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Should I be Concerned about Prostate Screening Results?

Hope everyone will have great health in 2020.

Question about Prostate Screen Results (PSA)

I am a 60 year-old male.  Non drinker, non smoker, and never touched an illegal drug.

From 2011-2014 the results were 0.3

From 2015-2018 the results were 0.4

The result for 2019 was 0.7.

Should I be alarmed that the increase was .3 when in the past it was either stable or .1?

Thank you for your time.
7 Responses
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20620809 tn?1504362969
I'm wondering now that it has been 3 months what the update is.  Care to let us know how it is going?
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Avatar universal
Digital rectal exam is no longer recommended for prostate cancers screening due to low sensitivity and specificity.

Source: https://www.uptodate.com/contents/screening-for-prostate-cancer
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I somewhat disagree with this - I'm a prostate cancer patient, had regular DREs which didn't really detect much of anything, other than some enlargement, so that part would seem to conform with this opinion. At the same time, I had rising PSAs but I (wrongly, as it turns out) thought the high # was due to other issues (I had very few symptoms) & put off seeing a Urologist till it rose quite high (9.2). But I think men need to have BOTH DREs & PSAs - neither alone is foolproof. In my case, it was the PSA that detected cancer. I did NOT immediately opt for a biopsy - I knew the risks inherent in it. But I saw a Urologist who agreed to do another test called PHI = Prostate Health Index - it's a simple blood test that combines PSA w/ 2 other factors, the 3 taken together generate a number. My Uro said, let's do this - it's possible you DON'T have cancer even tho the PSA is high. If your # comes back under 24, there's less than 10% chance of cancer. Unfortunately, mine came back at 68, which indicated virtually 100% chance, so I agreed to the biopsy, which confirmed it. So my advice to all men is, get both DREs & PSAs frequently, and if EITHER looks even a little suspicious, ask for the PHI test - it's just a blood draw, you get results in a few days & it's covered by Insurance & you might be able to avoid a biopsy.
I should add that in my case, I think the reason even my Urologist, who's a surgeon specializing in PCa, didn't feel much of anything abnormal in the DRE was that apparently, most of the cancer was in a region of the prostate that could not be felt thru the rectal wall - just a very unlucky circumstance for me, unfortunately. But for most guys, a hardened nodule probably WOULD be felt during a DRE. So DREs are NOT foolproof, but it's my opinion that in 99% of cases, either the DRE or a high PSA is going to indicate something wrong. I believe it's highly unlikely that someone would have both a low PSA & a completely negative DRE & yet have PCa - remotely possible, maybe, but extremely unlikely. Therefore, it's my opinion that doing BOTH regularly is the key to staying out of trouble...
If you had to put your faith in PSA or DRE, I would put more faith in PSA.
The only way medicine evolves for the better is if we use evidence-based medicine rather than relying on anecdotal cases. That resource UpToDate which I linked above analyzes all the medical literature thus far and summarizes everything for doctors since no doctor has time to stay on top of all the literature. Prostate cancer is different from other cancers in that it tends to be slow-growing in most cases. No one is saying not to screen for it all. The societies are just advocating a shared-decision approach with patients to weight benefits, risks, and alternatives. It is great that your prostate cancer was diagnosed early and you were able to benefit from it. But from a population standpoint, there may be many other men who now suffer from incontinence and/or erectile dysfunction as a result of unnecessary biopsies or treatment complications. Because the jury is still out, it is best to present patients with all the information and limitations of current medical knowledge so an educated decision can be made.
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Prostate cancer screening is a controversial topic in medicine. Many men will die with a slow-growing prostate cancer, even though that is not necessarily the cause of their death. Excessive screening may need to unnecessary biopsies and/or treatment. Hence, it is important to strike a balance and make clinical decisions based on evidence-based medicine. Below you will find the latest recommendations from the U.S. Preventative Services Task Force (USPSTF):

For men 55-69 years old, the decision to undergo periodic prostate-specific antigen (PSA)–based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening.

For men 70 years and older, the USPSTF recommends against PSA-based screening for prostate cancer.
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Avatar universal
Just wanna throw in my 2 cents worth - I’m a Prostate Cancer survivor & have quite a bit of knowledge about this issue. Normally, a PSA of around 4.0 is considered the point where it’s time to start looking at the possibility of cancer. However, I’m aware of rare cases where guys were diagnosed w/ PCa at a PSA much lower than that, like 2.2 - but that’s an exception.

Also be aware that you can have a PSA higher than 4 & still be cancer free. As others have pointed out, there are several things that can cause a high PSA - an enlarged prostate (very common in men over 50), prostatitis, extended bike rides, even recent sexual activity.  But I think any level below 1.0 at age 60 would normally not be anything to worry about.

The best way to keep an eye on this is to have fairly frequent digital rectal exams (DREs) - it’s not the most pleasant thing, but it only takes a few seconds & is necessary to assess both enlargement & the presence of harder nodules that might be suspicious for cancer, along with regular PSA tests. If at any point, smthg seems a little off, do NOT hesitate to see a Urologist. If caught early, when the disease is still  confined to the prostate, it’s nearly 100% curable.
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Didn't know you were a cancer survivor BonzoDog. Hats off to you and I'm glad!  This is excellent information you've shared. Thanks for your support.
Thx, GR ! Yes - I'm a survivor, for now. Unfortunately, I didn't heed my own advice back in 2017 (I'm much wiser now) -my PSA went up to 9.2 before I sought treatment & the surgery didn't get all of it, and PSA continues to rise. I just had 13 radiation treatments to a malignant lymph node, the treatments weren't bad at all, I felt nothing & very minimal side effects. Now waiting to see if that lowers my PSA. Even if it does, it's not likely a cure, I'll still need more treatment. But that's why I'm trying to get the word out to ALL guys - get frequent PSAs & DREs starting in your 40s, and if anything looks suspicious, see a Urologist right away. As I mentioned, if caught early, PCa is nearly 100% curable. Caught later (like mine) - not so much...
Had no idea you were going through this, man.  Sorry to hear and sounds like a tremendous journey.  Wishing total cure for you and can't tell you how much I appreciate spreading the appropriate potentially life saving information.
Avatar universal
Yes GuitarRox,,,,ended up with BPH, no cancer, this was in 2014, still on meds for bph.
FYI——MRI and color Doppler guided biopsy’s are more accurate than an dr. office trus biopsy.
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Avatar universal
As you get older the PSA May rise due to the natural rise in size of the prostate.
To make you feel better you can always ask the doctor to confirm things with non invasive follow up tests.
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Just wanted to say that this is excellent advice.  Have you been through this too?
707563 tn?1626361905
It's rising, but barely.


There can be some concern with that, but it doesn't really specify how much of a rise should cause concern. Has your doctor done a digital exam?

Helpful - 0
Hi Emily:

Thanks for reply.

The doctor (Internist) that takes the blood test for the PSA yearly had told me beforehand and years past that most spikes are caused  by non-cancerous issues such as age, irritation of the prostate, Benign prostatic hyperplasia, ejaculation, and or Urinary Tract Infection.  I did not have a digital exam.  

The internist did not see issue with the rise due to it still being  excellent in the range used but I always like to get a second and third set of eyes and ears on any question .

Thank you and be well!
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