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Newbie Question: First PSA ; should I get a Biopsy?

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Posted 10/25/2008 8:12 PM (GMT -8)
Well, Hi All, Seems like a great group;

I am 52 and went to the Urologist for an unrelated issues (cyst on Teste)

and took a PSA test; score 5.9

Ouch!  I am now scheduled to undergo the Prostate Biopsy next Monday and am pretty anxious over what might happen as you all know.

My question is, how often is score 5.9 cancer?  and if it is do I have my Prostate removed; seems so many here on this forum do that.  I have read that early PSA scores are unrelaiable and dont save lives; but that just doesnt make sense to me; If I have PC, even a low score I would think about removing it; but then I read that many of these are removed that would never develop?? 

Age: 52

10/17/08: First PSA 5.9

 

Posted 10/25/2008 8:34 PM (GMT -8)
I went to my doctor for the exact same reason (cysts on testicle, quite common as it turned out) and the doc also ordered a PSA test. Score 5.7 and the subsequent biopsy showed a Gleason 9.

Your 5.9 could be as a result of prostatitis in which case you would have nothing to worry about. But I imagine if your uro suspected prostatitis, he would have prescribed antibiotics first -- a biopsy isn't much fun.

Even if the worst has happened, and you do have PCa, chances are it will still be very treatable if not curable. Depending on your biopsy results, treatments other than surgery may also be possible, including none at all (called active surveillance or watchful waiting).

So if your uro thinks a biopsy is worth-while, I suggest proceed with it. Good luck and let's know what you discover.

Posted 10/25/2008 8:57 PM (GMT -8)

Most causes of elevated PSA in the grey area betwoon 4 and 10 are traced to benign causes.

Many things can cause a high PSA including inflamation and also very commonly an enlarged prostate: Larger it is the more PSA is produced, so prostate size needs to be factored into the calculation for PSA figures to have any real meaning.

Usually it's the trend in readings that's more important than any individual test.

Should you get a biopsy ?

An alternative approach would be to obtain a "freePSA" test which will indicate the probability of PC.

Posted 10/25/2008 9:08 PM (GMT -8)
Thanks, I was thinking a Free PSA test would be helpful, even if I go ahead with the Biopsy. Probably the same URO but I dont really know him from a hole in the wall. 
Posted 10/25/2008 9:22 PM (GMT -8)

How many samples does he plan on taking ?

Recently it's usual to have 12 samples. Some people indicate they have only had 6 samples: I can't see the point in that because biopsy can sometimes miss something, as it's only sampling a relatively small proportion of the prostate.

With only one PSA done, personally I'd have a "freePSA" test done first, but it's a personal decision.

Posted 10/26/2008 4:57 AM (GMT -8)
Ok,  Two points; First , the Doctor did a DRE after the Blood work; and the DRE lasted about 5 seconds and he said was good  (but remember I was in his office for something else; perhaps he hurried through; although that is not a good sign of a Doctor; but I dont know how lond a good DRE would take); Second I found an old PSA scorr back in 12/2007 and it was PSA (Immulite)  1.38;  So now what do I do?  Still go for another PSA test?  Free PSA test;

First PSA with family Doctor 12:2007:  1.38

PSA 08/2008:  5.9

Biospy has been scheduled for 11/3/08

Posted 10/26/2008 5:39 AM (GMT -8)
Hi Scotty. Be on the safe side and get the biopsy. It's not a big thing at all, just a little uncomfortable.
I just had one done with a psa of 4.1. Thought the dre was more a pain than the biopsy. Found a trace in one biopsy, with a Gleason rating on six. ( I think this must be the gold standard, almost never see a Gleason less than a six )
I plan on living a long life with out concern, so have opted for robotic surgery.
Hope this helps and good luck, Daivd T
Posted 10/26/2008 5:48 AM (GMT -8)
Thanks,  I agree a Biopsy is in the future; but I was reading where Rudy Guilianni first received a high PSA ; then to eliminate the possible infection cause; took Cipro for 10 days and was retested;  so i was wondering why that would not be the standard procedure?
Posted 10/26/2008 6:54 AM (GMT -8)
Sorry, can't help you there. Haven't heard that approach
Posted 10/26/2008 7:25 AM (GMT -8)
Scotty,

I don't agree at all with delaying a biopsy when there is a trend from a previous time. That's a significant rise in less than a year. Your Doc may be thinking that since this isn't a first rise, lets skip the formalities and rule out the worst potential sooner than later. It's still up to you. 30 days minimum [on Cipro] is the "standard protocol" first step before biopsy. Waiting 30 more days won't make a difference. Good Luck.

Swim
Posted 10/26/2008 7:34 AM (GMT -8)
PS:

A simple DRE nor sex, nor the combination of the 2 would raise any PSA by 4 points. Infection, trauma maybe. DRE, no, it won't.

Swim
Posted 10/26/2008 7:59 AM (GMT -8)
Thanks; I agree delaying a biopsy doesnt make sense if the PSA is confirmed; but is it possible that the PSA can drop back down quickly to under 2?;  A friend just recently has this happen, his doctor took his PSA (last count 1.5;  this year 5.5) then ordered another just within 2 weeks later; and it was 1.5?  Is that common? 

Posted 10/26/2008 8:20 AM (GMT -8)
Just a follow-up  the Velocity of my PSA 1 -> almost 6  in 9 months is beginning to make me think I am doomed  :(  (and I havent even had my Biopsy yet)  so sad;; sorry for the venting
Posted 10/26/2008 8:36 AM (GMT -8)
Biopsy is the only way to find out for sure. If you have it and it is caught early you have a very good chance of a cure and a pretty much normal life after treatment. I was 57 when I got the news. Now two years later things are looking pretty good. I know this a real hammer to the chest. Keep us informed and good luck to you.
Posted 10/26/2008 10:02 AM (GMT -8)
PSA test (and the results we learn afterwards) do save lives. When my Urologist suggested a biopsy (following a rise in my PSA results) - I didn't argue, no second thoughts, I had one . . . and good thing I did, because I had prostate cancer and have had the opportunity to remove the cancer from my body. I think I'll live a longer and happier life - because I had a yearly PSA test.
Posted 10/26/2008 10:34 AM (GMT -8)
Hey Scotty,

Well, you have plenty of conflicting advice which is good because you see various points of view. The important thing is that you be comfortable with whatever you decide to do. The numbers can drive you crazy. Just remember that you are not one fo the "next 1000 men off the street" and that statistics show trends and have nothing to do with you infividually.

In my case, early detection and aggresive action have saved my life twice.

Let's get well together....

Jim
Posted 10/26/2008 11:43 AM (GMT -8)
Yes, Selmet, took a  look at the link  (and many others!);

and it was very helpful, thanks.

I still am nervous and dont think waiting 6 weeks with Cipro is a good idea considering my psa went from 1.5 -> 5.9 in 9 months;  so I might end up going thru with the Biopsy; still undecided;

Posted 10/26/2008 1:27 PM (GMT -8)
As you can see, there are a lot of armchair doctors, with me being one also. With that being said,



                                                                       GET THE BIOSPY
Posted 10/26/2008 2:20 PM (GMT -8)
Hi Selmer; yes that makes alot of sense;  I think another PSA test will be taken before I take the Biopsy;  I will probably go to another Doctor as well; the one whom my friend went to; as he suggested an ultrasound and and another PSA test before suggesting a Biopsy  (my current Doctor never mentioned anthing just wanted the Biopsy - and he does not know of my first PSA); anyway considering that; the question now becomes hwo and when do I take next Biopsy  (FPSA, regualr PSA; Antibiotics first ?  )  Gee; never ends... 
Posted 10/26/2008 2:38 PM (GMT -8)

Scotty:

My situation was not entirely dissimilar, i.e. rising PSA but not totally comfortable with my original urologist.  So, I had my family doc do another PSA, including PSA free, then found an excellent urologist in whom I had confidence, brought him the data and asked for his opinion.  BTW, the new PSA was lower than the previous one.  Bottom line was the new uro recommended a biopsy because of the fluctuations.  Turns out I DID have PCa.

I'm not happy I've got it, but am real happy I caught it.  That's the bottom line.  Now I know what I'm dealing with and can make an informed decisiion which, for me, will be Brachytherapy.

Also, BTW, not all biopsies are that terrible.  My uro did it under anesthesia which some do not...and it was not that bad.

Good luck!

Posted 10/26/2008 4:35 PM (GMT -8)
Scotty, Believe me I am no expert but here are my thougthts. I can see the reasoning for having anothr psa before the biopsy. Also the ultra-sound. The rise in the psa could be from an infection not pca. Usually, if the rise in psa is caused by an infection the prostate is also enlarged. This was the reasoning that my urologist used for reccomending a biopsy. Hope this helps.

Good luck
Posted 10/27/2008 5:23 AM (GMT -8)
I must throw my hat into the ring. I had three PSA tests. One was related to getting some insurance and the first alarm something was wrong. Another one was the yearly checkup, and the third I purposely went for after the insurance PSA. All of them were 5.1. The initial doctor I went to did a DRE, and ultrasound with nothing showing - he told me it could be something else other than cancer and placed me on antibiotics -this went on for 6 weeks and did not clear it up and so I ended up with a biopsy and cancer as noted.

I can only say that there is a reason for the PSA. I would suggest a similar path as mine above, but would also suggest you move quickly. Sure, prostate cancer grows slow, but it does grow and the sooner you find out (if that is what it is) and deal with it the better. This will also be better for your peace of mind. I know during the time I was shuffling around I was in a most miserable state of mind with uncertainty. Whatever your outcome, and I hope it is not PC, it will very likely be fine. If it is PC, you are most likely catching it early and your outcome will most likely be a good one. By the way, I was worried sick before I had my biopsy thinking it was going to be the most difficult experience of life - it was not. No, it is not pleasant, but it was not near as bad as I thought it would be, and it last a very short time. Blessings.

RB

Age 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
Posted 10/27/2008 5:46 AM (GMT -8)

Hi Guys, Thanks for all yur responses; this forum is great.

My latest thinking today; is calling my Uro and asking to come in before the Biopsy for another PSA test and I will also request an Unltrsound.  I dont know if a Free PSA is helpful but I will ask him too.  I am also planning a second opinion visit with another URO in 3 weeks;  I am hopeful my first URO can get me in this week for the additional test; or I will have to decide whether to postpone the Biopsy for a 2-3 weeks more;  If I have PCa I know I will regret waiting even the 2 weeks.

Posted 10/27/2008 6:38 AM (GMT -8)

Scotty,

If I can add something....

I am glad you are taking the biopsy seriously by trying to find out as much as you can first. I think I would get it done quickly since it is pretty routine and nothing to be afraid of. It is uncomfortable but it doesn't last long.

One thing that concerns me is that you say you " don't know the URO from a hole in the wall". That's scary. In retrospect, had I given my biopsy more careful consideration I probably would not have used the Urologist I did. Also, besides taking the biopsy, you want to be sure it is read by a very competent pathologist. You also might need a second opinion. Do your homework here. Make sure you choose the best URO you can find.... even it takes a few weeks to get an appt. Although it is not a serious procedure the information it provides is critical for making the next decision.

I hope you get the best results - no cancer.

Posted 10/27/2008 8:19 AM (GMT -8)

You've gotten some well-thought-out answers to your question, Scotty. None of us, of course, make a decision in a vacuum.  Your decision affects you personally.  I can tell what my wife and I looked at, deciding in the midst of the swirl of emotions that accompanied a rise in PSA.  Here are some things I think worth considering:

(1) PSA velocity--It's not so much the absolute numbers that count as the relation of numbers.  An increase in velocity is a prime indicator of prostate cancer. 

(2) Whether to do a biopsy-- If you don't get a biopsy, you will be left with a lot of uncertainty.  Is it cancer or not?  Yes, you can do a course of antibiotics in case it's prostatitis, or wait longer and retest to see if the PSA goes down, but can you live with the uncertainty and all the possibilities--good and bad--that means?

(3) Biopsy--If it's not cancer, go home and kiss your loved ones, celebrate and enjoy your cancer-free life.  If it is cancer, you are faced with the question, is it slow- or fast-growing?  The answer is that nobody knows.  Here again, you can opt to wait or treat.  If you decide to treat, you are faced with many options.

The best you can do is to research and decide based on the best available information so you can live with your decision.  There are no perfect decisions, because all have risks and consequences.  More than two years after my own encounter with prostate cancer, I do not regret my own decisions and their consequences.


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