prostate cancer prevention

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medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1096
   Posted 11/22/2009 11:16 AM (GMT -6)   
I am new here.  Great forum.  My family history and psa history are in my signature.  I did free psa test only in the most recent test, and it was 27%, but given my total psa score, I am not sure free psa is relevant.  I am concerned about p ca, given my family history and high psa scores relative to my age, and would like to take prudent actions to try to prevent it.  My diet is good (very little meat, very little dairy, lots of fruit and veg, etc.).  I am considering taking finasteride or dutasteride for prevention purposes (not for BPH -- though I do have some mild urinary symptons, my estimated prostate volume is 25-30 grams).  I was encouraged by the reported results of the REDUCE study.  I consulted two urologists about finasteride/dutasteride for chemoprevention.  The first was on the fence but said on balance probably a good idea and gave me prescription.  The second -- one of the leading urologists in the country -- recommended against it (and said he does not take it himself, despite his own family history of lethal p ca).  I have read other well-regarded urologists also recommend against it, including Dr. Catalona in Chicago.  I am not sure if this is due to remaining concerns about the high-grade cancer that appeared in the PCPT study.  I doubt that, though, since high grade cancer apparently did not appear in the REDUCE study results, and it seems current thinking is that finasteride/dutasteride do not cause high grade cancer but instead, by shrinking the prostate, make it easier to detect.  Maybe the reluctance is because of the unknown impact of taking these drugs for many years.   In any event, I am really uncertain whether to start this or not.  By the way, I also asked the second urologist whether I should have a biopsy, given my higher-than-usual-for-my-age psa scores.  He did not recommend that, unless I need it for peace of mind.  He said psa velocity is, in his view, more important than absolute scores, and while my psa is high for my age, the trend is not bad.   (I turned down the "peace of mind" biopsy -- it does not sound like a lot of fun, and while I would readily do it if there were a reason or a credible doctor recommended it, I don't want to do it for recreational or "psychiatric" reasons).  Any thoughts appreciated. 

Age 45.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5
 


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/22/2009 11:38 AM (GMT -6)   
HUHHH!! But welcome to the site anyway.

There are going to be a bunch of guys along shortly that would trade your PSA result for theirs in a NY second.

For 5 years you have tracked your PSA, which is absolutely a great idea given your family history. Establishing a base line is important in being able to track velocity. Most would agree that velocity is a much more useful piece of information in tracking what's going on.

But in 5 years your PSA has changed .1 of a point from age 40 to 45. I see that at 43 and 44 you had a little spike of .2.

Given your young age, if I had to guess, those two years tests closely followed some sexual activity or any number of the other things that can cause a temporary spike in PSA results.

I would really try to relax a little on this. Be vigilant, test annually, but enjoy your life without the added stress of waiting for the proverbial shoe to drop.

There are a lot of guys on this very supportive and knowledgeable site that have more experience than me and they will be along soon.

I can only speak from own experience with PCA. At 59 my psa was 3.0, at 60 it was 6.4. Biopsy confirmed PCa. Surgery 3 months later. 3 psa tests over 60+ days showed .4, .53 and .6. Now that is considered velocity. IMRT scheduled for one week from now at just a little over 2 months from surgery.

You my friend appear to have a long and healthy life ahead of you. Enjoy it to it's fullest. My personal mantra of 20+ years, "Every Day is A Bonus", was never more true than now. But it is one that I have been living for a long time.

Be well and be happy,

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative
da Vinci 9/17/09
Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
NERVES SPARED-positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT scheduled to begin Nov 30,2009 (74 days post surgery)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/22/2009 11:47 AM (GMT -6)   
Welcome,

From reading your post and looking at your numbers, and factoring in that your father died of PC (how long did he have it, what was his treatment, what age did he die? woud help to know if you want to share), I would continue to have a PSA test done yearly until there is at least sufficienct evidence with your PSA increasing and velocity to justify a biopsy.

Please keep us posted.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place


T40
Regular Member


Date Joined Oct 2009
Total Posts : 103
   Posted 11/22/2009 11:53 AM (GMT -6)   
There is no such thing as a peace of mind biopsy.
Age 40
Pre-op PSA was 5.8 from wellness test on May 19, 09
Follow up test from uro was 4.6 with a 9.3% free psa
Gleason 3+3 in one core, 3+4 in second core of 12 samples taken
Uro recommended Robotic for someone of my age. My research confirms.
Surgery performed August 19th, 09.
One side nerves spared. Nerve graft on other side.
Six weeks incontinence almost over. ED a work in progress but seeing some response.
Post op October 2nd, 2009 All margins were negative. PSA results in a few days.


Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 11/22/2009 12:00 PM (GMT -6)   
I can only comment from my own personal experience. I used finasteride for many years to treat BPH. It wasn't effective for the BPH and did not prevent my PCa. But, I'm only one data point.

Carlos
Diagnosed 2/2008 at age 71, PSA 9.1, Gleason 8 (5+3)and stage T1c.  CT and bone scan neg.
Robotic surgery 5/2008, nerves spared, bladder neck spared with pelvic floor reconstruction.
All margins, SV and lymph nodes were neg. 
Staged pT2c, Gleason sum 8 (5+3).
Continent at 6 weeks. 
PSA <0.1 at 18 months, Nov. 2009.


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7213
   Posted 11/22/2009 1:25 PM (GMT -6)   
Your PSA numbers are excellent, really! Forget about it 9but keep getting PSA tests)

Mel
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro!
 
History of BPH/prostatitis.
 
Awaiting results of my PCA-3 test which will determine whether a biopsy is in my immediate future. Just in: BAD NEWS: PCA-3 = 75.9! Cut-off is 35. Biopsy scheduled for 11/30


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1096
   Posted 11/22/2009 1:48 PM (GMT -6)   
Purgatory - My father was diagnosed at age 62 or 63, but it was his first psa test ever, so it is impossible to know when he "got prostate cancer." His psa at diagnosis was around 14 and Gleason score was 3+4, though my guess is that if it had been re-read by an expert pathologist (or evaluated post-RP) it would have likely been upgraded. Estimated prostate size at diagnosis was 55 grams. Staged T2B. He had 3D conformal radiation (75 gys) with one shot of Lupron, as initial treatment. Post radiation psa nadir was .4, but rose thereafter. 4 years after diagnosis, when psa had increased to 6.5, he began 4-month Lurpon shots, then Casodex and Lupron (never tried ADT3) for a period of time, then he did a salvage cryo procedure (which I suspect was not a useful exercise by the time he did it, and also led to post-procedure pulmonary emboli), then LDK, then HDK/prednisone, then Taxotere, then some other chemos. He died at age 70. (I think he made some mistakes in his treatment, one of which was to stick with a urologist for way too long after recurrence, when he should have been treated by a medical oncologist, and preferably one with expertise in prostate cancer).

T40 -- you say "there is no such thing as a peace of mind biopsy." I assume your point is that even a negative biopsy may have missed cancer, so you never really have peace of mind? Or did I misunderstand your point?

Thanks to all.
Age 45.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/22/2009 2:35 PM (GMT -6)   
Hi medved,
Welcome to HealingWell. I like your proactive approach. Clearly, you have walked the walk with your father, and I am sorry to hear about the results. You started monitoring your PSA at 40, a very smart move, and you show a great understanding of the disease and the treatment protocols. If your center does it, I would add the PCA-3 test and the PAP tests. I would stay away from premature biopsy, but the Finasteride ride looks acceptable given the study results which show reduction in positive tests for high risk patients.

I hope you never test positive for prostate cancer. But you are doing right by staying on top of it...

Tony
Prostate Cancer Forum Co-Moderator


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 11/22/2009 3:19 PM (GMT -6)   
I would assume you are also having DRE's along with the PSA's. I think between the two, you should be able to detect PC early enough for adequate treatment.

Good luck !
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 11/22/2009 3:23 PM (GMT -6)   

Medved,

The following article will help you in monitorng your psa. Also Yana web site has a psa doublng time calculator that's useful in helpng track your psa doubling time/

http://www.prostate-cancer.org/pcricms/node/119

JohnT


64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT

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