Rapid change in PSA score

[xbluesuiter]

I had a PSA score of 6.62 last January, (2007).    I had a follow up blood test in June  that showed a PSA of 8.88,   I underwent a biopsy which came out negative.   In October I had a follow up test and my PSA was 7.67, I was informed by the Doctor at that time that they were convinced that I did not have prostrate cancer.  Last week I had a blood test taken with my annual physical and my PSA score is 14.17.  This seemed like an unusual change to my Doctor and she referred me to a Urologist.  Does this seem like a very large change in PSA scores for that amount of time.  Also any indication of what I may be in for.  I feel terrific, I am 61 years old and have not missed a days work in my life.  

[xbluesuiter]

When I went in for my check up at the urology clinic, the doctor checked my prostate gland and told me that while there was a little enlargement there were no nodules that she could detect.  She felt the best thing to do was start off with a blood test to validate the high increase in PSA.  She called last night to inform me that my PSA is 6.4, and that she is convinced that the high test was an error.  She told me that she wants to watch me and see me every 6 months, but that she does not suspect there is a problem right now.   Thank you Dr. Riley, you helped make what could have been a rough time waiting a little easier.  By taking the time to answer the questions on this site you are making life a little easier for some of us.  
Thanks for your time and explanations!!!!

[riley180]

Hi.
re:pushing for an earlier date
I don't think that January 22 is too far off. If your PSA was more than 20, even if you don't have symptoms of bone pain (prostate cancer has a propensity for involving bones), it may be best to evaluate the bones as well with a bone scan. In this setting I may be more alarmed and push for an earlier appointment.

[xbluesuiter]

Thanks for your quick response.  I have one additional question.  I am receiving this treatment from the VA.  I have been very happy with the care and treatment I have received from them in the past.  The soonest I can get into see the Urologist is January 22.  Is there any reason I should push for an earlier date.  I also have other options since I have health insurance.  I have been very happy with the care I have received from the VA.  
Thanks again.

[riley180]

Hi.
I understand the frustration of going through so tests, some of which were invasive only to retrieve intermediate/equivocal results.
In general, a biopsy is considered once PSA is higher than 4. In your case, you started out with 6.62 and it has reached 14.17 in less than a year. The oncologist will get worried if the PSA doubles in a shorter time than 3 years. But this is of course, in the setting of documented cancer. It is still entirely possible that age-related enlargement of the prostate can account for this PSA rise (afterall, the test is really prostate specific not prostate cancer specific, though at your age, PSA is usually under 5). Also, bear in mind that in laboratory testing, normal values are based on averages. This means that in completely healthy men, there will be 5% who will be outside the normal range and will be labeled as abnormal.
Once you are examined by the urologist, there is a good chance that a new biopsy will be advised. If the biopsy shows cancer, based on the pathologist report, your PSA, and the urologist’s digital rectal examination, treatment options will be discussed. It may be premature to go into the details for now.
Stay positive. The absence of any symptoms is not a guarantee that there is no cancer. On the other hand, these tests are of course, not fool-proof. It all comes down to a value judgment on your part. Some men would rather not undergo testing at all, unless there are problems with voiding. Some men would set limits as to how many biopsies they’re willing to undergo.
My best to you.