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Posted 12/4/2008 10:43 PM (GMT -7)
I (56 year old) recently had a high PSA of 6.5 (also after a DRE from my PCP) and saw an urologist. I have had a past history (maybe 20 years) of prostatitis problems. My last PSA about 1.5 years ago was 3.5. The uro suggested getting a confirmatory PSA, however after my appointment apparently the DRE aggravated my prostatitis (My DRE was OK). This Uro does not believe in treating with antibiotics and when I called to talk with him about this problem he didn't bother to call me back. Of course if the PSA value remains high the Uro would want to do a biopsy. I'm still waiting for the putative prostatitis to ease up befor getting another PSA. I have also made an appointment with a new urologist who I hope will do a better job of working with me.

My question: I am wondering if my symptoms are from cancer as opposed to prostatitis?. I am having some uriniation urgency/frequency/slight burning, and a newer symtom for me some perineal/anal discomfort. What do people with documented cancer have in terms of symptoms -if any??

Thanks
Posted 12/4/2008 11:29 PM (GMT -7)
Hey Rocket,
Prostate cancer in the early stages does not usually have symptoms. Mine didn't and it was in later stages. Prostitis can be a factor in having an elevated PSA, but so can cancer. You can wait, but don't wait too long. A biopsy is not such a big deal that you should exert too much effort to avoid having one.

Stay on top of this, and remember you are better off safe than sorry.

Tony
Age 46 (44 when Dx)

Pre-op PSA was 19.8

Surgery on Feb 16, 2007 @ The City of Hope

Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)

Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx

HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)

IMRT radiation for 38 Treatments ending August 3, '07

Current PSA (September 17 '08): <0.1 ~ Undetectable!

You can visit my Journey at:

Tony's Blog

Tony's Prostate Cancer InfoLink Page

STAY POSITIVE!

Posted 12/5/2008 3:12 AM (GMT -7)
I too didn't have any symptoms. I just happened to go to a free men's health screening one Saturday morning. DRE found some nodules and the rest is history. The best doctors in the world can hard to get a hold of...I try to get in good with their assistants who are much easier to talk too and will generally call you back after talking to the docs.. Age 53   - 5'11"   205lbs Overall Heath Condition - Good PSA - July 2007 & Jan 2008 -> 1.3 Gleason - 6 (biopsy done March 4, 2008-> 2 of 12) 06/25/08 - Da Vinci robotic laparoscopy 10/03/08 - 1st Quarter PSA -> less then .01 Surgeon - Keith A. Waguespack, M.D. Las Colinas and Plano Offices  
Posted 12/5/2008 6:56 AM (GMT -7)
I had no symptoms, went to the urologist as a followup to bladder infection because my primary MD suggested it. My PSA was 9.9, then the biopsy, which was positive. I have tried to remember any symptoms prior to diagnosis, but cannot recall any.
Randy
46 you when diagnosed, now 48
Pre-Op PSA 9.9
1 of 12 cores positive, Gleason 3+3
DaVinci on 9/5/2007
Post-Op Gleason 3+6, Negative Nodes and Margins
Less than 1% of prostate involved with CA
3 Month PSA 0.01, 6 Month PSA 0.01, 9 Month PSA 0.01
One Year PSA 0.01
Incontinence resolved 9/15/2007, one day after cath removal
ED showing significant improvement.
Occasional Success with Oral Meds
Success with BiMix

Posted 12/5/2008 7:11 AM (GMT -7)
Mine started with the frequent and urgent urination problems and needing to get up several times at night. When I went in for my annual physical I told my doctor about the symptoms thinking it was an infection. The testing didn't indicate an enlarged prostate and the culture of urine didn't show any signs of infection either. So I guess in my case the symptoms I had was related to the cancer...but very unusual from what I read.
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

Posted 12/5/2008 7:26 AM (GMT -7)
I had prostatitis several years ago and the doctor gave me antibiotics, it went away and that was it.

I never had prostate problems but - enlarged prostates do not mean cancer, and cancer does not mean an enlarged prostate.

Prostate cancer cells feed on testosterone, so often there are no symptoms. I had an almost random PSA check, which led to a biopsy, which was positive. I never had any symptoms, and the day before my surgery I used a chain saw in my back yard to cut down a dead tree. I felt fine. I was just extremely lucky (and blessed) that it was caught early. I was being stupid and it could have EASILY been another year before I had another physical exam, or any kind of blood work. By then, I am being told it would have been too late for me.

You can't be too careful. Tony is right - better to be safe than sorry.

kcragman
Age: 52
March 2006: PSA 2.5

Dec 2007: PSA taken for insurance application. I did not see the results until late Jan '08 - after I was rejected. Their lab said PSA 4.5. PSA again in Feb '08: 3.7.

March 2008: Biopsy. Gleason 7 (4+3) 12 cores taken. 5 on the left side were cancerous and the 6th was suspect.  

May 5, 2008: Da Vinci robotic laparoscopy at GW Hospital, Washington DC.

Post op: Gleason 9 (4+5). 15% of prostate involved. Stage: pT3a. Negative margins. Lymph nodes and associated glands all appear to be cancer free.

July 2008: PSA at 7 weeks was undetectable.
August 2008: PSA at 14 weeks (3 months) was undetectable.

Nov 2008: PSA at 6 months was undetectable.

Posted 12/5/2008 7:32 AM (GMT -7)
I had absolutely no symptons ahead of time. Just a stedily rising PSA from age 50. Didn't make me feel one way or the other ahead of time.

David in SC
Age 56, 56 at DX

PSA 2007 5.8

PSA 7-2008 12.3

PSA 9-2008 14.9

3rd Biopsy 9-2008 Positive

7 of 7 cores positive, ranging from 40 - 90%

2 tumours noted, Gleason 4+3 and 3+4

Periunual Invasion noted & High Grade PIN noted

Open RP surgery completed on Friday, November 14, 2008 at

St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon,

Nerve bundles not able to be spared, awaiting pathology report, Cath scheduled to be removed on 12-15-2008, staples removed 11-24-8

Posted 12/5/2008 7:51 AM (GMT -7)

Hello Rocket:

I had and have ZERO symptoms yet have confirmed PCa.  I think you will find that is the norm in early stage cancer.

FYI, any PSA test should be done prior to a DRE and/or sexual activity as both of those can cause artificially high PSA results.  A surprising number of PCP's don't know that fact.

I think you are doing the right thing in finding another uro in which you have confidence.  I did the same thing and now have an experienced, caring and RESPONSIVE physician.

By the way, should a biopsy be suggested and you decide to go ahead, I would suggest getting it done under anesthesia.  Some posters on this forum have stated that no anesthesia was not a problem and that it was just "uncomfortable"...others will confirm that it was a literal PIA.  In my case, it was done under anesthesia and there was no pain, and only mild after effects (think dark ejaculate).  Anyway, you might consider this anestheia question when picking your new urologist.

Age 62

Gleason 4 +3 = 7

T1C

PSA 4.2

27cc

Brachytheraply volume study done on 11/14/08

Brachytherapy scheduled December 9, 2008

Posted 12/5/2008 8:30 AM (GMT -7)
Just a quick thanks for all your responses. I think this is an excellent group.
Posted 12/5/2008 8:34 AM (GMT -7)
My suggestion is to goto another Urlogist if you uncomfotable with your current one. But I sugegst you get the biopsy, rather be safe then sorry. I had no symptoms my dre was ok. Cystoscope and MRI showed nothing. The biopsy showed it.
Age Dx 37, 7/2008

First PSA : 4.17 5/2008

Second PSA After 2 weeks of antibiotics : 3.9 6/2008

DRE: Negative 5/2008

Biopsy : 6 out 12 Postive all on right side, Gleason 7 (3+4).

Bone Scan/CAT Scan: Clear 7/2008

Cystoscope: Normal 7/2008

Prostate MRI: Normal 7/2008

Da Vinci Surgery 7/2008

PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).

First PostOp PSA 9/2008: <0.01

2nd PSA 12/2008: Praying for <0.01

Posted 12/5/2008 8:37 AM (GMT -7)
Hi Rocket,

I had no symptoms either other than the urgency and frequency of urination.  I suspected swollen prostate and went to a uro I had seen a couple of years earlier.  Dre showed no nodules, but Psa was 13.5, follow up Psa 14.5.  Went with a biopsy, which he performed with local anesthetic and lo and behold, 4 of 12 cancerous.  Biopsy was not uncomfortable and took only about 15 minutes total.  He sat my wife and I down and explained our options but pretty much told me that surgery would be what he recommended.  He doesn't do DaVinci because he said he was too old to be trained and do enough procedures to be proficient.  I went to one of six Drs. in Kansas that does the procedure and we consulted for nearly an hour.  Decided on DaVinci, if possible(due to some scar tissue from gut surgery 12 years ago) in January.  I think it was a good move to dump the first Dr. and go with another.  Good luck and let us know what you find out.

Bob

 AGE:57

 Dx: October,27(the day after my birthday)

 Psa 14.5

 Gleason:(4+3) 7

 Bone scan:Negative

 Cat scan: Negative

 Biopsy: 4 of 12 positive, left side, pre-cancerous on the right.

 Confined to prostate.

 DaVinci scheduled for Jan. 2009.Dr. Scott Montgomery, KC Urology,

Shawnee Mission Med. Center. Kansas

Posted 12/5/2008 1:01 PM (GMT -7)

...none, nothing, nada......just a winning PSA lottery number and the biopsy confirmed I had the winning ticket!! 

  Good move with the Uro by the way....

 

   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"..

       

Posted 12/5/2008 1:28 PM (GMT -7)
Similar to you, I had problems with prostatitis for over 20 years prior to PC diagnosis at age 59. My docs did believe in antibiotics for control of prostatitis, which alleviated some symptoms (mostly difficulty in urinating), but never really eliminated the problems. However, the prostatitis did get me to a good urologist regularly, who noticed a slight elevation in PSA about a year before diagnosis of PC; we watched the PSA and it continued slightly upward, so he recommended a biopsy "as a precaution", which found the very early stage PC. In my case what worked was to watch the PSA for a consistent climb, and if you have it get the biopsy. It's not much fun, but it beats the alternatives by a long way!
Never noticed any physical symptoms from the PC other than a feeling that the antibiotics weren't working quite as well as they used to. Incidentally the biopsy also showed the prostatitis was caused by a persistent e.coli bug, and since removal of the prostate in RP surgery, living without the prostatitis (or for that matter, the prostate) has been a blessing.
58-year old attorney, no family history of PCa
Biopsy 12/29/2007 with 1 of thirteen samples positive; estimated 5% involvement
3+3=6 Gleason
TR2C Stage
RRLP on 2/21/2008 with excellent prognosis (no evidence;margins and other tissue clear) on cancer clearance and sparing of both nerve bundles
Post-OP:Actual involvement 15%, one lobe only; PCa fully contained in prostate-no involvement with other tissues and margins clear
Catheter out on 3/2/2008; fully continent by 3/31/2008
Undetectable PSA on 3/31/2008
Working on ED: 20MG Levitra every other day; Vacuum pump almost daily; some improvement, but not there yet. Started using MUSE with some success, 11/1/2008
2d undectable PSA on 7/21/2008
3d undectable PSA on 10/30/2008

Posted 12/5/2008 2:13 PM (GMT -7)

Like others, I had zero symptoms.

That made it difficult submitting myself to surgery. 

Age:54

PSA 5/22/06: 5.6

Divinci surgery: 9/14/06

Gleason: 3+3

Organ confined, clean margins.

Both nerve bundles spared.

Posted 12/5/2008 2:37 PM (GMT -7)
Thats exactly how I felt too, Dave7. Made me wonder if I should have just taken my chances and did nothing, ,its a tough choice when you feel well.

David in SC
Age 56, 56 at DX

PSA 2007 5.8

PSA 7-2008 12.3

PSA 9-2008 14.9

3rd Biopsy 9-2008 Positive

7 of 7 cores positive, ranging from 40 - 90%

2 tumours noted, Gleason 4+3 and 3+4

Periunual Invasion noted & High Grade PIN noted

Open RP surgery completed on Friday, November 14, 2008 at

St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon,

Nerve bundles not able to be spared, awaiting pathology report, Cath scheduled to be removed on 12-15-2008, staples removed 11-24-8

Posted 12/5/2008 3:15 PM (GMT -7)
Not a symptom at all and nothing felt with a DRE. PSA climbed from 2.8ng/ml to 3.2 ng/ml to 3.9 ng/ml over three years, last one at 59 and 10 months. The significance of my age is that two months later the 60-70 PSA age range would have kicked in and said that up to 4.5 ng/ml was "normal" and thus not prompting any further investigation. A increase above 0.7 ng/ml in a year is another marker pointing at possible PCa but my last increase was right on that mark. It was excellent doctoring by my GP in referring me to a urologist who was not at all concerned but suggested the biopsy if I wanted to be cautious. PCa (Gleason 4+3=7) found in both lobes, involving a good volume of the gland and, following post surgical pathology, a point of focal extension. It is a bugger of a disease.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)

Posted 12/5/2008 4:47 PM (GMT -7)
Initially the doctor thought I had an infection due to elevated PSA. the doctor gave me antibiotics for 30 days and the PSA went down. 3.5 months later and I got another PSA test and it was back close to 4. I had the biopsy and was told I had cancer. As for symptoms, looking back I peed a lot more in the mornings than I do now but there was no pain or other indications (may have had premature ejaculation too).

As the others have said, don't wait too long. I ended up with a Gleason 8 and am a very lucky person. Let us know what happenss. this is a great site for information.
 

Age 48

occupation accountant

PSA increased from 2.6 to 3.5 in one year

biopsy march 2008 - cancer present gleason 7

decision - surgery (robotic)

surgery may 9, 2008 - houston, tx

pathology report -gleason 8

margins clear

4 week and 6 week PSA >.04 (undetectible)

6 month  PSA <.04 (low as the machine will go)

continent at 10 weeks (no pads!)

ED is an issue

Posted 12/5/2008 9:34 PM (GMT -7)
Rocket-
I had no symptoms and went rhrough 3 biopsys;12 needle. 14 needle and a 24 needle before finding 1 core at 5%. I got a 2nd opinion at UAB and it was the same as the first-still had PC! I got more treatment options at the second opinion and opted for brachytherapy.

A friend of mine was diagnosed with PC. He got a second opinion-surprise!! He didn't have PC!

The moral of the story: 1. get checked
2. get a 2nd opinion

Good Luck,

Paul
Posted 12/6/2008 8:11 AM (GMT -7)
I had an enlarged prostate for 15 years prior. I had two biopsies during the last four years. The first came back negative, the second came back cancer.

A biopsy is the way to go, in my opinion. You certainly don't want to put it off and find out you've had cancer developing for a number of years. That makes the treatment and recovery that much more difficult. This is your life we're talking about.

I'd also get another doctor, based on the apparent lack of communication.
Age 59 - diagnosed in Jan. 08 after biopsy
da Vinci Robotic Prostatectomy 4/11/08 - both nerves spared
Catheter removed 4/25/08
Prostate Pathology: Gleason Grade 6 (3+3)
5 wks post-op Continence: 1 pad night, 2 during day
7 wks post-op Continence: 2 pads every 24 hours
First post-op PSA at 7 wks: >0.1
14 wks post-op Continence: 1 pad days, no pad nights
Post-Op PSA at 5 months: >0.1
7 months post-op Continence: First pad-free day/night!
7 1/2 months post-op Continence: No more pads!
(ED is a different story)

Posted 12/6/2008 1:39 PM (GMT -7)
Hey Rocket thanks for this thread
I did have symptoms, I had a hard getting my stream started and I had a very weak stream, this on top of feeling of fatigue. I never thought it was cancer and when I went to my family doctor for a physical he did the DRE and found a nodule, he sent me to the Uro the next day and had a biopsy and the rest is history. I agree with Tony please stay on top of this, early detection is the key to surviving this beast. Please keep us posted as to how you are doing.

peace and love
Dale
My PSA at diagnosis was 16.3

age 46 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8

I had 44 IMRT's

Casodex

Currently on Lupron

I go to The Cancer Treatment Center of America

Married with two kids

latest PSA 5-27-08 0.11

PSA July 24th, 2008 is 0.04

cancer in 4 of 6 cores

92%

80%

37%

28%

Posted 12/6/2008 2:15 PM (GMT -7)
Thanks for the information. It seems like most people don't have prostatitis-like symptoms from their cancers. This is no proof that I don't have to deal with prostate cancer or tests such as a biopsy. Also some of you note that PCa may co-exist with prostatitis. My appointment with the new uro is in 1 1/2 weeks. I will be asking for an antibiotics trial and a PSA restest and see what he thinks. I am also having some anxiety issues dealing with this.

Thanks
Rich
Posted 12/6/2008 3:17 PM (GMT -7)
Don't we all! You have a relatively low PSA (6.5) coming from a base of 3.5 18 months ago. If this is indeed cancer, then it is starting to move, so count your lucky stars that you caught it early, when it is very treatable.

Bonus -- treatment for cancer will also cure your prostatitis.

However that is looking at the worst case -- and it's a long way from a death sentence. Your PSA may indeed be due to prostatis, in which case you have nothing extra to be anxious about. Good luck -- fingers crossed!
Age 63. Other than cancer, in good health; BMI 20

Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores

7 March 2008, RRP, non nerve sparing

Two nights in hospital; catheter and staples out after 7 days

Continent, no pads needed from the get-go

Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm

6-week and 7-month PSAs: 0

Bimix injections working well 

Posted 12/16/2008 10:45 AM (GMT -7)
I thought I should update things.----- As noted, I have a PSA of 6.5 taken about 2 1/2 months ago and I'm 56 years old. My DRE was negative. I also have had a history of prostatitis. 18 months ago my reading was 3.5. For my new test, I waited for my prostatitis-like symptoms to lessen and did not have a DRE (like before my 6.5 reading) and no sex for several days. My new reading is 3.6. I tend to think that my 6.5 reading was a fluctuation. My thinking now is that prostatitis is much more likely than PCa. For now I won't be getting a biopsy, I still intend to keep my appointment with the second urologist since I have some rear-end pain which can be fairly bad and may be related to prostatitis. Also I want to keep monitoring my PSA to establish a trend. My anxiety level has now decreased , but first-hand I know PSA can do a nasty job on you when it rises.

Thanks for all your comments
I will still stay in touch with this great board

Post Edited (rocket1952) : 12/16/2008 10:49:11 AM (GMT-7)

Posted 12/16/2008 10:58 AM (GMT -7)
Hi Rocket,
Good work. And you are on the right track to stay diligent with the PSA. Prostitis can elevate PSA. Your PSA is still high enough to let it serve as a reminder to be proavtive. You are very welcome here should you need us.

Tony
Age 46 (44 when Dx)

Pre-op PSA was 19.8

Surgery on Feb 16, 2007 @ The City of Hope

Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)

Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx

HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)

IMRT radiation for 38 Treatments ending August 3, '07

Current PSA (September 17 '08): <0.1 ~ Undetectable!

You can visit my Journey at:

Tony's Blog

Tony's Prostate Cancer InfoLink Page

STAY POSITIVE!

Posted 12/16/2008 12:19 PM (GMT -7)

Hi Rocket:

Glad to get your update and that you are still going to see a new urologist...that sounds smart.  And, not to be a downer, but PSA fluctuations may also indicate PCa presence.  I went thru a couple of urologists and PSA tests before finally admitting that having a biopsy was the right thing.  So, if your new uro recommends a biopsy, it's probably a good idea.  At least then you are armed with the knowledge, one way or another, to deal with your prostate issues.

But, I surely hope you get good news one way or another and PCa is not the issue with which you have to deal..

Keep us up to date and we'll hope for the best for you!

Age 62

Gleason 4 +3 = 7

T1C

PSA 4.2

27cc

Brachytheraply volume study done on 11/14/08

Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort. 

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