun 03, 2016 12:27 am

Hello, I am a 57 year old male. In the past 5 years my PSA has been below 0.5. Last year I went to a Urologist in April because of a frequent and urgent need to urinate and he checked me out. He ran a camera into my blatter and said that my prostate was closing in at the opening of my blatter. He had me try uroxatral for a month and it seemed to work fine. He did a PSA and it was 0.35. He suggested a microwave procedure to shrink my prostate. After considering it, I decided to just take the uroxatral. This past June,2009. I had a PSA done by my regular doctor and it was 1.41. He said that when it goes up 0.75 higher than my last PSA that we should try Septra DS for 10 days and repeat the PSA test. Five days after finishing the Septra DS, the PSA was 0.91 What do you recommend I should do now. Should biopsies still be done? When the Urologist did the digital exam in April 2008, he said that I had a small prostate. My regular doctor hasn't ever done a digital exam. He goes soley on the PSA. I still am using the uroxatral but still have an urgent need to urinate. When it hits, I have to go immediately. Your expert advice will be sincerely appreciated.  Stephen
aoidh66
 
Posts: 386
Joined: Wed Oct 03, 2012 9:17 pm

Changes In Psa

Postby Holdin » Fri Jun 03, 2016 6:29 am

Stephen, you are telling about 2 problems - frequent urinations(not helped with uroxatral) and a mild elevation of the PSA from prior levels.  They may or may not be related.  Let me address them separately.

There are many causes for urinary frequency.  The common ones include urinary tract infections, excessive fluid consumption(especially coffee, tea and beer which produce an additive diuretic effect), prostate conditions in men(ie benign or cancerous enlargement, prostatitis, prostatic congestion which is most often due to infrequent ejaculation, etc.), diabetes, urinary stones, a variety of kidney disorders associated with inability to concentrate the urine properly, urinary stones, several types of urinary bladder diseases(ie neuropathic bladder, stones, interstitial cystitis, etc.), overactive bladder syndrome and anxiety.   Kidney stones that get lodged in the lower ureter can often have this effect.  Although typically they cause severe pain and blood in the urine, sometimes they only cause severe frequency until passed.  Inflammatory or other masses in the pelvis can rest on the bladder and produce the constant urge to void.  There are unusual local conditions such as urethral diverticulae that can become inflamed and cause severe frequency.  Because frequency has so many etiologies, the patient is best seen by a urologist, as you have done.  Basic evaluation would include a history, physical examination, urinalysis and, if indicated, a urine culture.  Other tests that might be needed to find the cause include imaging of the kidneys, cystoscopy and urodynamic studies.  The cystoscopy you had showed some encroachment of the prostate.  This may or may not cause your frequency.  However prostate problems such as BPH and prostatitis are the most likely cause of your symptoms.

There is little doubt that the PSA blood test combined with a digital rectal examination of the prostate is a good screening evaluation(and the best presently available) for prostate cancer.  The chance of a false negative is minimized by utilization of both tests.  The American Urological Association suggests that the pros and cons of annual prostate cancer screening  be discussed with all men age 50 or over. For those in higher risk groups(ie Afro-Americans and those with a family history of prostate cancer occurring in relative age 65 or younger), screening should begin at age 40.  However, no test is 100% and cancer can still be missed.  Likewise, false positives can occur leading to unnecessary biopsies of the gland. The most common causes of false positives are prostatitis and  benign prostatic enlargement(BPH).   Bike riding, prolonged sitting, and sex within 48 hours of the blood test being drawn can also falsely elevate the PSA.  It is also very important to have the PSA done at the same laboratory.  The reason is that there are several methods for doing the analysis.  Because of this, the normal values for that lab and your specific level might vary from lab to lab.  Your primary care doctor may well have used a different lab that your urologist.  I suspect that you may well have prostatitis causing your symptoms and PSA elevation.  If one suspects prostatitis, generally a course of antibiotic therapy(fluoroquinolones, sulfa, tetracyclines) is prescribed for 4 weeks(I believe 10 days is insufficient) followed by a repeat PSA level in 6 weeks. I think this is a reasonable plan for you but would repeat the PSA through your urologists lab(if different from your primaries).

If still elevated, prostatic biopsy is recommended.  The performance of a free and total PSA level may be of use in deciding if one should  biopsy in borderline cases(benign felling prostate and PSA in the 4 - 10 range).  Free PSA is defined as that PSA in the blood that is not bound to protein.  Dr. Jerry Catalona from Washington University in St. Louis in the mid 1990's published the defining study on this subject.  As noted, this test is most useful in men with PSAs in the 4-10 range.  If the percentage of free to total PSA is greater than 26, the chance of prostate cancer was in the 2-3% range; and if 10% or less, in the 60-70 % range.  Most urologist use less than 15% as an indication to do a prostatic biopsy. There is also a controversy over which types of prostate cancer are being detected by PSA screening.  Detection of intermediate and high grade tumors early can increase the?chances of cure.  However, low grade tumors can also be found early and there are those who believe some of these tumors may never become active clinically.  The question then arises as to whether or not to treat them, especially in younger patients.  As with most subjects in medicine this is not a black and white issue.  I personally believe prostate cancer screening is important.  Take this from a urologist who was screened and cured of an intermediate grade cancer detected initially on PSA testing!?  Good luck!  
Holdin
 
Posts: 53
Joined: Wed Jan 01, 2014 5:40 pm


Return to Kidney Cancer

cron