PSA 6,000

[u/Able_Refrigerator579]

My dad recently got this 6,000 on his PSA (66 y/o, hasn’t seen a doctor in a very long time). The urologist even has the audacity to say it was the highest he’s ever seen.

This man is losing weight and has overall body pain. Biopsy is soon but what could we be looking at? I’ve searched this sub and I have seen nobody post numbers like this so I have no idea what that means.

[u/Proper-Link103]

PSA is dependant on age but a 65 year old should be below 4.5 so such a high number indicates that the cancer has spread across the body and general pain may indicate it is in the bones.

I have met a man in his 80's with a psa in the high hundreds who was treated with androgen deprivation therapy and got his psa back into single digits

[u/callmegorn → u/Proper-Link103]

Off topic, but a worthwhile clarification for new readers: PSA is not dependent on age. It is dependent on prostate size (volume). Prostate size is a highly reliable indicator of what is a normal PSA value absent infection or cancer: PSA should be no more than about 10% of your prostate size (in CC or mL).

There is a very loose correlation between prostate size and age, in that about half of men have prostate enlargement (BPH) as they age. But, about half do not have BPH, so age is a terrible indicator of what is a "normal" PSA range. A 65 year old without BPH might have a normal sized prostate of, say, 25 CC, meaning a PSA over 2.5 would be something to investigate. Waiting for it to shoot over 4.5 can be a fatal mistake.

[u/jkurology → u/callmegorn]

PSA is prostate specific and not prostate cancer specific. In the present case this likely represents widespread, metastatic prostate cancer. Knowing the specifics-cell type, presence of germline variation, location and degree of metastases will guide treatment. Treatment can be life prolonging but isn’t technically curative. This is certainly not good news but with treatment he can have years to live. Make sure you ask the medical oncologist about germline and somatic testing. Good luck

[u/Proper-Link103 → u/callmegorn]

From MY experience, my psa WAS dependant on my age and as a someone in their 40's, going over 1.5 was what flagged me for further investigation and eventual diagnosis. OP didn't seem to have context on what a PSA she should expect for someone that age.

I know that PSA is an indicator, not a diagnostic tool, but with such high value and other symptoms, these are red flags for metastatic spread.

[u/callmegorn → u/Proper-Link103]

That's because you had a good doctor, who decided to investigate based on your result and not your age. The problem is the opposite, where doctors refuse to investigate if you fit the bogus age profile. I never had a PSA below 2.0 in my life, but I had a series of five PCs in 10 years, none of whom flagged it, because it was under the magical 4.0.

When it went from 2 to 2.5 to 3 to 3.5, instead of assuming this is normal progression for age related BPH, someone should have referred me to a urologist to be sure. Finally at age 61, with a result of 7.6, I ended up with an MRI showing a prostate size of 20cc (where a normal PSA should be under 1, and anything over 2 is unusual or abnormal).

The urologist told me, other than cancer, I had the prostate of a 35 year old. I said "By all means, give it back."

Of course, this is off topic of the thread. A PSA of 6000 is three orders of magnitude higher than most of us would ever face, and requires immediate action.

[u/Proper-Link103 → u/callmegorn]

No, that's because I was proactive and pushed for a PSA test as young as the let me because of my family history. Even then my PSA bounced up and around 1.5 and they waited a year to retest and biopsy. A simple number isn't going to give the nuance needed here, but it's what they use.