PSA reading concern/first post

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jnew330
New Member


Date Joined Apr 2009
Total Posts : 1
   Posted 4/20/2009 5:07 PM (GMT -6)   
Hello everyone,
 
I don't know if I belong on this board with those of you who are dealing courageously with the illness. Don't know yet if there is a problem. I am 57, caucasian. Had a psa reading today of 4.2. Two years ago, Spring 2007 it was 2.91 and one year ago, Spring 2008 it was 3.25. Prostate is smooth and has been very slightly enlarged for several years. My doctor, an oncologist, advises retesting over the coming months.  How concerned should I be and is there any advice you have for me?
 
 
 

Uncle Harley
Regular Member


Date Joined Feb 2009
Total Posts : 85
   Posted 4/20/2009 5:15 PM (GMT -6)   
Jnew330, Of course you're welcome here. My advice would be patience, patience, & more patience. Read all you can & ask ?'s.
PSA History
3/99 1.2
3/00 1.04
3/01 1.16
7/02 1.24
2/06 1.59
3/07 1.79
3/08 2.54
8/08 2.3
4/09 2.3
12 needle prostate biopsy Jan 09
Dx of (1) core adenocarcinoma 20%
All other cores benign
Gleason 3+3 T1C
Currently in Active Surveillence
Age 60


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 4/20/2009 5:18 PM (GMT -6)   
Welcome Jnew and thanks for stopping by our wonderful family here at HW. At this stage of the game I think you should follow the advice of your doctor. I had a friend recently that had an excalating PSA and after a saturation biopsy it turned out to be an infection. Just be patient if you can and continue to go for those PSA test as scheduled. I hope you never have to deal with PCa but if you do we will be your biggest supporter. Hang around and join in the conversation. Remember we care.

peace and love
dale
My PSA at diagnosis was 16.3
age 47 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) 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
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
Testosterone keeps rising, the current number is 156, up from 57 in May
T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4252
   Posted 4/20/2009 6:06 PM (GMT -6)   
Your doctor should be able to estimate the size of your prostate and calculate the psa that it is generating. If your psa is greater then it would be a concern.
Also did you have a PCA3 urine test or a free psa?
If these are abnormal it would also be a concern and a biopsy would be the next step.
If all tests are normal then I wouldn't worry and just kepp getting your psa checked every 3-6 mos.
JohnT

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.

As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive

Awaiting schedule for seed impants

 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 4/20/2009 6:28 PM (GMT -6)   
Hi jnew,
Welcome to HealingWell. You are most welcome. And great 1st post. I think more people should post before their diagnosis. It show's you are proactive and eager to learn. I hope you do not have this disease. I would wish it upon nobody. But don't be afraid to take the necessary steps, and don't rush to anything if you are positive for a malignancy. Prostate cancer is slow in going and you should take the time to learn as much as you can about treatment modalities. Good luck, and ask anything you wish...

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 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!


kcragman
Regular Member


Date Joined May 2008
Total Posts : 240
   Posted 4/21/2009 11:51 AM (GMT -6)   
jnew330,

You went from a 2.9 to a 4.2 in 24 months, and your doctor wants to wait another few months to test again.
I went from 2.5 to 3.7 in a little less than 24 months - with no other symptoms. My urologist said my prostate "was possibly slightly enlarged." He also said "anything above 3.5 means a biopsy" (at least in my case). And, as it turns out, I had a serious case of PCa going on.

I'm not sure how concerned you should be, but man, we sure got different advice about what appears to be a very similar case.

(On the other hand, I was also told that I had an 80% chance of having a negative biopsy.)

Good luck,
kcragman
Age: 53; 52 at DX
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.
Feb 2008: PSA 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 node and nerve samples taken, and appeared 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.
Feb 2009: PSA at 9 months was undetectable.


mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 375
   Posted 4/21/2009 5:39 PM (GMT -6)   
I think kragman has a good point. If it was me I would ask for a biopsy right now. My PSA went from 1.9 to 2.85 in one year and the urologist said that was too much of an increase, had to have biopsy. As indicated below the second biopsy came back positive for prostate cancer. Worst case scenario, a positive biopsy would at least give you a Gleason score so you could know if you had a slow growing cancer (gleason score of 6 or less) that you could think about eventually treating versus a more aggressive cancer (gleason score7-10) that would call for immediate attention. I'd do the biopsy now....
my age=52 when all this happened,
DRE=negative
PSA went from 1.9 to 2.85 in one year, urologist ordered biopsy,
First biopsy on 03/08, "suspicious for cancer but not diagnostic"
Second biopsy on 08/14/08, 2/12 cores positive for Prostate Cancer on R side, 1 core=5% Ca, other core = 25% Ca, Gleason Score= 3+3=6 both cores,
Clinical Stage T1C
 
Bilateral nerve sparing Robotic Surgery on 09/11/08, pathological stage T2A at surgery,
No signs of spread, organ contained,
First post-op PSA=.01 on 10/15/08,
Second post-op PSA <.01 on 01/15/09,
Incontinence gone in early December '08,
ED remains, using daily Viagra and 2x/wk bimix/trimix injections for penile rehab


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4252
   Posted 4/21/2009 7:09 PM (GMT -6)   
jnew,

The Prostate Cancer Research Institute's web site has a few articles on PSA calculations in determining PC.
Click on "Papers" then the "undiagnosed section". there is a lot of info in the puplished papers by top professionals.
JT

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.

As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive

Awaiting schedule for seed impants

 


cowboy bob
Regular Member


Date Joined Sep 2007
Total Posts : 116
   Posted 4/22/2009 9:49 PM (GMT -6)   
In 2005 my psa was 2.6. In 2006 it was 3.5. In 2007 is was 4.6, I was urinating a number of times at night due to the prostate being enlarged, and I was told I should get a biopsy. I got one and was found to have a few cancer cells in one corner of my prostate. Since it was caught super early, and the cells were still inside the prostate, I had my prostate removed, and the cancer was thus all gone. I'm just glad I had the biopsy and got the ball rolling early. Just my take on it.

TeddyG
Regular Member


Date Joined Apr 2009
Total Posts : 133
   Posted 4/22/2009 10:51 PM (GMT -6)   

Hello jNew. Good questions and now that you are sensitized to the issues you must continue the research. The John-Hopkins website has alot of info and also has a "White Paper" that candidly addresses many of the threshold questions that you will be asking. Also there are a few books that help in decision making including one by Hopkins surgeon Patrick Walsh. Frankly, the position that you are in is hard because it is scary and you don't know which way to turn if you are like me. Painful as it was, I read everything that I could (so did my wife which was very helpful) and we then at least had a baseline of knowledge and had good questions to ask the docs. There is also alot of crap on the internet regarding treatments so you must review credible information from credible sources.

Based on what you numbers are, it appears that your doc is suggesting "wait and watch" which will be maddening until the next test. If the PSA continues to rise, the next step is a biopsy. Some experts believe that a doubling of the PSA w/in a year or 18 months is significant cause for a biopsy. The state of the art in diagnosing the cancer and then in classifying it as aggressive or not as advanced as we would like. In making decisions to test and what treatment to pursue if you are affected, there are numerous variables including the lab results, age and fitness, along with other medical issues that you may have. The only way to walk through the matrix is to educate yourself.

Best wishes,

TeddyG


hawkfan75
Regular Member


Date Joined Jan 2007
Total Posts : 165
   Posted 4/23/2009 1:06 AM (GMT -6)   

Look at my age and numbers - very similar to yours.  Listen to your doctors, but I'd push to get a biopsy to give you peace of mind, or let you know what to look for next.  Good luck

 


Age 57 at diagnosis (2006),  PSA 4.7 (up from 3.2 one year previous)
Biopsy November 8, 2006 1 of 10 cores positive 5% LEFT Side Gleason 3+3
Robotic surgery January 19, 2007
Post Surgery Pathology Stage T3a, Gleason 3+4, positive margins and capsular penetration RIGHT Side
Post Surgery PSA:  March 5, 2007:  0.01    5 month PSA  0.08
Adjuvant therapy began June 26, 2007 with Zoladex injection
Radiation began August 23, 2007, ended October 8
First post radiation PSA, December 18, 2007:  0;  March 2008 - still 0;  July 2008 - 0; Sept. 2008 - 0;  Dec 2008 - 0;  March 2009 - 0;  Final Zoladex injection!
 
 


davazoll
New Member


Date Joined Apr 2009
Total Posts : 3
   Posted 4/23/2009 10:32 AM (GMT -6)   
My opinion is "find out". I would want a biopsy. I had a negative DRE and was told I'm not a good candidate for PCa. Even after my biopsy came back with positive cores my Doc was super surprised (I was too) but at least I knew.
 
We all have to do what is right for ourselves and for me it was the biopsy and then the surgery as quick as possible. Others will disagree. The biopsy was a surprise in performance and how little it hurt. I was expecting something so much more barbaric...
 
Good luck with your decisions 
Age 52 at Diagnosis (now 53)
PSA 2005 1.8
PSA 2008 4.25
Biopsy 1/09
4 of 12 cores positive 30-40% involved
Gleason 3+4=7
DaVinci: 2/24/09, performed by Dr Doug Southerland, Tacoma WA
nerve sparing was possible
cath removed: 3/3/09
path report: clear margins, negative lymph
currently 2 pad a day man

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