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Dr. Y.
Dr. Y., Urologist
Category: Urology
Satisfied Customers: 20378
Experience:  I am fellowship trained specializing in general urology and reconstructive urology.
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I just turned 60. My PSA last ten years has gone up and down

Customer Question

I just turned 60. My PSA for the last ten years has gone up and down from 6-20. I have had 4 biopsies. The second one they found 10% of one core had cancer. That was 5 years ago. I also had an MRI which my urologist showed nothing to be concerned about. However, 3 PSAs ago it went up to 20+. I was very scared. I had another biopsy with 17 cores and all negative. After that one it went down to 16 and now this last one Nov. 28 it went up slightly to 17.5. Again I am scared. My urologist wants me to do another MRI to see if there is anything abnormal-lesion etc which MAY indicate cancer (maybe the same they found five years ago or maybe it has gotten a little worse.) If it shows something abnormal, then another biopsy.
I am terrified. Though I was told that some men have high PSAs and may have minuscule carcinoma that could remain the same until you die of something else, or it could get worse and then treatment of course or no cancer.
I guess i just want someone to allay my fears before I do something rash.
I guess I just want someone to allay my fears that i will die in a year. I already have chronic depression
Submitted: 1 year ago.
Category: Urology
Expert:  Dr. Y. replied 1 year ago.

Was the Gleason score of the cancer 6?

Customer: replied 1 year ago.
I do not remember
Customer: replied 1 year ago.
one sec maybe I can check
Customer: replied 1 year ago.
April 16 2010 Adenocarcinoma Gleason 6/10 (3 +3) 10% of the biopsy and 1 of three cores
Customer: replied 1 year ago.
16 cores taken at this biopsy 5 years ago
Customer: replied 1 year ago.
October 17 biopsy 17 cores taken all negative
Customer: replied 1 year ago.
the cancer that was found 5 years ago was in right medial; 2015 biopsy 4 cores were taken in same area -all neg like the rest and PSA was above 20 before the biopsy, then went down to 16+ and latest 17.5 slightly up again
Customer: replied 1 year ago.
I am going to worry anyway but it would be nice if you could allay my fears about imminent death or my mortality. I will do the MRI regardless in a month and then go from there. he says he is more concerned about what the MRI will show than the previous 2 negative biopsies
Customer: replied 1 year ago.
Do you have sufficient information to assess the situation for me, so I do not worry so much?
Customer: replied 1 year ago.
I await your answer please
Expert:  Dr. Y. replied 1 year ago.

Based on your Gleason score of your cancer, there is no chance that you are going to die from this cancer. As long as your doctor monitors your PSA, they can certainly act on the cancer before it becomes aggressive. Gleason six tumors are ones that we monitor in today's urology practice. It is customary to perform active surveillance where we just watch the PSA with this very early-stage cancer. You do not have to worry about dying from this. Hope this helps

Customer: replied 1 year ago.
Do you think that the MRI will show something abnormal because the cores they take are random and can miss cancer. That is why he wants to an MRI to see if there is a lesion for example which may be cancer or may be nothing. Then a biopsy in this specific" hot spot" as he states will determine whether the cancer is the same or increased. or nothing What is your honest prognosis and do you think some where down the line I will require laser surgery, radiation etc and the 65,000 dollar question is if only 10% of one core of over 60 cores taken in a decade shows cancer then why do my PSAs go up and down and are in the intermediate rage as high as 20?
Customer: replied 1 year ago.
though I have been told that some men naturally or genetically have high PSAs
Customer: replied 1 year ago.
Actually the first urologist I went do way back told me of a patient with very low PSAs 1-3 range but something seemed inconsistent withe next one despite being so low and in fact they found some cancer with such low PSAs
Customer: replied 1 year ago.
Every time I go for a PSA test I am scared to death saying to myself what is the "number" going to be this time because it is all over the place though in the last 2 years in the mid to high teens.
This procedure only exacerbates my hypochondria, anxiety and chronic depression
Customer: replied 1 year ago.
Waiting your final response to my questions
Customer: replied 1 year ago.
waiting............... I have to go soon.....sorry
Customer: replied 1 year ago.
Still waiting. Please reply asap. Thank you.
Expert:  Dr. Y. replied 1 year ago.

The MRI is probably not going to show anything since you have such an early stage cancer. Cancer can occur at any PSA value. But most cancers occur above the PSA level of 4.0. This is where we make the cut off otherwise we would detect too many insignificant low level cancers that would likely not progressed to anything at all. Again, based on your very early-stage prostate cancer, you have nothing to worry about in terms of dying from this.

Customer: replied 1 year ago.
One last thing. If the cancer is so minimal is there any reason why my PSAs are this high?
Expert:  Dr. Y. replied 1 year ago.

It could be due to a larger prostate or the presence of inflammation as well

Customer: replied 1 year ago.
Ok. The biopsies did indicate acute inflammation sometimes and yes it is enlarged, so you are probably correct.Thank you.
Expert:  Dr. Y. replied 1 year ago.

You're welcome. Please don't forget to leave me a rating.