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  • Flucturating psa -

    Over the past ten years my psa has fluctuated from 2.0 to 5.2. Recently (from December to now) it went from 3.8 to 4.97. I do have an enlarged prostate, measuring 5.7 x 4.6 x 4.6 and volume 60 cc. This measurement was taken in January, 2028. Prior to the most recent test, I had a bout of constipation. I also had a biopsy in 2018, all negative. My questions are (1) how much would a large prostate affect a psa score and (2) can the constipation affect a psa score? I had a great doctor, Dr. Ehdaie from Memorial Sloan Kettering in Ny but have not found a urlogist since I moved to North Carolina.

  • #2
    Hi Ken, and Welcome to the Forum! I had a 20-plus-year history of BPH with a fluctuating, but slowly increasing, PSA (however, my fluctuation were rather small). BPH is the growth of (benign) prostatic tissue, and this is logically reflected in a PSA that usually goes up more than one would expect from age alone. I had many (negative) biopsies over the years whenever my uro at the time felt the PSA increase was a bit more than would be expected from the contribution of my BPH. It basically a question of tracking one's increasing prostate size (as judged by DRE and the the automatic estimates of an ultrasound probe or MRI.) This requires an experienced uro to determine whether an MRI or biopsy is advisable based on one's size and PSA increase and BPH + PSA history. (At the time of my TURP for BPH, my prostate size was 90 cc.)

    Any unexpected rise in PSA should be confirmed with a retest after a period of time.

    Over the years I never questioned my uros when they felt a biopsy was advisable. This resulted in many negative ones--until my last, which revealed high-grade PCa. The upside is that IMO my cancer was caught early and this contributed to my excellent outcome from surgery.

    My hunch is that straining because of constipation might make one's PSA go up a bit. I would ask you uro.

    On that point, I have an excellent, Duke-trained uro, in whom I have a lot of trust. He performed both my successful TURP and then my RP. Where in NC are you located? Feel free to private message me here.

    Last edited by DjinTonic; 07-30-2022, 10:02 AM.
    69 yr at diagnosis, BPH x 20 yr, 9 (!) negative biopsies, PCA3-
    7-05-13 TURP for BPH (90→30 g) path negative for PCa, then 6-mo. checks
    6-06-17 Nodule on right + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule was negative for PCa
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) acinar adenocarcinoma
    5% of prostate (4.5 x 5 x 4 cm, 64 g) involved
    Dry; ED OK with sildenafil
    11-10-17 Decipher score: 0.37, Low Risk:
    5-yr met risk: 2.4%, 10-yr PCa-specific mortality: 3.3%
    9-16-17 (5 wk) PSA <0.1
    LabCorp uPSA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007 (nadir)
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (retest)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015
    08-28-19 (2 yr. ) 0.016
    12-18-19 (28 m) 0.015
    06-30-20 (34 m) <0.014
    12-30-20 (40 m) 0.037 (?)
    03-31-21 (43 m) 0.020
    07-13-21(46 m) 0.018
    01-25-22 (52 m) 0.023
    07-25-22 (5 yr) 0.039


    • #3
      Just came back from my regular primary doctor. He looked at the results of my psa's from th past 10 years. He said the same thing as the urologist in New York that is "this is within normal range for you." We will do another psa in 6 months to see.