Raised PSA and urgent referral for older man - advice please

Hello Pepe .

Welcome to the prostate family but sorry that your father is suffering from several problems. As a starter I have attached a link to a very helpful book which you can download for free which will help explain what tests they can do to determine if he has prostate cancer or whether his urinary problems are due to a benign condition such as prostatitis (which can cause an increase in the PSA) or a narrowing of the urethra (the tube which connects from the bladder to the outside). The first thing urology will probably do is some sort of scan but with his CKD you will need to ask whether it is safe to give him a contrast dye - it is possible to have the scans without a dye and should not affect the results. Which scan he has could be determined by whether he is able to stay still for a lengthy period of time. I presume they have ruled out a urinary infection which can cause lower back pain? The Urologist would normally do a DRE (digital rectal examination) where he sticks his finger up the back passage to feel what the texture of the prostate is and whether there are any lumps on it. He might also do a flow test to check the volume of urine excreted along with the rate. An ultrasound is a quick test which might be carried out. Once the results from a scan are back you should be told whether there are any suspicious areas in the prostate which, if present, would normally lead to further tests such as a prostate biopsy and additional scans, however, the overall health of the patient will determine whether this is practicable. With older men the first treatment offered for prostate cancer is usually hormone therapy but this can make dementia worse, plus there is an increased risk of cardiovascular events. Surgery is not normally offered to men above 75. There are different types of radiotherapy which could be a possibility. What will also be taken into account is that prostate cancer is normally slow growing so it is possible that your dad would be put on Active Surveillance where they monitor things with regular PSA blood tests but don't give any active treatment until things start to escalate. 

https://issuu.com/magazineproduction/docs/js_prostate_cancer_guide_for_patients_ezine

Macmillan have a support line for the whole family and can be contacted on 

0808 808 00 00

Please have a read of the book and come back with any questions no matter how small or silly you might think them and we will try to help.

Hello Pepe 

Another warm welcome to the online Prostate Community from me - I am so sorry to read about your Dad's issues.

Alwayshope has given you a super reply - I  will just add a personal note. I was having issues with flow and also not eating and drinking properly (at age 66). Little did I know my Prostate had grown, crushed my bladder which in turn retained urine and crushed my kidneys causing CKD. (You can read my full story by clicking on my avatar).

Below is a link to Prostate Cancer UK's - How Prostate Cancer is diagnosed.

https://shop.prostatecanceruk.org/our-publications/all-publications/how-prostate-cancer-is-diagnosed

If you have any further questions we are all happy to answer them for you.

Best wishes - Brian.

Well thank you so much for this reply. It is more than I had hoped for and is super helpful. I really appreciate it! Do you happen to know how likely it is for it not to be cancer with a PSA of 24.8? 

Yes his urine was tested and was clear so no infection. He never ever complains about pain so I imagine the back pain must be quite severe for him to mention it. 

Thank you once again. This will be very helpful for my Mum and I going into the appointment and gives us some questions to ask the urologist. 

Thank you so much for your reply. I will give your story a read now. Dad's kidney function declined very rapidly from 60 to 30 over a year. It's been 30 since January but we've been waiting for this kidney appointment. I'm annoyed that the GP didn't do any checks for prostate issues before now. 

Do you think that the kidney ultrasound where they noted that his prostate wasn't enlarged could be incorrect? Any idea how accurate an ultrasound of this type would be for the prostate? Would it have picked up any cancer? 

Hello Pepe 

Thank you for your reply - my kidney eGFR was down to 8!! on arrival at hospital.

I am unsure how accurate an ultrasound is at both kidney and prostate readings - I do know they use ultrasound in taking a Prostate Biopsy, to find the prostate but I don't think it can pick up cancer on it's own but I know some research projects are looking into this.

In reply to your question about PSA readings  - for a man aged 83 "normal" is under 4 so I am so sorry to say 24-8 would indicate cancer. You can have Prostate Cancer without an enlarged prostate. The formal diagnosis is usually made by taking sample cores from a prostate biopsy.

Best wishes - Brian.

A PSA at this level is usually indicative of prostate cancer but not definitive. I have read many instances where a high PSA even in the hundreds turns out to be due to a benign condition. It might be an idea if you make a list for the Urologist about when the problem started, does he have difficulty starting the flow, how often does he urinate, does it wake him at night and how many times, does he leak in-between times, does he have difficulty controlling the urinating until he can get to the toilet. Some of these things can be helped with pelvic floor exercises - think of the muscles you squeeze when you feel the need to pee and hold until you can release the flow. There is an app called the  SQUEEZY APP which you can download which tells you how to do them properly and reminds you when. It depends on how open your dad is to doing them but if you insert a bit of fun into the routine it may help.

https://squeezyapp.com/

My husband is almost 81 and is still able to tolerate most treatments for advanced prostate cancer. He also has cardiovascular issues plus CKD thanks to the cancer restricing flow during the first treatment (radiotherapy). The doctors are well used to treating men with co morbidities if it does turn out to be prostate cancer.

All the best for your meeting next week and please let us know how you get on.

Just to add on to Brian's post. An ultrasound can be pretty accurate at picking up prostate cancer but, like all things, it depends on the expertise of the operator.

My husband's eGFR got down to 28 but has since improved to the 40's. Diet can help - did the Nephrologist make any recommendations?

He put him on tamsulosin but that was it really. I just re read the report from his kidney ultrasound back in April and it states that bladder contained 283ml of urine and then after he'd been for a wee it contained 210ml! Does this seem like it should have been investigated further at the time and not left until 5 months later?? 

Thank you Brian. I would much rather honesty and knowing what we are likely up against helps me. I just read your story - what a rollercoaster! I'm so pleased that you are doing well now and have completed your treatment. Thank you for becoming a community champion so you can help to support people like myself and my Dad. We are very grateful. 

Hello Pepe 

It's no problem. We have all been at the start of a "journey" and know what it's like not knowing what to expect - it's those first "dark day that cause so much worry and anxiety.

If we can help to raise people's knowledge and guide them through to their treatment path be it curative or not then we have done some good. 3 years ago I thought prostate Cancer was something someone else got - how very wrong I was!!

We are happy to help - keep asking questions and do let us know how dad gets on

Best wishes - Brian.