Welcome new friend- sm864w

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James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4462
   Posted 1/8/2010 5:29 PM (GMT -6)   
In another, years old thread sm864w posted for the first time. ,I am taking the liberty of moving his post here, in his own thread, so it will be seen and responded to without pullling up ld threads again. Welcome to the Forum, hope you will get plenty of responses soon.

Hi I am new to this forum. 60 year old good health(?). I ran my first half marathon last november. about 4 years ago my psa jumped from 2 to 4.2 and had biopsy. six regions(?) no problem. psa has been aprox 4.1 - 4.2 last few years and yesterday's test came in at 7.1. No bike riding or sex the day before.

So my PCP wants me to go back to urologist for another biopsy. BTW my dad had protate cancer. any other "easy" tests that I should explore before I enjoy another biopsy? Really appreciate the feedback.


Elite Member

Date Joined Oct 2008
Total Posts : 25380
   Posted 1/8/2010 5:53 PM (GMT -6)   
hello and welcome to HW Prostate Cancer,

Unfortunately, the biopsy is really the only accurate way to know at this point. Some of us had more than one, I had three before diagnosis. Not a lot of fun, but needed.

Please keep us posted. Hope you don't need to become a member, but if you do, you will find yourself at home here.

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
Post SRT PSA: 1/10 .12
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place

Veteran Member

Date Joined Nov 2009
Total Posts : 1096
   Posted 1/8/2010 6:25 PM (GMT -6)   
Did you get a free psa level? You could ask about PCA-3, to give some indication of whether a biopsy is needed. But probably your uroglogist will recommend biopsy anyway.
Age 45.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 1/8/2010 6:26 PM (GMT -6)   
Welcome sm864w As David above said, biopsy is the only test that will identify cancer. Any other test would just add or take away the probabilities of having cancer. And if any of those tests suggest probablility of cancer, then off to the biopsy to confirm anyway. So unless your doctor says otherwise, I would imagine it will be just the biopsy.

Just remember though, the biopsy has been known to not detect cancer even though cancer is present because only a small sampling of cores from the prostate are tested. Cancer can be missed unless the core sampling rate is high. You can talk to your doctor about a saturated biopy which will sample 20 or more cores and give a better picture. However the DRE and ultrasound can detect larger tumors and may guide your doctor to sample those areas. And I have to add also that an elevated PSA doesn't necessarily mean cancer either.

Good luck and let us know the outcomes.
You are beating back cancer, so hold your head up with dignity
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08
                 12 month Oct 2009 .09 

Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 1/8/2010 7:04 PM (GMT -6)   
You should know that biopsy can be done under different levels of sedation. Talk to your doctor and if he doesn't seem sympathetic, talk to a different doctor.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day

Veteran Member

Date Joined Dec 2008
Total Posts : 673
   Posted 1/8/2010 10:44 PM (GMT -6)   

I believe a biopsy is really the only definitive way to diagnose cancer at this time (if I'm wrong, let me know). Good imaging will help the TRUS biopsy doc to target specific areas, as had been suggested already. A biopsy can miss smaller tumours. A saturation biopsy can improve the odds of detection.

I had more discomfort from the manipulation of the TRUS probe (to target certain areas) than I did from the needle biopsy itself. Sedatives are available and are pretty common practice for a biopsy. 

-Nov/Dec 07, March 08 and Dec 08: Severe perineum pain . Septra/Bactrim for 8 months for diagnosed prostatitis.
-PSA start of 2008: 5.3..... PSA June of 2008: 7.3
-14 DRE all benign or nothing felt
-TRUS Biopsy Nov 08: 5 of 8 cores positive GS 3+3 or 6. 30-65%. Perineural invasion.
-General Health: pretty good, 5' 10", 180 lbs, slim.
-Open RP surgery: May 09 both nerve bundles spared. Bilateral lymph node dissection performed. Discharged 48 hours after surgery.
-Post Surgery Pathology: pT3a N0 MX, extraprostatic extension (EPE), stage III prostate cancer, lymph nodes clear, seminal vesicles clear, Gleason upraded to 3+4 GS 7. EPE within surgical margins. Other than prostate and EPE, all tissue removed negative for cancer involvement.
-Bladder control within 48 hours of catheter removal
-ED ongoing but improving significantly with Trimix at 7 months post-op. Oral ED meds didn't do much.

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4237
   Posted 1/8/2010 11:27 PM (GMT -6)   
A 6 core biopsy is rarely done anymore. 12 cores are the recommended number of samples and on a 2nd biopsy I would go for 16. If the 2nd biopsy doesn't pick up anything and your psa keeps rising I would definately get a color doppler ultrasound.
Your family history and recent PSA rise would indicate that another biopsy is an appropriate course of action.

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.


Forum Moderator

Date Joined Sep 2008
Total Posts : 4183
   Posted 1/9/2010 12:07 PM (GMT -6)   
Dear sm:
Welcome to the site and sorry you have to be here.  Hopefully your next test will be clean and you can ride off into the sunset with some other prostate issue besides cancer.
In any case, I do think another biopsy is in order.  A six sample biopsy that was previously done is not really state of the art excellence any more.  Most first rate urologists will get a minimum of 12 samples and 16 is becoming more common...especially in a second biopsy.
As far as biopsy pain is concerned, we have had numerous threads on this forum on the subject and you may want to go back and look them over.  The bottom line is that some men felt the biopsy was no big deal and others felt the pain was excruciating.  My urologist did a 16 sample biopsy under IV sedation.  He does that for two reasons:  (1) he doesn't feel there is any reason to subject his patients to unnecessary pain and discomfort and (2) he likes to take his time without a patient squiming in pain during the procedure.  This makes sense to me and you might consider this as you go forward.
Good luck,
Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 12/09.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

Veteran Member

Date Joined Nov 2009
Total Posts : 1096
   Posted 1/9/2010 10:28 PM (GMT -6)   
When the docs use iv sedation for a biopsy, what sort of sedative is typical?  Versed plus a painkiller?  Something else?
Age 45.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5

Forum Moderator

Date Joined Sep 2008
Total Posts : 4183
   Posted 1/10/2010 9:39 AM (GMT -6)   

It depends on the anesthesiologist.  It's pretty much like colonoscopy sedation.  I understand the most common cocktail is most likely midazolam (Versed) and fentanyl (Sublimaze).


Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 12/09.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!
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