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44 with a mildly elevated PSA -- worried about nothing?

User
Posted 05 Apr 2017 at 11:20

Hi,

I'm a 44-year old male. I have some very minor symptoms of prostate enlargement -- urinary urgency/frequency and some dribbling. I recently asked my doctor if I should have my prostate checked and she said "not until 50 unless you show signs". She did a DRE on the spot and it was positive for enlargement.

She ordered a PSA and urinalysis. My urinalysis is negative for nitrates and negative for bacterial culture.

My PSA is 2.9 and I understand this is fairly low, but from what I've read this is a bit of a concern at 44? My TSAf % is 16%, which has me a little more worried.

I want to see a urologist, but I suspect my GP will fight me on that. Am I worrying over nothing? What should I ask for in terms of next steps? 

User
Posted 05 Apr 2017 at 16:36

Slightly different view to my friends above (sorry) - the free PSA ratio of 16% is reassuring but unreliable at PSA of less than 4.0. For your age, PSA of 2.9 is above referral threshold so there should be no problem getting a referral to a urologist if you live in England. It may be infection or you inherited a tendency to enlarged prostate but urgency / frequency at your age should be enough for a referral regardless of any anxiety about prostate cancer. My husband was first referred at age 35 for frequency and slow flow - his PSA was low but the urologist still wanted to find out why he was having problems (it turned out to be a bladder muscle problem for which he took tablets for 15 years). If you have any other problems such as difficulty getting an erection, dry orgasms or retrograde ejaculation do not be embarrassed - you must tell the GP that as well.

Just one query - you are not a professional cyclist are you?

Edited by member 05 Apr 2017 at 16:37  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 06 Apr 2017 at 14:24

I don't know Lola but this is Geeky's thread so perhaps your question should be on one of your threads instead?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 06 Apr 2017 at 19:36
Geekything

I'm 46 and had an original PSA of 6.2. To cut a long story short, I've had my robotic surgery and with non nerve sparing suffer the delights of ED. I often wonder what my PSA would have been at age 45 when I had my well man clinic. They didn't test for PSA. Maybe the cancer would not have been in the nerve bundles, maybe the tumour would have been smaller. I'm glad you're seeing the urologist - early referral may mean better outcomes if you do have PCa.

Good luck

Ulsterman

User
Posted 05 Apr 2017 at 11:57

I Don't think your PSA is too high but since you are young and your prostate is enlarged, I'd rather see an uro.
Anyway wait until someone more knowledged than me says st. I'm still "new" in this stuff.
Best wishes
Lola.

User
Posted 05 Apr 2017 at 13:36

Hello Geekything

Is there any history of Prostate/Breast cancer in your immediate family? It may act as a lever if the answer is yes.

PSA of 2.9 seems low compared to some on here with PSA in the hundreds and thousands but we also have a few with low PSA and cancer so PSA of itself doesn't say yay or nay to cancer, it just indicates something needs investigating.

So your GP is also saying that there isn't an infection?

If you are really bothered then ask the GP to refer you to a urologist. although she may ask you to wait a while to see if your symptoms of enlargement reduce.

One thing I wouldn't do is ignore any of it and hope it all goes away.

I'm sure others will be along to advise so hang in there until then

Best Wishes

Sandra

****

We can't control the winds - but we can adjust our sails
User
Posted 05 Apr 2017 at 14:12

Hi Geekything,

Whilst it is true that most men are not diagnosed until the are 50+ some men are diagnosed well under this age - we have them on this forum. So being under 50 should not be a bar to having having a PSA/DRE which you have now had done. It also seems from what you say that an infection had been ruled out. The next step is to ask your GP to request an appointment with a urologist to try to determine whether the urinary symptoms are entirely due to your enlarged Prostate (Benign Prostatic Hyperplasia - referred to as BPH). I would not be put off just because your PSA is not high. Some forms of cancer do not show high PSA and even less symptoms than you have for a man of your age. Should it be cancer it is best to be found at an early stage where appropriate action can lead to best chance of cure.

Barry
User
Posted 05 Apr 2017 at 20:49

I think your GP is a bit out of date - fortunately the urologist should know quite a lot about the subject!

There is a familial link between ovarian cancer and prostate cancer and they are of course both hormonal cancers.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 05 Apr 2017 at 21:29

My husband is 44, PSA measured at 2.7 then 3.6 12 months later then 3, 2 months later. He had biopsy and had cancer. Prostate removed 2 months later and hopefully now all clear.
It is good that you have a referral. Our Urologist was surprised by the positive biopsy result but there you go, it is unusual but not unheard of.
Julie

User
Posted 05 Apr 2017 at 22:42

John's was 3.1 and it was already spreading into his bladder. We also have members here who have been diagnosed in their 30s so the assumption that it is an old man's disease is a myth. As I said, the GP perhaps doesn't have much experience of prostate cancer - good that you have been referred.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 06 Apr 2017 at 04:17

Lyn, I have to sons, 36, 39. You think it's time they checked their prostate, as their father has a PCa?

Good morning,

Lola.

User
Posted 06 Apr 2017 at 05:18

Lola, my son is 45 and has been checked. He isn't stressed about the possibility but he knows that he has to be aware.

I also have three grandsons who have been told that their granddad has had prostate cancer so they'll know for the future.

Warn your boys by all means but there is no need to panic them. There can be a familial link but it isn't always the case.

Just make them aware of the possibility. I've no doubt that they will consider it, for your sake at least and to put your mind at rest

For us mothers, our sons are now grown men. All we can do it point them in the right direction and we've done our duty. Love can only go so far but then we have to leave it up to them

We can't control the winds - but we can adjust our sails
User
Posted 06 Apr 2017 at 08:32

Lola, if it is available in Spain they should probably start getting tested from the age of about 40 - 45, just to keep an eye on things. But as Paco was not diagnosed young, it is very unlikely that there is a family gene.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 06 Apr 2017 at 08:49

Thanks, Lyn.

Since the oldest one , 39, is not very prompt as far as matter of health is concerned, I'll begin already.
telling him to visit the consultant.

They can go both "Seguridad Social" (state health care) and private insurance as it's provided by the companies they work for. Do you think it's better to spare the general consultant and visit the uro directly

User
Posted 06 Apr 2017 at 14:43

Geeky, so sorry for using your thread to my own questions. Sometimes, when reading other's conversations that are someway related to your issues you forget that's not your thread.
I wish you all the best.
Lola

User
Posted 06 Apr 2017 at 16:21

No problem on the thread hijacking ;)

One question....my free PSA % is 16.....I thought this was in the "danger" territory but it appears not? Did I misinterpret the stats? I do understand it's not considered reliable < 4.0 PSA, although it does appear the Mayo Clinic think otherwise (valid > 2.5 PSA).

Thanks!

User
Posted 06 Apr 2017 at 19:01

The methods for testing PSA and fPSA vary here and in the USA so although in the US the optimum range is seen as 2.5 - 4.0 and fPSA ratio benchmark is 16%, in the UK it tends to be thought unreliable below 4.0 with a threshold of 25%. Either way, you are right on the border of inconclusive at the minute.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

Show Most Thanked Posts
User
Posted 05 Apr 2017 at 11:57

I Don't think your PSA is too high but since you are young and your prostate is enlarged, I'd rather see an uro.
Anyway wait until someone more knowledged than me says st. I'm still "new" in this stuff.
Best wishes
Lola.

User
Posted 05 Apr 2017 at 13:36

Hello Geekything

Is there any history of Prostate/Breast cancer in your immediate family? It may act as a lever if the answer is yes.

PSA of 2.9 seems low compared to some on here with PSA in the hundreds and thousands but we also have a few with low PSA and cancer so PSA of itself doesn't say yay or nay to cancer, it just indicates something needs investigating.

So your GP is also saying that there isn't an infection?

If you are really bothered then ask the GP to refer you to a urologist. although she may ask you to wait a while to see if your symptoms of enlargement reduce.

One thing I wouldn't do is ignore any of it and hope it all goes away.

I'm sure others will be along to advise so hang in there until then

Best Wishes

Sandra

****

We can't control the winds - but we can adjust our sails
User
Posted 05 Apr 2017 at 14:12

Hi Geekything,

Whilst it is true that most men are not diagnosed until the are 50+ some men are diagnosed well under this age - we have them on this forum. So being under 50 should not be a bar to having having a PSA/DRE which you have now had done. It also seems from what you say that an infection had been ruled out. The next step is to ask your GP to request an appointment with a urologist to try to determine whether the urinary symptoms are entirely due to your enlarged Prostate (Benign Prostatic Hyperplasia - referred to as BPH). I would not be put off just because your PSA is not high. Some forms of cancer do not show high PSA and even less symptoms than you have for a man of your age. Should it be cancer it is best to be found at an early stage where appropriate action can lead to best chance of cure.

Barry
User
Posted 05 Apr 2017 at 16:36

Slightly different view to my friends above (sorry) - the free PSA ratio of 16% is reassuring but unreliable at PSA of less than 4.0. For your age, PSA of 2.9 is above referral threshold so there should be no problem getting a referral to a urologist if you live in England. It may be infection or you inherited a tendency to enlarged prostate but urgency / frequency at your age should be enough for a referral regardless of any anxiety about prostate cancer. My husband was first referred at age 35 for frequency and slow flow - his PSA was low but the urologist still wanted to find out why he was having problems (it turned out to be a bladder muscle problem for which he took tablets for 15 years). If you have any other problems such as difficulty getting an erection, dry orgasms or retrograde ejaculation do not be embarrassed - you must tell the GP that as well.

Just one query - you are not a professional cyclist are you?

Edited by member 05 Apr 2017 at 16:37  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 05 Apr 2017 at 20:13

My GP has referred me to a urologist -- mainly because she could see I was worried. She claims that a 2.9 PSA in a 44-year old is perfectly normal and that if I had cancer it'd be much, much higher.

To answer the questions:

- No history of prostate or breast cancer that I know of. My mother died from ovarian cancer, but I understand that's completely unrelated.

- I am not a professional cyclist and had no form of prostate manipulation before my PSA test.

Thanks to everyone for the replies!

Edited by member 05 Apr 2017 at 20:15  | Reason: Not specified

User
Posted 05 Apr 2017 at 20:49

I think your GP is a bit out of date - fortunately the urologist should know quite a lot about the subject!

There is a familial link between ovarian cancer and prostate cancer and they are of course both hormonal cancers.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 05 Apr 2017 at 21:29

My husband is 44, PSA measured at 2.7 then 3.6 12 months later then 3, 2 months later. He had biopsy and had cancer. Prostate removed 2 months later and hopefully now all clear.
It is good that you have a referral. Our Urologist was surprised by the positive biopsy result but there you go, it is unusual but not unheard of.
Julie

User
Posted 05 Apr 2017 at 22:42

John's was 3.1 and it was already spreading into his bladder. We also have members here who have been diagnosed in their 30s so the assumption that it is an old man's disease is a myth. As I said, the GP perhaps doesn't have much experience of prostate cancer - good that you have been referred.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 06 Apr 2017 at 04:17

Lyn, I have to sons, 36, 39. You think it's time they checked their prostate, as their father has a PCa?

Good morning,

Lola.

User
Posted 06 Apr 2017 at 05:18

Lola, my son is 45 and has been checked. He isn't stressed about the possibility but he knows that he has to be aware.

I also have three grandsons who have been told that their granddad has had prostate cancer so they'll know for the future.

Warn your boys by all means but there is no need to panic them. There can be a familial link but it isn't always the case.

Just make them aware of the possibility. I've no doubt that they will consider it, for your sake at least and to put your mind at rest

For us mothers, our sons are now grown men. All we can do it point them in the right direction and we've done our duty. Love can only go so far but then we have to leave it up to them

We can't control the winds - but we can adjust our sails
User
Posted 06 Apr 2017 at 08:32

Lola, if it is available in Spain they should probably start getting tested from the age of about 40 - 45, just to keep an eye on things. But as Paco was not diagnosed young, it is very unlikely that there is a family gene.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 06 Apr 2017 at 08:49

Thanks, Lyn.

Since the oldest one , 39, is not very prompt as far as matter of health is concerned, I'll begin already.
telling him to visit the consultant.

They can go both "Seguridad Social" (state health care) and private insurance as it's provided by the companies they work for. Do you think it's better to spare the general consultant and visit the uro directly

User
Posted 06 Apr 2017 at 14:24

I don't know Lola but this is Geeky's thread so perhaps your question should be on one of your threads instead?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 06 Apr 2017 at 14:43

Geeky, so sorry for using your thread to my own questions. Sometimes, when reading other's conversations that are someway related to your issues you forget that's not your thread.
I wish you all the best.
Lola

User
Posted 06 Apr 2017 at 16:21

No problem on the thread hijacking ;)

One question....my free PSA % is 16.....I thought this was in the "danger" territory but it appears not? Did I misinterpret the stats? I do understand it's not considered reliable < 4.0 PSA, although it does appear the Mayo Clinic think otherwise (valid > 2.5 PSA).

Thanks!

User
Posted 06 Apr 2017 at 19:01

The methods for testing PSA and fPSA vary here and in the USA so although in the US the optimum range is seen as 2.5 - 4.0 and fPSA ratio benchmark is 16%, in the UK it tends to be thought unreliable below 4.0 with a threshold of 25%. Either way, you are right on the border of inconclusive at the minute.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 06 Apr 2017 at 19:36
Geekything

I'm 46 and had an original PSA of 6.2. To cut a long story short, I've had my robotic surgery and with non nerve sparing suffer the delights of ED. I often wonder what my PSA would have been at age 45 when I had my well man clinic. They didn't test for PSA. Maybe the cancer would not have been in the nerve bundles, maybe the tumour would have been smaller. I'm glad you're seeing the urologist - early referral may mean better outcomes if you do have PCa.

Good luck

Ulsterman

User
Posted 08 Apr 2017 at 12:15

One other tidbit....my wife reminded me I'd had a slightly abnormal ultrasound in 2013 (it was a renal ultrasound, but I guess they checked my prostate whilst they were there). The remarks were prostate size slightly elevated. I guess this validates the DRE of "enlarged prostate".

Patiently waiting for my referral.

User
Posted 17 Apr 2017 at 21:12
Don't wait too patiently!
 
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