Rising PSA

I presume he's on Active Surveillance? That's a doubling time of about a year, so definitely needs to go back for another MRI to see if any further followup is required.

hi Andy, no he hasent been on active surveillance. He just has an annual PSA test. The GP has now referred him to the urologist. What can we expect from that visit? Does PSA rise with an enlarged prostate? Thank you for posting. 

PSA does rise with an enlarged prostate. This is compensated for by calculating PSA density (PSA divided by prostate volume) rather than using just PSA alone.

They will probably do an MRI, digital rectal exam, and maybe check for any infection, before deciding if any further investigation is required.

Hello Andy, thank you for your message. It is so kind of you. My husband has gone into complete shut down mode and will not discuss this at all. He is also French, so doesn't have extensive medical vocabulary. I dont either, so I thought one of us needs to find out all we can. 

Please could you explain how the PSA divided by prostate volume works? Many thanks 

A normal Prostate is around 25-30ml in size. Consider a man at an age where a PSA of 3 is the threshold for referral. If his prostate is 50-60ml, he has twice as much prostate tissue, and therefore his threshold for referral would be a PSA of 6. However, a GP doesn't have any way to accurately measure prostate size, so they would have to refer at a PSA of 3, and it will only be after the MRI scan done by urology that the large prostate size will be accurately known and hence that PSA level 6 or greater would be a concern in that case.

Thank you so much Andy, that is very kind of you. My husband has a prostate  size of 62 and he should have a PSA of 6.5. So according to the calculation a PSA of 10 is in proportion to the size. Thank you so much for explaining it so clearly, that was very helpful and very much appreciated. 

Hello Fluffy. My husband was monitored for some 10 years with, in the early years, annual PSA tests which were always at the upper margins for his age and we were referred to urology and agreed to just monitor PSAs. About 5 years ago his PSA rose to about 8 ( he was 70 ish and I can’t remember the exact dates). We were referred back to urology and the consultant told us nothing needed to be done until his PSA was 10. 

anyway, he hit 10 last summer. After MRI, biopsy and bone scan he was diagnosed with locally advanced prostate cancer and no metastases detected so T3 a N0 M0 Gleason 4+3=7. The oncologist told us that the cancer might have been there for a long while but the treatment is still with the ‘intention to cure’.

i don’t know whether it would have been better to have had the treatment 5 years ago when the cancer/ grading might have been better and he would have been younger and fitter and better able to cope with the treatment? Or, has it been better to wait, giving him 5 years without treatment and now dealing with a more serious cancer at an older age? The diagnostics have improved over the last 5 years. New treatments are being introduced all the time and research is discovering more - such that he is having 20 days of radiotherapy rather than 37 , for example.

my husband had no symptoms and at rectal examination he was diagnosed with a smooth enlarged, benign-feeling prostate . 

an MRI scan involves an injection of dye into a vein and then the scan. It didn’t take long. My husband agreed to it thinking it would bring peace of mind! how wrong was that thinking but how lucky we were to have the cancer found when it is hopefully treatable and hopefully curable. 

I hope our experiences help inform you and your husband about your next step and hope that you really do get the peace of mind one way or another that we are still seeking.

The watch and active surveillance option  is much safer now with the advent of the mp MRI My husband was being monitored for 5 years due to family history of prostate cancer. His PSA never went above 6 so he was not offered a biopsy.

He recently had an MRI which showed a suspicious lesion graded PIRADS 5. Subsequent biopsy showed he has localised PC with a Gleason score of 7(3+4) and Hormone Therapy starts this week I think he is fortunate that the new type of MRI can show when treatment is needed at an earlier stage without relying only on PSA which doesn’t always tell the full story. 

A rise in PSA from 6 to 10 maybe should trigger a request for another MRI scan which would either give some peace of mind or show any changes in the prostate. I’m sure there will be an NHS protocol for active surveillance or someone on here might be aware of any guidance which would clarify your husband’s situation. I’m sure some on Active Surveillance having mentioned that they have annual MRIs

 Best wishes to you and your husband  Robina 

Hello Robina,

Thank you for taking the time to write. I am so sorry to hear that you have been going through such a tough journey but hope and pray the treatment  is successful . It was kind if you to write. I think we will ask to have an MRI again and go from there. The waiting and not knowing is so painful, but its reassuring to know that MRI can so accurately show up changes. I send you my warmest wishes. Thank you for sharing your story. 

Hello, 

Thank you so  much for  sharing your experiences. It is interesting  to know of others  in similar situations. Yes it is a dilemma  not knowing when to start treatment  but as you say being without treatment for 5 years must be beneficial. Why was your husband being monitored initially? Was it due to the high is PSA results and were these caused by the enlarged prostate? My husband is of a similar age and although we were told if it reached 8 we should return to urology , it was only picked up at the annual PSA test that it had already past10. We hope it will not be bad news. Thank you for taking the time to write.