My husband has recently been diagnosed with prostate cancer. Not having any treatment at the moment. On watch & wait with 3 monthly check ups. Having his first check up later today. We are both scared that his psa levels has risen.
Any procedure such as biopsy, cystoscopy or colonoscopy etc can raise the PSA. Also any infection of the prostate or bladder etc - was told to wait at least 6 weeks after a cystoscopy and after a colonoscopy. Also, has he been told to avoid intercourse and any strenuous exercise in the 48 hours prior to the PSA test? I had been having the PSA test for years before someone told me that.
I find having PSA levels is a nightmare, for me only every 6 months. I' m.not sure I'll ever feel OK about it. It seems so unpredictable.
It's interesting to read how people write about PSA. It's similar to the way some people with diabetes mellitus talk about their blood sugar levels.
However, it's not the same for two reasons. One is that normal blood sugar levels are more or less the same for everyone. Normal PSA levels are not the same for everyone.
The other reason is that diabetes is a dysfunction of sugar metabolism. Prostate cancer is not a dysfunction of PSA metabolism.
You can therefore read of men with a PSA of 8 or more and no cancer and men with a PSA of less than 5 with cancer.
There are a few things that can cause raised PSA other than cancer hence avoiding ejaculation 48 hours prior to a test, ( by whatever activity) or forms of exercise stressing the gland e.g. cycling. Trauma, infection and inflammation can raise PSA levels. e.g. following a biopsy, prostatitis etc.
A significant thing is, not.just is the PSA going up, but is it coming down again. Raised PSA levels caused by non cancerous conditions will come down again if the condition is resolved. .If it's due to cancer then, all other things being equal, it won't come down again. Typically, it's considered worrying if PSA levels rise 3 consecutive times, not just gone up and come down again.
The other thing to consider is, if it's getting higher, how fast is it getting higher i.e. the PSA Velocity. You may read about "doubling time", the PSA getting twice as much in less than 10 months is.considered indicative.
Overall, it's probably not a great idea for anyone to compare their actual PSA level with anyone else. It's probably better to just to look at whether it's changing,.if it goes up, does it come down again and how fast is it rising.
However, AFTER treatment there are some key values which are considered indicative of whether treatment has or is working or not, but the same criteria apply.
For example, post prostatectomy PSA is expected to be undetectable, if it isn't and starts rising it's considered a "recurrence" when it is 0.2 or more on 3 consecutive tests. If is is "low detectable" i.e. less than 0.2 and rising less than 0.05 a year, it's considered "stable", if it's low detectable, below 0.2 and either rises on 3 occasions or rises more than 0.05 a year then it's "unstable".
I read that the prognosis for stable low detectable PSA following surgery is little different from undetectable. Much poorer for unstable.
Sorry to hear of your husbands condition, like most of the people on here, we will try and give advice and help where we can, we’re not doctore, just been through lots of experiences ourselves.
It seems strange that although diagnosed with PC he did not at least have hormone tablets, we all know PC is very slow to grow, but if you have it you would like some action taking not be put on surveillance.
Have you discussed with them what procedures can be taken or on offer ?
Considering the consequences of the iatrogenic effects of any treatment and their effect on quality of life, it doesn't seem strange at all that hormone therapy ( HT) isn't given with active surveillance. HT is treatment. Active surveillance is only appropriate if treatment isn't thought to be necessary.
One of the factors affecting the provision of routine PSA screening is that it can lead to unnecessary overtreatment. This along with the high proportion of "false positives".
Don't worry about this aspect, having regular PSA tests is stressful enough as it is without thinking you should be having some treatment, when really, it's not necessary and might do more harm than good.
If surveillance is thought to be appropriste, it's a bit premature to be discussing treatments. If active treatment is eventually thought to be necessary, further investigations would have to be carried out before appropriate treatment can be decided, which may NOT include HT.
If anyone is unhappy being monitored rather than having active treatment, I guess they could request it, but generally speaking, it's not advisable and men shouldn't feel.pressured into feeling they should have it.
