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Do I Have Prostate Cancer or Just High PSA Numbers?

The prostate is in an isolated funny place. God must have been a civil engineer, because who else would a put a waste facility straight through the recreational area? The prostate is extremely small, about the size of a walnut and weighing less than 2 ounces. The prostate is squeezed into a very congested area, making it difficult to reach or maintain. The prostate is a challenge for us patients and doubly for our doctors.

My name is Phillip Young, and I’m a 72-year-old Caucasian man with no family history of prostate cancer, or really any cancers beyond non-aggressive skin cancer. My health is active and good, but I need to take high blood pressure medicine and blood thinners due to a recent massive blood clot.

My urinary plumbing works normally. I’ve had several doctors check my prostate during digital rectal exams (DRE) with no reported issues. My mpMRI, however, did show an enlarged prostate at 51 grams with 30 grams being normal for my age.

I’m doing this talk because my PSA level rose 50% in one year. That is a big jump in my PSA number, so I thought it was a good time to really take a deep dive into what is going on. I’m a cyclist and exercise daily.

I attended the UCSD Prostate Cancer Summit in February with a panel of almost a dozen doctors talking about prostate cancer. One of the doctors commented that autopsies of average 70-year-olds who had passed from all causes revealed that half of them had prostate cancer! I thought that was pretty interesting being about that age myself. Please think about attending the UCSD Prostate Cancer Summit in February 2024 in downtown San Diego. There’s no cost to attend, and it is well worth your time.

My PSA in 2021 was 1.4ng/mL, and it jumped up 0.7ng/mL in 2022 to 2.1ng/mL – a 50% increase in one year. Just recently in 2023, I had my PSA checked again and it went from 2.0ng/mL to 2.9ng/mL, which was a 0.9 ng/mL increase. The important part to look at in PSA testing is the velocity – how quickly it rises over time. The NCCN & AUA organizations recommend investigating a one-year PSA rise of more than 0.35ng/mL. You should be concerned if it rises 0.35ng/mL or greater within one year.

I’m seeing Dr. Aditya Bagrodia at UCSD Urology, a research hospital with the latest technology. Whenever I need a prostate biopsy, Dr. Aditya Bagrodia performs them using an mpMRI/ultrasound-guided transperineal approach. Most doctors in town will go through the rectum to do biopsies, which has a much greater chance of causing an infection. The infection rate for biopsies through the rectum in England was so high that their National Health Service switched to the transperineal approach which doesn’t go through the rectum. It is nice to know there’s at least one doctor in San Diego doing transperineal biopsies. At the prostate summit, I was talking to a doctor about whether biopsies can push cancer cells outside the prostate and travel freely to metastasize throughout the body. Most doctors see biopsies as having a small but unknown risk. There is no free lunch in life, so just be aware of the risk and if you really need the biopsy before proceeding.

I want to thank Bill Lewis, IPCSG Mentor for helping me immensely through my PSC/PCa journey. He is a great, smart, informed guy, and I really appreciate all he has done for me.
So, the real question is do I have prostate cancer or do I just have a high PSA number? Here is my chart: I started in 1991 at 0.8ng/mL when I was 40 years old. I’ve had my PSA tested yearly. Then from 2021 to 2022 my PSA jumped from that 1.4ng/mL to 2.1ng/mL – that’s what got my attention! I wanted the best prostate help, so I chose UCSD Urology because it is a teaching/research hospital with a great reputation. Initially it was hard to figure out what to do next about my PSA increase. Now if you follow the chart, my PSA dropped down. Then I had a pulmonary embolism (PE) and while at the hospital my PSA was checked which showed it had gone up to 2.9ng/mL. Then my PSA dropped back down during my annual physical. The important part to note is that both increases corresponded to infections. I had just recovered from COVID-19 and a week later I took a PSA test, so I had an infection causing the PSA rise. I was in the hospital with a pulmonary embolism (PE) and tested at 2.9ng/mL and so again it was an infection causing my PSA rise.

My prostate has been slowing enlarging over 32 years, producing more PSA with a 125% increase to date. I was sick with COVID-19 and a pulmonary embolism (PE), which are infections my body had to deal with. I was eating a lot of yogurt, and I thought maybe it was bad for me since I didn’t know if the milk hormones were making my PSA worse, so I cut back on my yogurt. I do ride a bike. Before you get PSA tested, you should stop bicycling five days before the test. Maybe my high PSA was related to bicycling. Also, ejaculations within three days of the PSA test can be an issue.

FYI, if PSA levels are greater than 20ng/mL, it is likely that the prostate cancer (PCa) has metastasized. Thankfully, my PSA levels are under 3.0ng/mL.
Here are some other data/talking points:
The miR Sentinel Prostate Cancer Test was a possibility, but it was not available in California.
My doctor recommended the 4Kscore® Blood Test, but I was declined because of my low PSA score and since it works best analyzing aggressive prostate cancer.
I got back with my doctor and we decided on the ExoDx™ Prostate Cancer Urine Test. It is just a simple urine test mailed to your house, then you mail it back. If you want the results faster, I really recommend you immediately fill out and sign their release form. You will have to sign a new release form for every test.

At the UCSD Prostate Cancer Summit, a vendor named Promised from San Francisco was offering free DNA tests. Promise is offering medical grade DNA tests that are not “23 & Me” non-medical/recreational tests. I am always concerned about these DNA tests, and I never want to give away my DNA sequence. Promise does not share your DNA sequence with other companies. Also, you can check a box on the form to direct your sample to be destroyed.

My ExoDx™ Prostate Cancer Urine Test score was 22 which indicates about a 30% chance of having prostate cancer with a Gleason score equal to or greater than 7. They recommended a 12-core biopsy because of my score.
My PSA drops after each infection recovery. My free unbound (not to captured by another protein) PSA is very high, being good at 41%. Anything greater than 25% free PSA indicates about an 8% chance of having prostate cancer.
I’m doing the Active Surveillance with PSA testing twice a year and once a year the ExoDx™ Prostate Cancer Urine testing.

The zero mutation results from my Promise Germline DNA tests looked at BRACA1 and BRACA2 (BReast CAncer genes) plus 27 other genes with 15 of those related to prostate cancer. Part of the Promise PCa program is that if you have any mutated gene(s), Promise will do long-term yearly monitoring for you. If you don’t have any mutated genes, you can do bi-annual PCa treatment updates. I have zero mutated genes, and I don’t think I have PCa.
My UCSD doctor ordered an mpMRI 3-Tesla Multi-parametric Magnetic Resonance Imaging w/ Water Diffusion using Restriction Spectrum Imaging (RSI) software that looked at 3 zones (central/transition/peripheral) for me.
Part of the mpMRI test is determining my Pi-RADS v2.1 score. My level was in the lowest category with a very low chance of prostate cancer.
My prostate density was 0.033ng/cc and is in the lowest good range.

When you do your multi-parametric MRI, ask your doctor to get the water diffusion index number. Normal living healthy tissues have a lot of water and cancer tissue doesn’t have as much. Having a lot of water in your cells is a good thing. My water density is 1400, in the good range from 0 to 1800. My cells are looking healthy and normal.

My doctor and I decided overall, things are looking pretty good and I’m not going to do a 12-core biopsy right now. I’m on Active Surveillance with PSA every six months and doing ExoDx™ Prostate Cancer Urine Tests every year.
I’m really happy to get with UCSD and their urology team for the best prostate advice and testing, and be proactive with my health.

In summary, multiple digital rectal exams (DRE) felt smooth and normal, my PSA jumped twice with related infections, my slightly enlarged prostate produced increasing PSA, the ExoDx™ Prostate Cancer Urine test showed a 30% prostate cancer chance, I had very high good free unbound PSA and zero mutated genes, I had Pi-Rads in the lowest good group, and my prostate cells’ high water diffusion looks good.

Active Surveillance is my future with PSA testing twice a year and ExoDx™ Prostate Cancer Urine testing yearly as well as consultations with Dr. Aditya Bagrodia at UCSD Urology.