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Hello,
I am 66 years old with two brothers that are currently in remission after RP surgery within the last 10 years. I have not been diagnosed with cancer.
Since my brothers both had PC I have been watching my PSA closely over the years. I get a PSA test and DRE every 6 months.
My PSA has slowly risen over the past 12 years from 1.6 to 3.4 as of January this year.
Last Sunday I did a strenuous 90-mile bike ride, the next day (Monday) I had my regular 6 months check up (dumb). In addition to the bike ride on Sunday, I also masturbated on Monday morning and few hours before my appointment (dumber)
The appointment consisted a urine specimen test and emptying my bladder.
A sonogram was done to ensure my bladder was emptying. (it was)
A DRE exam and a PSA test, (the blood was drawn before the DRE)
They can do on the spot PSA testing in this office and my PSA was a whopping 9, my DRE was normal.
Naturally I was a very concerned about the PSA result but the urologist assured me that it is likely due to the cycling and masturbation.
I am repeating the PSA later this week.
I read on this website that long distance cycling and masturbation can increase a PSA result. If fact according to the site long distance cycling can skew the result up to 3 times.
I would love to get your thoughts.
I have no other symptoms typical of prostate issues.
The answer to your questions, as you probably already know, is yes. In this instance however, it would be prudent to repeat the PSA test is say a months time, without the extracurricular activities. Do let us know how you get on.
F. C./ D&D*/ PSAs:
Relative to sexual activity think in terms of abstaining two (preferably) three days prior to PSA testing. I am less certain about how long you should forego cycling activity.
You may have data available to you that could help you and your urologist in the decision-making process. Review your PSA history. If the gradients are similar for the 1st and last year that would be one thing. However, if the gradient for the twelfth year is substantially steeper than the 1st, it may signify something else altogether.
In the meantime follow John's sound advice
Don O.
*Sorry! Hope my distorted sense of humor is not overly misguided.
Thanks for your comments guys.
I had another PSA 4 days later with a reading of 4.9. My Urologist was very pleased. Plan to do it again in a few weeks after 7 full days of inactivity.
This site really helps control the anxiety that comes along with all of this.
Jerry:
I think you are very wise to closely monitor your PSA. A blood draw every month (or every three months} should suffice, i. e.,until you and your urologist are satisfied that a reliable pattern exists.
Best wishes. Let us know your results by continuing to report here on this thread.
Don O.
________________________________________________________________________________________________________
Here is the summary report:
Lymph Nodes: Normal Size
Bones: Metal artifact from right symphysis fracture and acetabular injury. No aggressive bone lesions are seen. (this is from a bicycle crash in 2007)
Extra prostatic findings: No unusual extraprostatic pelvic soft tissue masses are seen
IMPRESSION: The study is limited with mild technical artifact induced by the metal hardware from the patient's right hip fracture. However, there is a focal abnormal area of restricted diffusion identified on image 18 and 19 measuring 6 mm in size. This shows a mean ADC value of 900 and a peak low value of 800. This shows high signal intensity on the high b value image. This may represent a small early focus of low-grade prostate cancer. The remaining portion of the gland shows benign inflammatory changes in the peripheral zone in the mid gland as well as benign changes in the seminal vesicles.
If the patient is a candidate for a biopsy, I would recommend including the small area of restricted diffusion in the left ventral transition zone in the mid gland with targeted biopsy. No extraprostatic disease is seen.
____________________________________________________________________________________________________________
I live near Dr. Duke Bahn's office in Ventura California and I am considering a visit with him to have a Color Doppler TRUS study performed and possibly a biopsy if he recommends it.
Hi Jerry,
I guess any further discussion with your treating physician relates to the issue of whether or not to proceed down the biopsy path. Your readiness or otherwise to investigate, what in all probability would be considered to be a small low grade tumour, is a matter for possible conjecture twixt you and your physician and a good many others on here as well. Contemporary thinking today suggests that low risk prostate cancer can be managed without active treatment but regular monitoring. But on the other hand you do have an elevated PSA and a family history of PCa? So if that small foci is indeed low grade PCa, do you want to know about it? Do you want to treat it? Or would you be comfortable in having ongoing monitoring and see what develops (if anything)? I guess if I were you Jerry, I would probably choose active surveillance for the time being with six monthly PSA's and a follow up MRI in 12/12. Bottom line is that you have increased risk but couple that with evidence of a possible low grade PCa that may not require treatment for quite a while. It all depends on your comfort zone?
best wishes,
john
p.s. Happy to discuss my rationale further if you wish.
Hello John,
Actually the MRI results calmed me down despite the possibility of a low-grade PCa lurking.
I am comfortable with active surveillance at this point, but I am leaning toward the Trus exam with
Doctor Bahn. He does not accept insurance but for $700 it may be worth a second look with a different
technology.
I do have one question rolling around in my head that so far I have not found an answer to: At what
point in the growth of a cancerous prostate tumor does it exhibit aggressive behavior that can be determined
via the Gleason scoring method? In other words, will a biopsy tell me what I really need to know that may
influence my decisions going forward?
It's kind of difficult to follow these threads because of the format of the site.
But I recall that you have a strong family history of PC and had an elevated PSA (of about 9.0?) after a 90 mile bike ride.
Your PSA had been around 3.0 or so, which is fine.
The PSA of 9, of course, is alarming. As we know, any kind of activity that stresses the prostate can put a temporary, artificial spike into the PSA reading -- things such as sex, bike riding, DRE, strenuous exercise, etc.
But I don't know if it would cause a jump of about 6 full points. It might add a point or two, but I don't think much more than that. On the other hand, that 90 mile bike ride is a bit beyond normal prostate stressing activities, so maybe it is possible that this explains that high PSA.
Have you had another PSA yet? A PSA where you are completely, physically inactive for 2-3 days before the blood draw? If not, this should probably be your next move.
If the PSA is still on the higher side, a biopsy would be the best way to proceed. There is a 2-edged sword with biopsies: ONLY a biopsy can diagnose/grade prostate cancer. And standard 12-core biopsies miss other tumors (in addition to any detected) that are present about 20% of the time -- sometimes those missed tumors are more aggressive than the one(s) detected.
At what point in the growth of a cancerous prostate tumor does it exhibit aggressive behavior that can be determined
Jerry that is not an easy question to answer. Essentially we are talking about the transition from a pussy cat to a tiger. Let me make a few points. All cases of PCa will progress over time. The rate of progression can vary greatly even among persons with similar PSA, Gleason Score, and Staging. Extra capsular extension can occur anytime, even in low grade early stage tumours. Progression can still occur with a normal, and even below normal, PSA reading. Progression tends to be slower as a person ages.
Ok, so the point that I am trying to make is that nothing is guaranteed. But we do have a few tell tale signs to look for. PSA signature, Tumour bulk, and formation of nodule/s. Bi-annual blood screening and an annual DRE and probably a second yearly MRI are all useful. I think that I would be comfortable following that form of active surveillance in your case.
So yes it is a bit of a gamble, but a manageable one. Your urologist is of course a very central figure in the whole process and it is vital that you have the utmost confidence in them.
Hello John,
It's not the answer I would have preferred, but it is very well stated and the reality of the situation. I like my Urologist as she is very supportive and willing to authorize any further exams I choose to have. She says I can drop by anytime without an appointment and they will do an on the spot PSA with the results in 15 minutes, I'm thinking a monthly PSA for the time being. I do a lot of cycling so I'll have to give a rest for a week each month.
For now active surveillance seems to be the way to go.
Thank you so much for the informative responses from John and the others.
I will stay in touch.
Got another PSA yesterday, 5.0. I decided to go ahead and schedule a biopsy in October even though my urologist is still comfortable with just watching the PSA over the next few months. The MRI report indicates the possibility of low-grade cancer but I am concerned about the subjectivity of these reports. What if it's the beginning of aggressive cancer? My uro says aggressive cancer will have a high Gleason early on, but the MRI images should reflect this aggressive nature.
Your thoughts would be appreciated.
Got another PSA yesterday, 5.0. I decided to go ahead and schedule a biopsy in October even though my urologist is still comfortable with just watching the PSA over the next few months. The MRI report indicates the possibility of low-grade cancer but I am concerned about the subjectivity of these reports. What if it's the beginning of aggressive cancer? My uro says aggressive cancer will have a high Gleason early on, but the MRI images should reflect this aggressive nature.
Your thoughts would be appreciated.
Jerry
Hi Jerry,
I would consider finding another urologist. Any uro that has a patient with a PSA of 5.0, and advises to wait a few more months, is someone to run away from.
While it does not fall into the normal category, it IS VERY possible for such a PSA number to be associated with more aggressive prostate cancer. In fact, I've seen at least one other person who turned up with prostate cancer even with a PSA of UNDER 1.0.
I don't recall if this case involved a higher Gleason score or not, but that is also possible.
I don't recall from the earlier part of this thread, but do you have BPH? If so, that could also be an explanation for your 5.0. But that still does not rule out the possibility of having a tumor at the same time. Two uros urged me to have a biopsy with a PSA similar to yours, and I refused -- until my number went up a couple notches.
Turned out that I DID have prostate cancer all along. Fortunately, it was Gleason 6.
I would suggest that you do need to have a biopsy. If you do, best to make sure the uro has a lot of experience and a good track record/reputation.
Good luck!
Chuck
esident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Pathology showed Gleason 3 + 3, pT2c, N0, MX, R1
adenocarcinoma of the prostate.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain painlessly removed morning after surgery.
Catheter painlessly out in 7 days. No incontinence, occasional minor dripping. 100% continent after 3 weeks.
Post-op exams 2/13/12, 9/10/12, 9/9/13, 9/30/14 PSA <0.1. PSA tests now annual.
Semi-firm erections from time to time 3+ years post-op.
Sexual function affected, pre-op, from significant BPH.
MRI Fusion Biopsy results were negative for cancer. 16 cores were taken with 4 cores targeting the small spot noticed on the MRI. Will get PSA's every three months for now. If PSA continues to rise a second MRI will be done followed by biopsy.
Thanks again for all your comments. I read many of the stories which were a tremendous help in calming my nerves.
Jerry
You are correct about the bicycling, masturbating, etc., prior to the PSA blood draw.
Basically, the preparation for a PSA test includes the following:
IN THE 48-72 HOURS BEFORE THE TEST:
* Do NOT have any kind of sex
* Do NOT ride a bike
* Do NOT perform any strenuous exercise
* Do NOT have a digital rectal exam performed
All of the above activities can put stress/excitement on the prostate and, as a result, trigger a falsely high PSA reading.
