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Do PSAs go up and down?

Obviously they do - cause mine is - just not sure it means anything since my trend is up. I am getting a biopsy done in a month.

Thanks

Maybe not an important question - but I am not sure. I suppose a lot of guys would like to have a psa this low.

My history of PSA
Oct 2000 0.8
Oct 2005 1.1
Oct 2006 1
Oct 2007 1.3
Oct 2008 1.6
Oct 2009 2.6
Nov 2010 not done (I think doc said not needed every year)
Nov 2011 not done - dr checked wrong box apparently
Nov 2012 not done
May 2013 3.78
Jun 2013 3.79
Feb?2014 3.7 - (Not sure of exact figure)
Oct 2014 3.5
Mar 2015 4.7
Mar 2015 4.3 (with 13.7% free)

Re: Do PSAs go up and down?

I should add nothing done before higher psa that would make it higher. And once I did get on antibiotics before repeat psa test. I think that is the 3.5 result.

Re: Do PSAs go up and down?

Seems the trend is more important than one up or down.

"What is important to know about PSA?

"The absolute level and rate of change of PSA are important. A raised PSA may be either transient i.e. temporary or sustained and persistent. PSA varies by as much as 33% between tests, although not usually as much. For example, if the PSA is 3 ng/ml on 1 occasion, it may go down to 2 ng/ml or even up to 4 ng/ml on another occasion without being significant. This may be just normal variation in PSA measurements."

"Therefore, several readings over time (e.g. 1 per month or every 3 months) may be needed to determine if a raised PSA is genuine or due to a temporary aberration. After several readings have been made, it is possible to calculate the PSA velocity, rate of change or doubling time, which may give additional information as to the chance or severity of prostate cancer."

http://www.windsorurology.co.uk/Clinical_Information/PSA.aspx

Re: Do PSAs go up and down?

Don,

The % free PSA is low and is a predictor of PC.

Fred

Re: Do PSAs go up and down?

Fred
The % free PSA is low and is a predictor of PC.


Yes 24% according to one study (at my age).

But another study says 59%?

"A 2008 study of 125 men who had a prostate biopsy showed that the percentage of free PSA in men with a total PSA of 2.5 ng/ml or less could indicate who was most likely to have prostate cancer: 59% of the men with a free PSA of 14% or less had prostate cancer versus just 13% of the men with a free PSA of 28% or more."

study I usually see and that my doctor listed:

"The table below lists the probability of prostate cancer for
men with non-suspicious DRE results and total PSA between
4 and 10 ng/mL, by patient age (Catalona et al, JAMA 1998,
279:1542).

% Free PSA - 50-64 yr - 65-75 yr
0.00-10.00% - 56% - 55%
10.01-15.00% - 24% - 35%
15.01-20.00% - 17% - 23%
20.01-25.00% - 10% - 20%
>>> >25.00% - 5% - 9%

And other info "in the age of 12 core biopsies" - now the rates of finding cancer are higher. 10 to 11% or less free = 85% of the time cancer is found?
---

Copyright © 2008-14 Prostate Cancer International, Inc.

The free PSA test in prostate cancer risk assessment: an update
Posted on January 18, 2011

The potential of the percentage of free (unbound) PSA to total PSA (usually abbreviated to %fPSA) as a measure to assist in the analysis of risk for prostate cancer has been known for years. However, researchers at the Cleveland Clinic thought it might be a good idea to check on that potential in an era of 10- and 12-core biopsies (compared the sextant biopsies customary in the early to mid 1990s).

Lee et al. have assessed data from 1,077 men who had had their %fPSA measured (as well as their total serum PSA) and who had undergone an initial extended prostate biopsy.

The men were divided into two groups based on their total serum PSA levels:

Group A was made up of the men with a total serum PSA level >4.0 ng/ml.
Group B included only men with a total PSA level ≤ 4.0 ng/ml.

The results of the analysis showed that:

Cancer was detected in 453/1,077 patients (42.1 percent).
The average (mean) PSA level among all patients was 7.6 ng/ml.
The average (mean) %fPSA was 18.0 percent.
The ability of %fPSA to predict prostate cancer on initial extended biopsy was significantly better in Group B than in Group A.
For men in Group B, a %fPSA level of 11 percent or less was 85 percent specific for a positive biopsy result.
For men in Group A, a %fPSA level of 10 percent or less was 85 percent specific for a positive biopsy result.

Lee et al. conclude that the performance of %fPSA in predicting the presence of prostate cancer is not altered when an extended biopsy scheme was used compared to the older sextant biopsy. They are careful to note that a %fPSA level higher than 10 or 11 percent can not be used to rule out the possibility of a biopsy result that is positive for prostate cancer. However, they also note that a low %fPSA value is likely to be particularly useful in predicting prostate cancer — especially in men who may have a PSA level < 4 ng/ml and no indication of potentially cancerous tissue on digital rectal examination.

Re: Do PSAs go up and down?

Here are a couple calculators where you can plug in your info - including free psa and get a percentage back. This is essentially what I was looking for. I am definitely in need of biopsies.

http://www.clevelandclinic.org/lp/prostate-cancer-risk-assessment/index.html

Kind of depressing but helpful in accepting reality. I have a 14-17% chance high risk cancer, 33-35% chance cancer. Biopsy on May 14th.

Another one with about the same results:
http://sunnybrook.ca/content/?page=occ-prostatecalc

Both sites come with the appropriate disclaimers

Re: Do PSAs go up and down?

Hope your May 14 biopsy went OK. You should have the results by now. Have had 4 of them over 7 years, so know the feeling. Very invasive to say the least. Was shocked when my initial biopsy delivered the diagnosis of PCa - Gleason 6(3+3). In my experience it is very important to get the actual written pathology report and study it well. Imperfect a measure, though it is, track your PSA.

In response to your question I regularly checked and tracked my PSA over 8 years. At the time of diagnosis it had risen to 3.2. After changing up a lot of stuff in my lifestyle, it got back down to as low as 1.8. Over time it spiked on a few occasions, as high as 6, but essentially rose over time, on average ever trending higher to recently 4-5 range, before I was driven to surgery by last biopsy results and progression in my case. I was kind of a nut about it and checked PSA on average every 6-8 weeks. This is a synopsis to date of my PCa and PSA history:

12/07 Age 57 - Diag PCa - PSA 3.2 - Bio 2/8 GS 6(3+3) - T1C
1/08 chg MD - begin WW/Expectant Management- Macrobiotic Vegan - BMI 26.1
9/08 PSA 1.7 - T1C - BMI 19.1
3/09 MRI - Inconclusive
6/09 PSA 1.8 - T1C - Bio 2/10 GS 6(3+3) - BMI 19.5
10/11 PSA 3.6 - T1C - Bio 3/9 GS 6(3+3)
3/15 PSA 4.9 - T1C - Bio 3/8 GS 7/3+4)
5/15 Age 65 - Rad Prost Surgery - GS 7(3+4) - No Lymph - 1 Positive Margin 2mm

Despite all my lifestyle efforts; macrobiotic diet, rigorous Yoga practice and supplements, seems genetics still trumps all. Jury is out for a couple of months before we check PSA following surgery. Being lean and well conditioned through Yoga ahead of surgery is helping to deliver a rapid recovery.

USA

Re: Do PSAs go up and down?

Yes my biopsy was ok - a couple HGPIN found - which may not mean anything according to recent studies. Continued testing is needed anyway with my PSA.

Re: Do PSAs go up and down?

Interesting
My psa started climbing in 2006 after I had a double bypass surgery. It started at 1.0 2006. 2.0 2007,1,75 2008, 2.75 2009, 3.0 2010, 4.0 2011 4.5 in 2012, 3.5 in 2013, 3.5 in 2014 now in 2015 its 8.0.

I had the regular psa done as well as the Free psa test. The free psa test indicated 8.0 with 15% free They said it means I have a 35% chance of having a positive biopsy result.

My question is does anyone know if Lipitor , lisinopril or Atenolol have any effect on creating a higher psa number? Urologist will do another psa later this month to see if psa changes. He did the DRE and there was no sign of any problems, I do not have any of the symptoms of BHP enlarged prostrate which normally is present.??

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