psa and biopsy

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clearwater
New Member


Date Joined May 2010
Total Posts : 2
   Posted 5/21/2010 3:54 PM (GMT -6)   
Hello,  First post. However, i have been here many times.

February of this year I had an 8 core biopsy, results were negative. I just had my follow up psa and it is up. I see my Urologist in a couple of weeks and I know he’s going to want another biopsy. Only blood work done up to this point is the standard psa blood test. Suggestions? Go along with my second biopsy? Request psa free test? No family history to my knowledge. Mother, Father and Grandparents died young. Seems as if I already know many of you, any information you can provide is appreciated.

Thank You

Age 52

PSA History:  7/05 1.36

                     1/09 3.34

                     12/09 4.20

                     1/10 4.90 (8 core biopsy negative results)

                     5/10 6.62


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2163
   Posted 5/21/2010 4:03 PM (GMT -6)   
Clearwater,

Welcome to the discussion. Sorry you have to be here, MAYBE you don't. But glad you came out of the lurk and stepped forward.

There are many here that may be able to answer your questions more directly, but for what it's worth; seems like a little soon for another biopsy, you have barley had time to heal. From other discussions that have taken place here there are many other things that may account for a rising PSA. I am sure your doc will be talking to you about them and looking into them.

As I said there are many who are better informed than I that will surely answer you. My path has been kind of straight forward. PSA uptick, positive biopsy, surgery, radiation, and continued follow up. Haven't had to deviate from the norm to far so my personal experience level is somewhat limited. And my own experiences are all that I am comfortable in speaking from. No MD after my name.

Best of luck to you and your family. Let's hope you don't have to officially join the PCa club, but now that you have come forward feel free to converse anytime.

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
Gleason Score (3+4) 7 in all positive cores
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

2/24/10 FIRST POST RAD PSA 1.0---CARRRP --waiting for the next test.
3/22/10 Second Post RAD PSA 1.5 Dammmmnnn stubborn son of a gun
4/19/10 YAHOO PSA dropped to 1.2 Moving in the right direction.
5/7/10 PSA test 1.3 Sodium Fluoride PET Scan & CT SCAN -scheduled
5/20/10 PSA test 1.2 Holding off on future tests for 3 months- single lytic lesion found and scheduling radiation.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24283
   Posted 5/21/2010 4:08 PM (GMT -6)   
Its been 4 months since your biopsy, not too soon if you and your dr sure another is warranted. My last two biospies were barely 6 weeks apart, the dr saw suspicous "shadows" in the scan, and on the 3rd one, only took cores there, and came up 7 of 7 positive. He doesnt think your PSA rise is related to any kind of prostate infection?
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 2716
   Posted 5/21/2010 4:11 PM (GMT -6)   

Hi Clearwater and welcome.  I tend to agree with Sonny that it seems a little soon for a second biopsy but of course I'm not your doctor.  I do have four specific suggestions:

1.  I think a % free PSA test is in order.

2.  I think a PCA3 test may be in order.  Here is a link with info about this test: http://www.medscape.com/viewarticle/554369.  If you Google PCA3 test you will find tons of other info.

3.  An 8 core biopsy is on the low end of samples.  For the next round of biopsies perhaps a 12 or 16 core biopsy is in order.

4.  You might ask your doc about prostatitis or other infection.  Your rapid rise in PSA is the last few months might suggest a course of anti-biotics before moving on to the next biopsy.

You may receive other thoughts, but those are mine for today.

Good luck and please let us know how you progress.

Tudpock (Jim)


Age 62, Gleason 3 + 4 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 4/10/10.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2621
   Posted 5/21/2010 5:21 PM (GMT -6)   
I think a color doppler may also be a test to consider. Appears to be a big help in these hard to find situations with rising PSA and negative biopsy.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01


Sharp18
Regular Member


Date Joined Mar 2010
Total Posts : 78
   Posted 5/21/2010 5:55 PM (GMT -6)   
I'll definetely go with another biopsy

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 5/22/2010 8:51 AM (GMT -6)   

 

Welcome!  My experience with a biopsy wasn't in the top ten things I enjoyed doing, so I (and the AUA) think you might want to think hard about rushing into another one.

The fact is that far too many biopsies take place.   This is not my own personal shoot-from-the-hip, Ready-Fire-Aim conclusion.  This is the conclusion of the American Urological Association (AUA).

The AUA's "Prostate Specific-Antigen Best Practice Statement:  2009 Update" says that in addition to PSA and DRE results, doctors should take these into account before proceeding to biopsy:

  • free and total PSA (complexed PSA)
  • patient age
  • PSA density
  • PSA velocity
  • family history
  • ethnicity
  • prior biopsy history

Before proceeding to biopsy, a variety of factors can influence PSA and should be considered in the interpretation of results...especially at low, but abnormal levels (in the 5-6 ng/mL range).

PSA tests are not very "specific"; that is, they may indicate prostate cancer or they may indicate a number of other non-cancerous causes.  The PSA rise you have experiences has more of a signature for infection than for prostate cancer; it still could be due to PC, but that would be very atypical.  That being said, even if it is due mostly to infection, if the doctor looks hard enough it will be likely that he will find some cells which are naturally developing into cancerous shapes—as it does with age for ALL men.

My specific recommendations: 

1.  Get yourself intimate with the free online AUA document referenced above to make yourself an informed, empowered patient...avoid "shooting-from-the-hip."  It can be found at:  http://www.auanet.org/content/media/psa09.pdf?CFid=658649&CFTOKEN=15265454&jsessionid=84301aded42bfce88a3d743f7f76175f4a2f

2.  Request that your doctor seek to eliminate all doubt that the PSA rise is due to infection or other non-cancerous causes.

3.  Request that your doctor perform a complexed (free and total) PSA test. Numerous medical studies have assessed the use of complexed PSA as an alternative test to total PSA for early prostate cancer detection. The majority of studies report an increased specificity and thus a decrease in the number of unnecessary biopsies utilizing complexed PSA in the total PSA range of 2.5 to 6.0 ng/mL...right in your range.  One can easily search and find more info on “free PSA”, but here’s a briefing:

PSA exists in the blood in two forms:  one bound to plasma proteins (complexed) and the other in the free state; total PSA is the combination of both.  Benign prostate tissue contains more free PSA than prostate cancer tissue.  Patients with prostate cancer tend to have lower free/total ratios, whereas men with benign disease have higher free/total ratios, except in the case of prostatitis.  Using the ratio of free/total PSA will reduce the number of biopsies in men with PSA levels between 4 and 10 ng/mL.

So, despite all this, while biosies aren't in the top ten list, it is likely that someday another one will be in your future...sorry, it's just the reality.  Hopefully, some of these points will lead to other, simpler but informative tests being done FIRST to really conclude where another biopsy is warranted or not, but the sad reality is that prostate cancer is a naturally occurring outcome of men aging.  Now that you've had one, I would agree with Tudpock that next time you should have the 12 or 16 sample version...once they are in there, they might as well make the most of your and their time!

best wishes...

Post Edited (Casey59) : 5/22/2010 8:00:02 AM (GMT-6)


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 5232
   Posted 5/22/2010 9:15 AM (GMT -6)   

 

Your PSA is rising quickly and that is worrisome, although it can well be an infection.

The following seems like a sensible plan.

1) Get on an antibiotic for 4-6 weeks.

 

2) Re-do the PSA along with a PSA Free test.

 

3) If still elevated, you might want to do a biopsy or a PCA-3 Test

4) Do a biopsy unless there is notable improvement in test results.

Mel

 


63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3 was about 75 (way above the 35 threshold). That led to:

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent! Uh...OH. As of about 3/16/10 problems with constant urgency although no pads needed--feels like an infection but none showing in urine.

Update: since late March all is well in that area. I would say 99.9% continent (a spurt here and there, maybe 5 spurts per week).

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in mid-June.


clearwater
New Member


Date Joined May 2010
Total Posts : 2
   Posted 5/24/2010 12:45 PM (GMT -6)   
Thank you for all the suggestions, that’s why I came here. I will talk to my urologist about all your recommendations at my next scheduled appointment on June 8th. I will post update following that appointment. I forgot to mention that between the 12/09 and 1/10 psa I took a thirty day supply of cipro. Urine was collected and tested on both occasions (not sure for what), was told it was good. Thank you again, I will keep you posted in a couple of weeks. God bless you all.
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