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Mr GTO
New Member


Date Joined Oct 2008
Total Posts : 5
   Posted 10/29/2008 5:35 PM (GMT -6)   
Hello, I just found this forum - got here through a Google search after spending days researching prostate issues. Here's my story.
 
I'm 53 and in fairly good health. I went in for a yearly checkup and the PSA came back 4.2. It had been 1.4 15 months earlier. I was referred to a Urologist who I saw 3 weeks after the first test, who did the DRE and another PSA test after the DRE - came back 3.8 (different lab).
 
The Dr.said the prostate was 'smooth' upon DRE but enlarged. He was more concerned about the 300% PSA increase from 15 months ago. But, I have since learned that several things were not told me before either PSA. Such as:
 
Exercise, Sex, no DRE in the prior 72 hours before the PSA. I exercised, had sex, and drank lots of coffee within 24 hours of each test,  and the DRE 30 minutes before the second test.
Also, I understand you should allow 6 weeks before repeating the test. It was only 3 weeks.
 
Now -- I don't have any of the urination issues, or other symptoms that you might expect. However, I do get frequent twinges, aches in the prostate area and groin, a general weird feeling there and infrequently a very brief knifelike pain up the rectum in that area. Used get them sometimes when younger after having been aroused but not satisfied :) I have had these things off and on for many many years as long as I can remember.  Maybe a little more recently, but then again I'm thinking about it.   The Dr. said riding a bicycle can cause the PSA elevation.  I don't bike but I do some serious rowing at home and the seat is hard like a bike. I have noticed that the aches are a bit more after rowing. Coincidently, I started rowing in the past year.
 
The Dr. wants to do a biopsy.  He is a local Dr. in Fredericksburg Va.  Do you think I should shop around? I don't know that he has that much experience, he's young and does pediatric work.  Can anyone recommend someone in the DC, Northern Va, Maryland area?
 
Should I need to go the next step -- does anyone have information comparing results of the Da Vinci vs the Cyberknife? Are they the best?  I just learned about both.  I'm more concerned about continence if it comes to that then ED.  In the same geographical area --- would anyone recommend someone for either of those procedures? I could travel too.   Just trying to research and get my ducks in order.
 
I have a consult 10/31 and the Dr. wants to schedule the biopsy.
 
Sorry for the long winded post -- I have a lot to get off my chest and right now my mind is spinning.    Thanks for any help...JR
 

lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 672
   Posted 10/29/2008 6:11 PM (GMT -6)   

Hello Mr GTO

You have found the best place on the web for information about prostate cancer.

You seem to have done a good job researching PSA testing.  The most important thing to know is that it can vary due to outside influence.  Your doctor is right that the big increase is often an indicator.  However, as you have found, there can be many reasons for that change.

If it were me, I would get another PSA test in six weeks, keeping in mind that certain things such sex can raise the number.  At that time, if it is still high then a biopsy would be in order.  You can usually safely wait many months before going ahead. I'm sure that others here can help you with information about doctors and treatments if that becomes necessary.

Your various symptoms sound like normal stuff, many times prostate cancer has no symptoms at all.  I never had a prostate symptom or enlargment or infection .

My first PSA of concern was over four months before my biopsy was scheduled, and then I waited another four months before my DaVinci surgery. Take your time and get all the facts right before moving ahead.



PSA up to 4.7 July 2006 , bump noted during DRE
Biopsy 10/16/06
stage T2A  -  Psa 4.7
Gleason  4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8
No extension or invasion found
No continence problems
PSA 90 day (-.01)  , (6 month -.01) , (9 month +.02) , (1 year +.02) ( 18 months +.02)
ED still a problem, minor succces with bi-mix
plaque buildup due to injections 
 
 
 

Post Edited (lifeguyd) : 10/29/2008 6:15:44 PM (GMT-6)


Bluenose
Regular Member


Date Joined May 2008
Total Posts : 260
   Posted 10/29/2008 6:18 PM (GMT -6)   

 

 Hello there Mr. Goat! I'm assuming from your screen name, you drive one? Anyway, sorry you're here but glad you came,  welcome, welcome to the best site on the net for Prostate issues. Many of us who've traveled the road you're on now......research and knowledge is your best offense. Many more of the guys and gals will be along soon. I promise.

  With that being said I'll just share this with you. My PSA too rose from around the 1.5 or so  to 5.0 in fifteen months as well, three months later it had dropped back down to 4.1. I too before the first one, had sex, never stopped my workouts in the gym, and rode my bicycle....so, it is about the velocity of the rise. I had the biopsy, it wasn't bad at all. Of course my doc puts all of his patients in a "twilight state" so I don't remember a thing about the biopsy. Most of the fella's here have a different story. If it were me, I'd go for the biopsy, but then that's just me. I think I'd probably be shopping around for a more experienced Doc too. You'll hear from the gang and many a option you have-

   good luck  

                                                                        

 


 
   age: 53
   Pre-0p PSA  Feb. 08, 5.0
      4.22.08, 4.1
      PSA  spiked once about 8yrs ago to 5.0 three months later
      back to 2.9...then into the 1.2 range until my re-scheduled 
      "missed" appointment this past Feb.
      Biopsy 5.1.08 
      Gleason-3+4=7
      T2a
      5 of 15 cores positive
      Da Vinci scheduled..7.29.08..as I read somewhere on this 
      site....."the first show of the day"
       DaVinci completed 7.29.08, Bladder Sling installed, hernia repair 
       completed during surgery.    
        Sent home 30hrs,  JP drain in place 7days,
       Path report "cancer fully contained"....Margins clear
        Cath removed 8.8.08(ten days)...one lightly used pad 24 hours
        ED therapy begins 8.9.08. 100mg viagra three times a week,
        pump everyday and hold for ten minutes.
        8.16.08 switched to Levitra 20mg.......whahoo, got lucky...
        immediate results..... 
        9.15.08 pad free at night, one thin (light) pad during the daytime
        hours. Just because I'm chicken..!
         9.18.08 1st post-0p-PSA-Undetectable...Zero's!  Yes!
 
           ..."just tryin' to reason with hurricane season"..
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4118
   Posted 10/29/2008 7:24 PM (GMT -6)   

Hi GTO:

I am happy to recommend an excellent urologist in Northern Virginia.  He is Dr. Walter O'Brien with offices in Leesburg and Reston.  You can check out the web site of his practice at www.urologygroupvirginia.com. I had another urologist to whom I had been referred by my family doc.  I just didn't have faith in the first guy, so asked a neighbor who is a local hospital administrator.  He had heard of O'Brien's practice; I found O'Brien and colleagues listed in "Washington's Best Doctors".

Anyway, I went to Dr. O'Brien and have been extremely satisfied.  He looked over my test results and recommended a biopsy.  I agreed, he did it (under anesthesia!) and, unfortunately, I was diagnosed with PCa.  BTW, he only gets path results from a well known lab in Richmond.  And, while he is a surgeon, he took a lot of time with my wife and I explaining the treatment options and then referred me to both another surgeon (robotic) and a highly experience radiation guy.

Bottom line is he is everything I would want and expect in a doc and I recommend him highly. 

Good luck!


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
27cc
Brachytheraply volume study 11/14/08; brachytherapy to be scheduled in early December


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 10/30/2008 7:04 AM (GMT -6)   
Hi GTO ... Big Welcome to HealingWell

about the biopsy, it had some discomfort for me, although everyone is different. The rise in PSA should be of concern, but the biggest problem I see is...was the second PSA reading elevated abnormally because of activity prior to the blood test? From what I have read only, while those activities will raise the level of PSA, it is questionable as to how much it will alter the results. The drop you reported is a good sign, but it was from a different lab so it is hard to use that as a solid marker for PSA reduction. PSA levels will vary slightly from day to day so while you are left with more confusion than answers right now and the best thing I would recommend is to find an urologist that you are comfortable with and follow his recommendations based on the test results so far. I suspect he will recommend a biopsy given your age to make sure and rule out whether it is cancer or just inflammation or infection. That way he can properly treat your current symptoms. By the way...typically prostate cancer doesn't have symptoms in the early stages..so with your low PSA and having symptoms usually will mean that you don't have cancer...but a biopsy is the only accurate way to know for sure. Any other test will only lead you either in the direction of a biopsy or towards a treatment for infection/inflammation.

Good luck and keep us posted as you learn more and if you have additional questions just ask...that is what this forum is about. Getting answers from cancer survivors and their personal journeys.
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA Oct 08 <.05


Navy corpsman
Regular Member


Date Joined Aug 2008
Total Posts : 61
   Posted 10/30/2008 10:22 AM (GMT -6)   

GTO -

I live in Locust Grove out by Lake of the Woods.  If I had to have my biopsy done over I would go to the surgeon who did my RRP. IMO the biopsy is critical to finding cancer that is just beginning to develop.  Try to find the most experienced doctor you can for any treatment or procedure.

If you would like to talk on the phone e-mail your number.


Age:  44
We have a family history of PCa.  My Dad and uncle died from it at 65 and 53. My PSA velocity increased in the last 2 years and I had to talk my GP into refering me to a urologist.
Biopsy results:  5 of 11 cores positive, all 30%. Gleason 6. T1c. PSA 2.53  Date of biopsy 15MAY08.
Open RRP at Johns Hopkins with Dr. Partin on 09JUL08.
Pathology report:  Gleason 6, pT2, neg. margins, 0 lymph node and seminal vessical, organ confined, I lost 1 nerve bundle and 22 lymph nodes.
As of today, about a month after surgery, I feel at about 80%. Urinary control seems to be improving. Little Elvis has taken a nap and has not awakened yet. I hope when he wakes up he is well rested because he is going to get one heck of a workout.
 
 


Mr GTO
New Member


Date Joined Oct 2008
Total Posts : 5
   Posted 10/30/2008 6:48 PM (GMT -6)   
Everyone: Thanks a bunch for the information. I have a consult tomorrow morning and now a lot of questions to ask. So we'll see where that leads.

Yes -- the DRE was done just prior to that last PSA test in the office. I am thinking I'll do the biopsy anyway. My only concern with that is that I read that a lot of men have some cancer and live with it their entire lives with it never giving problem, so many biopsies result in unneeded surgery. At least that's what I've read about. I'm looking for someone that I know will do a good job on the biopsy and have a good pathologist look at the results.

Also -- yes -- I do have a GTO, I've had 4 of them. The one I have now I bought when in the Navy back in 76, restored it 10 years ago. thanks again -- I'll post later.

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4118
   Posted 10/30/2008 8:14 PM (GMT -6)   
Dear GTO:

I think that your biopsy will only lead to unneeded surgery if YOU allow it to do so. I recommend that you look at the biopsy as information, period. From that info you, with help from your physicians and your research, can and should decide on your treatment. Maybe the biopsy will show no PCa, hence rejoice and go forward. If, however, you do get the bad news, then the real work begins as to making a decision. Unlike other cancers, this one doesn't have a one size fits all answer. So...then it's up to you. Surgery or other treatment will not be because you had a biopsy, it will be because you decide how to handle this problem.

I'm sure we all hope you get the good news. But, if it's bad, at least you have some choices.
Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
27cc
Brachytheraply volume study 11/14/08; brachytherapy to be scheduled in early December


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 10/31/2008 11:04 PM (GMT -6)   
I didn't have as large a percentage increase in the PSA results as you did in such a period, and my exams didn't reveal anything suspicious to my primary care physician or the Urologist he referred me to - but the Urologist was concerned enough about the rise in the PSA test result that he and my primary care physician recommended a biopsy - and that's the advice I followed.  The results of my biopsy revealed the presence of cancer and that led me to have surgery to remove it.  I have no regrets about having the biopsy, and if the results hadn't revealed cancer (because it wasn't present) I would have rested easier knowing that information.  I rely heavily upon my excellent relationship with my primary care physician, his examinations of me, the testing he does and his recommendations of specialists when he thinks I should get additional opinions.  Best wishes for you.

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (getting better, though)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0

 

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