How do you know if you have cancer

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Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 2/6/2009 12:54 AM (GMT -6)   
Sorry if this as been asked many times before but I am still new to this it seems to me that unless a biopsy finds cancer you never really know if you have cancer or not. If you have a PSA of higher that 4 it is a marker for cancer but alot of people have cancer wuth a PSA of much lower than 4. so you go and have a biopsy and come back clear but then you are told that the samples taken might of miss a cancer so it does not mean you are clear. If there is another way of finding if you have prostate cancer why is it not used first
 
I am just out of my first biopsy which seems clear and it sounds like I am going to have 3 monthly checkups but with BPH and a PSA of 9.7 if the PSA increases how will the doctor know if it is cancer or BPH getting worse
 
Oh I do not understand all this

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 2/6/2009 2:04 AM (GMT -6)   
Hi Colin,
Welcome to HealingWell. I hope you don't have cancer, but if you do, this is a great place to get support and information. The patient to patient interaction is amazing here. On your PSA, it alone does not confirm cancer. I have seen PSA's of 10 that continuously test negative. Unfortinately I have seen a PSA as low as 1 be cancer. Most of the time there are no symptoms. So a biopsy is necessary to do an initial sampling of the tissue. Did you say you have received your back? And it was negative? If you continue to increase, I would ask for a saturation biopsy on your next go. This is where more samples are taken while you are under general anesthesia. Your doctor will know what it is.

I hope they never find cancer. And welcome to our site.

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 15, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 2/6/2009 4:51 AM (GMT -6)   
Hi Tony

I had a 12 core biopsy done which said that it showed BPH, Atypical Hyperplasia (which they are doing another check to see what it is) and low grade PIN and most people on here said that was good and not to worry (thread http://www.healingwell.com/community/default.aspx?f=35&m=1374451) but it seems that the Doctor could not say that I did not have cancer because he might not have hit the cancer cells on the biopsy so what I was trying to find out is there a definite way to find out if I have Prostate Cancer

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 2/6/2009 5:15 AM (GMT -6)   
Colin45,
Welcome to the best patient to patient site about prostate cancer. Firstly, indeed a PSA of 4 can be a marker for prostate cancer. But it can also indicate BPH as well as being indicative of a low grade prostate infection. A free PSA test can also show whether there is a likelihood of cancer but at lower PSA levels (below 10) it can also be misleading. The most dependable is the biopsy. The biopsy can indeed miss cancer by virtue of the needles missing any tumour but usually the urologist is guided by any ultrasound irregularities he may see on the ultrasound. The more needles (as Tony suggested) the better the profile of the gland. Rejoice that the doctor found nothing but keep on carefully monitoring your future PSA's and be vigilant. As Tony suggested an increasing PSA may warrant a more detailed biopsy sampling.
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)


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 2/6/2009 7:05 AM (GMT -6)   
Billymac-explained the fpsa test which another parameter to look at, but only as a possible clue. The newer urine test PCA3 is another tool that can be used (see-google Bostwick laboratories for info on that)it is said to be quite accurate, I don't know. An oncologist can do other tests to like: PAP, pyrilinks but those are just kind of marker tests and might be only useful on advanced prostate cancer patients. I am a patient diagnosed in 2002 with plenty of PCa 12/12 (all 80-90% levels), but since treamtents and stuff....my PAP and pyrilinks (and other)tests do not reveal anything at this stage and other blood tests and marker items are all in normal ranges  (nice to see of course), but no warranty on  PCa.

Did you know there is such a thing as a PCa sniffying-detecting dogs??? I have heard about such, might have been in England, hey dogs got the nose, how they trained them is beyond me. Maybe there is a detection center in England or wherever, PCa is stranger than fiction my friend.

Biopsies are the most definitive test that they have currently as for accuracy and even then, it is not as good as we patients actually need for total assessment. Per Dr. Strum- (ruling out protatitis first and perhaps some bph increases) velocity over time (continuously) and psa doubling times (within one year), are your red flag that should or could lead to biopsies.
 
 (there are others if you google prostate cancer and sniffing dogs)
 
 
Maybe some one else has something to add to this.


 

Post Edited (zufus) : 2/6/2009 5:49:45 PM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/6/2009 8:20 AM (GMT -6)   
Colin, hello and welcome, hope we can help you.

With what you wrote and posted, your doctor will be keeping a close eye on that rising PSA. At some point, I am sure they will want to do a more extensive biopsy as Tony suggested above. It took 3 spread out over 15 months to confirm my cancer, other men have had more than that and still don't have cancer. One person said the biopsy is like blindly sticking a long needle into a loaf of raisin bread, and if the needle doesn't pull out a raisin, then it must not be raisin bread. something like that. hope that it is never PC for you, but we are here to help and support you.

David in SC
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
 
 


mvesr
Veteran Member


Date Joined Apr 2007
Total Posts : 823
   Posted 2/6/2009 7:32 PM (GMT -6)   
Hi colin45.

Hope you don't have it

Mika
age at dx 54 now 56
psa at dx 4.3
got the bad news 1/29/07
open surgery Duke Medical Center 5-29-07
never more than 2 pads
Tossed the pads this spring
ED still a problem
Got a shot last week and it was great
A year an a half of zero's
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 2/6/2009 8:01 PM (GMT -6)   
Colin,
There are several ways to indicate a likelyhood of PC rather than BPH.
PSA3 and Saturation biopsies have already been mentioned in replies to your post and are effective.
Free PSA, PSA doubling time, and PSA velocity are also indicators.
Scans such as endo rectal MRIS and color doppler ultrasound can identify most tumors, but you need a biopsy to really know for sure.
If tests such as free PSA, PSA3 and your PSA doubling time indicate PC then I would either get a saturation biopsy or a color doppler targeted biopsy.
I was one of those guys who went through 13 biopsies before anything was found. Color doppler or saturation biopsy would have picked it up years sooner.
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


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 2/12/2009 3:53 AM (GMT -6)   

Hi again just had my final Diagnosis with Immunohistological Study which was on the Atypical Hyperplasia which on the new report is changed to Basal cell Hyperplasia as follows

Study reveals CK-HMW positive cells all atypical glands from both sides. No adenocarcinoma in both specimins

What does CK-HMW positive cells all atypical glands mean

It seems like I am on another three month wait to see if my PSA of 9.7 goes up or down


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/12/2009 8:27 AM (GMT -6)   
JohnT: By all accounts, you are our King of Biopses, not sure anyone could top yours. I am still awarded the King Of Catheter Troubles. Both awards we could live without out! lol.
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, Right nerves saved, 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 .05
 
 


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 2/12/2009 9:16 AM (GMT -6)   
Think you may have the wrong thread

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/12/2009 9:57 AM (GMT -6)   
Colin

CK stands for cytokeratin which is characteristically, squamous carcinomas. The HMW stands for High Molecular Weight

High molecular weight cytokeratin is completely negative for adinocarcinoma

Hope this helps


You are beating back cancer, so hold your head up with dignity
 
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 5 week Oct 2008 <.05
       3 month Jan 2009 .06

Post Edited (LV-TX) : 2/12/2009 8:03:56 AM (GMT-7)


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 2/12/2009 11:03 AM (GMT -6)   
Yes thanks that helps me understand a bit more I have now to wait now for 3 months to see if my PSA goes up or down to see if I have to have a 26 core biopsy or not the problem is this 9.7 PSA was the first PSA reading that I have so i have no guide lines to go by I suppose i just have to be patient which is a problem for me 

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/12/2009 11:39 AM (GMT -6)   
Yeah Colin...having patience is probably one of the...if not the biggest...problems in dealing with this disease. Even if you do have cancer and then remove the prostate with surgery, or any other mode of treatment...there is still that anxiety and dealing with patience for the next PSA test. It becomes a lifetime routine I am afraid.
You are beating back cancer, so hold your head up with dignity
 
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 5 week Oct 2008 <.05
       3 month Jan 2009 .06

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