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ASR
New Member


Date Joined Apr 2010
Total Posts : 9
   Posted 4/8/2010 11:10 PM (GMT -6)   
Am a healthy male of 39 years who is currently visiting Australia. At the end of last January I saw a GP for lower back ache and reducing libido after the strenuous 15 day Brisbane trip. The GP ordered some blood & urine test along with PSA ( as I informed him that my father was diagnosed with PCa at the age of 52 & died at 59).

The PSA reading raised my eyebrows- it was 5.51! He advised me to see a urologist. Accordingly I met a urologist here who ordered for repeat PSA along with free psa test besides a DRE. The DRE result was normal and the second PSA test was performed in February 10th. The PSA result was 3.75 & the free Psa %age was 10. I was offered "Norixin (400 mg)" for 15 days. Meantime,, I saw another urologist who performed the DRE again- the result was normal. After going through my medical history ( that I had Typhoid last year & I am bit resistant to Ciprofloxacine) he advised me to drop Norixin & prescribed "Vibramycin" in lieu of. However, After the short course (15days) I re-took PSA & Free PSA test (March 10) & the result was 3.11 & 14%. At this point he opined for a prostate biopsy.

In these months I noticed that (a) I am getting my libido back (especially the nocturnal erections which I did not experience since last September), (b) urine urgency ( I get to urinate in almost every 02 hours but I don't have to get up at night).

Under the circumstance, I seek your benign advice on the following issues,

(1) Do you think my case could be prostatitis?

(1.b)Shall I take another round of antibiotics (May be Norixin or Cipro) before I take PSA test again? And, shall I take the free %age psa into cognizence (my PSA reading doesn't fall in to 4-10 range)

(2) Shall I opt for biopsy?

I am passing my days here with great anxiety. Your help would be greatly appreciated. Thanks in advance.


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4119
   Posted 4/8/2010 11:20 PM (GMT -6)   
You are very young. I can not give you medical advise. You should listen to you Uro. When I met with my Uro and he said "With you family history we probably want to do a biopsy" I agreed.

A bioply is the only way to know if there is cancer in that gland. Not telling you to get a biopsy. Just know the purpose.

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1 pre cancer core
10/08 Nerve-Sparing open radical
Surgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clear

3 month: PSA <0.1
6 month: PSA <0.1
10 month:PSA <0.1
1 year: PSA <0.1
16 month:PSA <0.1

ED - Started Cialis at 3 months, tried all 3, 6 months added pump, 9 months Tried MUSE (YUCK) Bad experience.
1 year mark Found new Urologist visit was at 14th month post surgery
Started Injections, Caverject! (Success)
17 month: ED making improvements : Oral Meds gets me 85%


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/8/2010 11:20 PM (GMT -6)   
ASR, welcome to HW Prostate Cancer. Glad you found us. Did your father die of PC at age 59, or some other reason?

At 39, you would be way on the young side for PC, but certainly not impossible, particularly since your father had it.

With what you wrote, I would go for the biopsy. Not the most pleasant thing in the world, but not all that terrible either, a clean biopsy at this point would help give you better peace of mind at this point. And if there were something going on, God forbid, as in PC, then the earlier you know about it, the more options you would have at your disposal.

Wish you the best, and hope we can deny you membership in this club, not one anybody would choose. Please keep us well posted, and again, welcome friend.

David in South Carolina, USA
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04
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 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 4/8/2010 11:22 PM (GMT -6)   

i WOULD suggest the PCA-3 test.

 

Mel


63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3 was about 75 (way above the 35 threshold). That led to:

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent! Uh...OH. As of about 3/16/10 problems with constant urgency although no pads needed--feels like an infection but none showing in urine.

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in mid-June.


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 4/9/2010 7:35 AM (GMT -6)   
ASR, sorry to hear of your concerns and especially of your dad's death at such a young age!

I too would vote for a biopsy though I can tell you from my husband's experience that they are not always accurate (e.g., they don't always find the cancer or they find only a smattering of it when, in fact, there's more extensive disease).

Your free PSA is a bit low ... if I remember correctly, they wanted my husband's above 25 (this may be age dependent but I don't think it is) and his was 11 (this was at age 58).

Good luck - you are quite young to be faced with this worry.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2243
   Posted 4/9/2010 8:25 AM (GMT -6)   
ASR,
I would personally go for the biopsy, knowing what I know now. It is slighlty uncomfortable but I recovered quickly and was jogging 24 hours later. It might help ease the anxiety more than any other option, especially given your fathers early death. But you are the one that has to make the choice and we will support you beyond just giving our own opinion. Keep us posted.
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed, 61 yo 2010
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
2 pads per day, 1 depends but getting better,
 started ED tx 7/17, slow go
Post op dx of neuropathy
T2C left lateral and left posterior margins involved
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Starting IMRT on 1/18/10, Completed 39 tx at 72 gys on 3/12/10
Great family and friends
Michael


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 4/9/2010 9:28 AM (GMT -6)   

Just to elaborate on the PCA-3 test: it is very easy. They do a DRE and then you pee into the cup. It is very specific for PC. It would seem you would be a good candidate for this test. I was hoping to save myself an unneeded biopsy. Unfortunately...see my signature!

Mel


63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3 was about 75 (way above the 35 threshold). That led to:

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent! Uh...OH. As of about 3/16/10 problems with constant urgency although no pads needed--feels like an infection but none showing in urine.

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in mid-June.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 4/9/2010 11:04 AM (GMT -6)   
With your family history and your low free psa and high psa for your age I would get a biopsy and also get a PCA3 test so it can be used as a baseline to monitor future rises.
JT

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


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 4/9/2010 12:32 PM (GMT -6)   
I agree with what each person above posted.
I'm expecting my brother to call with his biopsy results today. We are 2 out of 3 so far. My brother age 47 and myself have already had robotic surgery. My other brother PSA numbers are very suspect and had his biopsy last Friday. My father also died as a result of prostate cancer...unfortunately I have 2 sons that I'm sure are going to be involved in the same decision making that you are faced with at this time.
Good Luck
Hero
Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. involving up to 75%
da Vinci at Wash U, Barnes on 11/02/09
Modified Pathology, Gleason 4 + 3 = 7. Gleason 7 present throughout Prostate.  Negative surgical margins
4 of 4 periprostatic Lymph Nodes Negative, 10 of 10 pelvic Lymph Nodes Negative. Seminal Vesicles tumor free. No prostate extension
Post-op PSA 12/10/2009, Undetectable
12/12/2009, Pad Free and Started jogging.


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2460
   Posted 4/9/2010 2:12 PM (GMT -6)   
ASR,
Your free PSA is low and your PSA is high for a 39 year old. Also the fact that your father dies of PCa warrants a biopsy. The biopsy is not a big deal (at least to most people).
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11.5 months test 1/21/10 result 0.004


T40
Regular Member


Date Joined Oct 2009
Total Posts : 103
   Posted 4/9/2010 5:18 PM (GMT -6)   
When I found out my Free % was 9.3 my doctor advised a biopsy. Anything under 15% is an indicator, according to him, of prostate cancer. Anything 25% or higher is indicative of possible prostatitis. Not trying to be a downer. Just telling you how it is. I'm 41 and was 40 when I found out.

T
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
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.
4 months no longer using pads. ED using trimix with positive response.
Post op October 2nd, 2009 All margins were negative. PSA results in a few days.
Post op pathology 3+4 PT2A NOMO
6 wk PSA .004
3 month PSA .003 12-18-09
6 month PSA .003 3-17-10


ASR
New Member


Date Joined Apr 2010
Total Posts : 9
   Posted 4/10/2010 5:14 AM (GMT -6)   
Wow!
T40, Ed C, Herophilus, John T, Compiler, 60Michael, sephie, Purgatory, Corvetteman3- thank you all so much. You all made me feel a lot better and more at ease.
I really, really appreciate all the quick responses. I can't tell you all how much it all means to me. I've been so nervous and tense-only the negative thoughts
going through my head as long as am staying awake.
This "C" word to too scary to breathe free even for a while- may be it doesn't pose that much threat which is engulfing me, but I guess this fear is somewhat embedded in my mind. Truth to be told, I am kind of a guy who shivers at the mild temperature at any medical chamber. However, that's not the prime point for me to defer my biopsy till this end. It is the fear that what I gonna do if it comes positive with low gleason score & low stage? At that point, am scared of being overtreated (because of the collatoral damage in terms of morbidity), on the otherhand "watchful waiting" is also a strenous game to play!
Yes, I'd take PCA3 test prior to biopsy (in case that's not well below 35) on my next blood draw for PSA, & Free PSA tests.
I will keep you all posted as to my diagnosis as I value your ideas & advice.
Thanks once again.
ASR

Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 4/10/2010 6:52 AM (GMT -6)   
The treatment decision is very different from diagnosis. Knowing that you have a low grade disease is better than risking that you are in an early stage of high grade one. Find out and then make the treatment (or lack thereof) decision. Information is power. Go for biopsy.
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10


ASR
New Member


Date Joined Apr 2010
Total Posts : 9
   Posted 4/10/2010 8:42 AM (GMT -6)   
Thanks Geebra for your thoughtful comments......
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