High PSA velocity, no cancer

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worker
New Member


Date Joined Dec 2008
Total Posts : 5
   Posted 12/10/2008 12:05 PM (GMT -6)   
Selmer and LT-TX
Thanks for the fast responce, very much appreciated. (LT-TX let me know if this is not the way to start a new thread.) Selmer, your caring advice is appreciated and is also reposted.

Here is my history.
I am another no cancer (per biopsy), but high psa velocity person. Rarely have Symtoms (great diifficulty with urination start, high urges, and long time finish 3- 5 minutes). However, they are brought on by heavy lifting (ex, lift and drag logs to clear land for 3 hours). Age is 66. Father and Uncle had prostate cancer at 75, PSA = 4.5, father had Lupron for a couple of months was taken off it and the PSA droped and the cancer shrunk and remained dormant, died at 78 from heart attack. Uncle had radio active distruction of his prostate and is 82 and living.
PSA History 11/2008 = 9.5, 5/2008 bisopsy showed no cancer for 12 cores, 5/2008 = 6.2, 4/2007=4.5, 3/2006 = 3
DRE normal, No measure of free PSA was done, Small volume prostrate, no density measure
11/2008 - Uro gave 7 days of broad spectrum antiibotics (levenquin ??) to eradicate any urinary infection that would impact PSA

My internet has me second guessing my urologist, who is not that communicative. (He would not discuss odds, LT strategy, etc)
Please add your pros and cons to the following:

1 - If high (>9), he will want to do another biopsy. Do you know of any other reliable tests AMAS, ECPA, protate MRI, ....
(I was pushing for an AMAS test via Oncolab and wanted to know his recommendation, cost to me $165 instead of a ..........biopsy, this is praised by some doctors and considered worthless by others, .... my uro-doc never heard of it....he also ........... does not measure free PSA, ....why not? his answer is we don't do that??)
2 - I read that if the PSA is high, one should be on 30 days of antibiotics because unrinary infections are difficult and timely to ..........eradicate. Please comment. ( If high I think uro-doc should employ 30 days of antibiotics, and find a more reliable test ..........other than biopsy)
3 - What are the odds of me getting protrate cancer in the future with this high velocity PSA?
4 - Is my uro-doc OK?
5 - John Hopkins sends me email on latest break-thus, but they want to sell books to us in order to get that information. Do you know where else I can get latest breakthur information such as the diet we should be on.


From Selmer:
You seem to indicate you already had a biopsy. When was that and what were the results? What is your age?
Did the same urologist do that? [no cancer, 66, same uro-doc]

If you don't communicate well with your urologist, and you think it is his fault, then you should get one you can put faith in. On the other hand, perhaps you just feel he isn't saying what you want to hear. [ might get a new one, if he wants an immediate biopsy. Based on your statement below, I think 6 more months need to pass before the next biopsy to allow normal PSA settling to occur ]

Some doctors give 7 days of antibiotics, some 14 and some 30. Realize that most prostatitis is non-bacterial and the antibiotics don't affect it very much if at all.

Having said all of the above, and being a person who normally looks for a way to avoid unnecessary biopsies, your PSA numbers appear to be on a steady and increasing march. If its not caused by some other reason then you need another biopsy. Looks like the velocity is taking off.
Again, how many biopsies and when did you have them previously?

After you get your next PSA back.....see what it is........then if needed get a quick second opinion, and make a decision. Lots of first time biopsies, like you apparently had, can easily miss cancer. Think of the cancer, if it exists, like some olives in a loaf of bread. You stick 12 probes into a loaf of bread, and you could easily miss even several olives. Some people go from zero positive cores on the first biopsy to perhaps 4 of 12 on the second biopsy. Hit or miss.

Good luck, but I suspect your PSA isn't gonna drop back below the prior 6/2 reading from May, 2008.
Let us know.......and if its back to 6.2 or below, perhaps you could request a free-PSA from another urologist, although you may well find him/her suggesting you do the biopsy anyway.

Selmer
KICK UP


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4831
   Posted 12/10/2008 12:55 PM (GMT -6)   

I have a 70 year old friend who's PSA was about 12 or so for YEARS. I think he did 4 or 5 biopsies over the years....Then his PSA went up and BOOM, he's got prostate cancer.


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

 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 12/10/2008 1:16 PM (GMT -6)   
Hello Worker and welcome again. Glad you made your own post so many others will read and respond.

Couple of notes here...you are in the higher risk category of getting prostate cancer based on a father and uncle having prostate cancer than most of the general public. Age is another factor, in that the older you get the more likely it will be present. The good news is that if it is found it might be the indolent type where treatment may not be necessary or treatment can be delayed. But first things first. So far the first biopsy was negative..that is good news...but the high PSA is of concern in my opinion. I would follow the treatment plan by your doctor of using the antibotics first...but I am willing to bet that another biopsy will be in order. It isn't uncommon from what I have read that sometimes several biopsies are done before the cancer was detected. Generally PCa is multi-focal meaning there isn't just one big mass, but several smaller sized masses and that makes it hard to pinpoint with a biopsy needle. You may also talk with your doctor about performing a saturated biopsy which will utilize sometimes 40 or more core samples thus giving a pretty good overall sampling rate. As far as your doctor...hmmm...only you can decide that one. I want a doctor that is straight forward and not sugar coat anything...and just my luck those type doctors usually have the worst bedside manners. One thing for sure, you will need to be very proactive with your health and if you have any questions about anything, seek a second opinion. None of the doctors I have were offended by seeking a second opinion and actually they endorsed getting second medical opinions. I am sure you doctor will be the same way.
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


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 12/10/2008 2:08 PM (GMT -6)   

Hi Worker,

Not much to add to the advice given here, just an anecdote for your consideration. I have a friend who was tracking his PSA for years and, at age 65, it began to escalate rapidly. He had undergone a number of 12 core biopsies over the past several years. The last biopsy was a 45 core saturation approach. The cancer was found at that time. I do not recall the gleason score but he had DaVinci at Mayo Clinic about a year ago. So far things are going his way.

Good luck,

Don


Diagnosed 04/10/08
Age 58
PSA 21.5 (first and only test resulted from follow up visit to emergency room for kidney stone. first time for kidney stone too)
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear
Chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
PSA test on July 14, 08 after 8 weeks hormone .82
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
Second Lupron shot 09/11/08
Next PSA test by oncologist 03/09
 
 


aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 12/10/2008 5:46 PM (GMT -6)   

"free PSA" and "PSA density calculations"  are done to determine the amount of PSA being produced by benign causes or by an enlarged prostate producing more PSA, however elevated PSA due to natural causes is usually a more gradual process over some years.

If you have another biopsy, it would be logical under the circumstances to employ the "transperineal" biopsy method.


worker
New Member


Date Joined Dec 2008
Total Posts : 5
   Posted 12/10/2008 5:56 PM (GMT -6)   
Selmer said...
worker said...

Here is my history.
I am another no cancer (per biopsy), but high psa velocity person. Rarely have Symtoms (great diifficulty with urination start, high urges, and long time finish 3- 5 minutes). However, they are brought on by heavy lifting (ex, lift and drag logs to clear land for 3 hours). Age is 66. Father and Uncle had prostate cancer at 75, PSA = 4.5, father had Lupron for a couple of months was taken off it and the PSA droped and the cancer shrunk and remained dormant, died at 78 from heart attack. Uncle had radio active distruction of his prostate and is 82 and living.
PSA History 11/2008 = 9.5, 5/2008 bisopsy showed no cancer for 12 cores, 5/2008 = 6.2, 4/2007=4.5, 3/2006 = 3

If you don't communicate well with your urologist, and you think it is his fault, then you should get one you can put faith in. On the other hand, perhaps you just feel he isn't saying what you want to hear. [ might get a new one, if he wants an immediate biopsy. Based on your statement below, I think 6 more months need to pass before the next biopsy to allow normal PSA settling to occur ]

Having said all of the above, and being a person who normally looks for a way to avoid unnecessary biopsies, your PSA numbers appear to be on a steady and increasing march. If its not caused by some other reason then you need another biopsy. Looks like the velocity is taking off.


Worker...... One statement you made jumped out at me.....

" Based on your statement below, I think 6 more months need to pass before the next biopsy to allow normal PSA settling to occur"

You seem to be referring to something I said..

Let me be very clear. Nothing I said in my post suggests you should wait "6 more months" before getting a 2nd biopsy. We were discussing courses of antibiotics being from 7 days to 30 days.
We were discussing getting 2nd opinions. We were discussing seeing what your post antibiotic PSA turns out to be. But we never said anything about waiting 6 more months.
Now if this next PSA in a week or two turns out to drop way down, back to 6.2 or well below, then you, in conjunction with that second opinion from another urologist, might want to delay a biopsy.
You would have to discuss your entire history with him and then make your choice.
However given the velocity you've seen over the past 6 months, unless there is a dramatic reversal in this current PSA you will be doing, then it appears from this lay person's perspective that you'd be making a very risky bet by waiting 6 months to "allow normal PSA settling to occur"...

Not sure where you got that idea from my posts in this thread as they relate to your particular situation.

Hope that makes my points clearer. Remember I have ZERO medical training. If you want to alter course or wait any considerable time, I really think you ought to get a second opinion from another urologist.

Let us know how this next PSA test in a couple weeks turns out.

Selmer


Thanks for pointing out my judgement error. I will expain: I was thinking about potential urininary infection (am not sure I had one, but had symtoms 6 days after the PSA was drawn Nov 20, 08) and jumped to an opinion on strategy if the PSA comes back high. These thoughts include ....antibiotics being ineffective , ....long time needed to for a urinary infection to be cleared up. You indeed said nothing about the stategy I conjured up: waiting 6 months urinary infection to clear up and then get another PSA and if high then get the biopsy at that time. Will let youi know late this week about the PSA.
KICK UP


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4235
   Posted 12/12/2008 11:02 PM (GMT -6)   

Worker,

I had a similar case with rising PSA for 10 years, I had 13 biopsies and an MRI all negative. I saw 5 different uroligists at major universities and they said keep getting biopsies every year. I finally found a prostate oncologist that knew what he was doing and sent me to a radioligist that does targeted biopsies with color doppler ultra sound. He found a large tumor that everyone else had missed for the past 10 years.

Transition zone tumors are very difficult to discover by biopsies or MRI. 25% of all cancers are in the transition zone so normal biopsies won't pick them up because most urologists only biopsy the perphril zone.

There are a number of causes for a rising PSA. PSA leakage, which normally levels off somewhere along the line. Prostate Cancer. BPH from an enlarged prostate. Infection which can be cured by Cipro. The biopsy should have picked up any infection.

Some recommendations.

Have a PSA3 urine test. It's a new exotic test that is more accurate than free PSA in determining cancer. Find a doctor that uses color doppler, I think there are only 3 in the US. Start with Dr Bahn in Ventura ca, www.pioa.org he's done over 1400 biopsies using color doppler and has exceptional skills.

As for diet, read "The China Study" by Cambell, you can get it on Amazon for about $13

Hope this helps. Good luck.

JohnT


Diagnosed 10-08 at 63 with PSA of 33
PSA was 4.4 in 1999 and has risen steadily.
Had 13 biopsies and an endorectal MRI, all negative until 10-08. Two cores out of 25 with a gleason 6
2nd opinion with an oncologist said cancer found was insignificant, but suspected larger tumor somewhere.
Doppler ultrasound with target biopsy indicate a large tumor in the transition zone, gleason 7.
Bone and CT scans negative.
PSA3= 43; high normal is 35
Currently evaluating treatment options, surgery is not an option as a high probability of positive margin exists.
John T


worker
New Member


Date Joined Dec 2008
Total Posts : 5
   Posted 12/15/2008 1:19 PM (GMT -6)   
Hello selmer, LV-TX, John T, aus, don 821, steve n dallas
Thanks for your information and support.

Good news, the latest PSA is 3 (after 7days of levequin), so right now I feel blessed.

I am opent to recommentations on diet and supplements (my urologist is not.)
Also recommend tests other than biopsy that you know are reliable
John T, I did note your comments on PSA3, ..., and the china diet book. Thankyou)
He believes them to be worthless.
FYI I also doubled my dose of simvastatin from 20 to 40mg while I was on the antibotics because I read it helps lower the psa, (of course the urologist had no comment on that)
WORKER
Age is 66. 185 lbs, Good health, stent for left ventricle blockage, on cardio medicine ( nicacin, simvastin, plavix, asprin, omega3 fish oil )
Father and Uncle had prostate cancer at 75
MY history
3/2006: psa = 3
4/2007: psa = 4.5
5/2008: psa =6.2
5/2008: biopsy & sonogram: 12 cores, no cancer
11/2008: psa = 9.5
4 days after blood test had urination problems
7 days of levequin
12/2008 psa = 3
urologist will schedule psa (not biopsy) 6/2009


worker
New Member


Date Joined Dec 2008
Total Posts : 5
   Posted 12/22/2008 6:03 PM (GMT -6)   
Selmer,
Updated the profile with medicine and blood test stats. I appreciate the info. and I will be reading your recommendations.

Thankyou,
Worker
WORKER
Age is 66. 185 lbs, Good health, stent for left ventricle blockage, on cardio medicine ( nicacin, simvastin, plavix, asprin, omega3 fish oil )
Father and Uncle had prostate cancer at 75
MY history
3/2006: psa = 3
4/2007: psa = 4.5
5/2007: stent for left ventricle blockage
      Started: (1500mg)niacin, (40mg)simvastin, plavix, asprin, (1500mg)omega3 fish oil
8/2007: TC= 107, HDL=34, LDL=61
      Changed dosage (2000mg)niacin, (20mg)simvastin, plavix, asprin, (2000mg)omega3 02/2008: TC= 125, HDL=42, LDL=76
5/2008: psa =6.2
5/2008: biopsy & sonogram: 12 cores, no cancer
06/2008: TC= 138, HDL=48, LDL=77
11/2008: psa = 9.5
4 days after blood test had urination problems
12/2-8/2008: 7 days of levequin
12/4-8/2008: 4 days of (40mg)simvastin,
12/9/2008 psa = 3
urologist will schedule psa (not biopsy) 6/2009


frankiehelp
New Member


Date Joined Feb 2009
Total Posts : 6
   Posted 2/7/2009 5:47 PM (GMT -6)   
yeah  First I am very happy for you,No cancer was find.I am 55 years ago ,I have my psa test July 2008 4.00.Dec 2008 5.60,Feb 2009 12.56,I am taken cipro
medication and wait for the another psa testa after 3 wks. I am so worry.the sudden jump on my psa.
 
Thanks
 
 

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4235
   Posted 2/7/2009 7:39 PM (GMT -6)   
A couple more thoughts for those with rising PSAs:
If your doctor is not charting PSA Velocity, PSAV, PSA density, PSAD, and PSA doubling time, PSADT, then you should get another doctor who can. According to Dr Strum he has never seen a patient in 25 years of practice with a PSADT of 12 than was not eventually diagonosed with PC.
JohnT

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/7/2009 7:46 PM (GMT -6)   
I fully agree with you, John, on your last post. I am a big believer in PSA velocity and doubling time. It was my very alert GP, that for 6 years kept close tabs on my rising numbers, and his insistence that I see the urlogist for my first of three biopsies almost 1 1/2 years before my PC dx.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


frankiehelp
New Member


Date Joined Feb 2009
Total Posts : 6
   Posted 2/8/2009 7:12 AM (GMT -6)   
Hi John T,
Thanks for your information,I am so worry for my PSA velocity ,suddenly jump in a 2 months,I feel nothing wrong for my selfself,I don't belelive when my doctor told me my psa result.
I am on antibiotics medication for 4 weeks,and see what is the PSA will be.It the PSA still high then I will go for my second biopsy.I am very worry why my PSA can doublt in 2 months from 5.6 to 12.56 .if any one can give me some reson. I will go the see my doctor 24 feb 2009 for anyother psa test.

my history
4/08 PSA=4.00
Biopsy No cancer
11/08 PSA=5.60
1/09 PSA=12.56

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4235
   Posted 2/8/2009 12:36 PM (GMT -6)   
PSA jumping around, rapidily increasing then decreasing is usually a sign of infection. The PSA that rises slowly and consistantly is what you really need to be concerened about. This indicates that something is growing at a steady rate, either your prostate or PC cells.
JohnT

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


frankiehelp
New Member


Date Joined Feb 2009
Total Posts : 6
   Posted 2/8/2009 3:35 PM (GMT -6)   
Hi John,

After reading your email,It make me felt much better,I hope sudden increase so much is sign of infection not cancer.I hope more friend have this experence to let me know.Now i just wait for 2 weeks for any other psa test.
My question is the rapidily cancer in postate,will it possible increase psa leave doublt in two months?

frankiehelp
New Member


Date Joined Feb 2009
Total Posts : 6
   Posted 2/8/2009 5:58 PM (GMT -6)   
Hi selmer,
I will re-read your following pages to learn more above psa test result.It is very helpful.
I hope it is prostatitis infection caused the psa sudden go up so high.
will that possible the rapaidly cancer can causes the psa go from 5.56 to 12.56 in 7 weeks ?

03/08 psa=4 take cipro for 4 weeks
04/08 psa=4 and than take a biopsy test no cancer
12/08 psa=5.56
02/09 psa=12.56
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