PSA reading and biopsy history -- confusing?

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Hope4Happiness
Regular Member


Date Joined Apr 2010
Total Posts : 63
   Posted 4/24/2010 6:15 AM (GMT -6)   
There seems to be quite a wealth of information on this board. I was hoping some of you could share some knowledge in regard to my case.

I am a 44-year-old white male with no history of prostate cancer in my immediate family. I have no symptoms of any kind, and the five DREs I've had during the past two years have revealed nothing suspicious.

Here is my history --

PSA date and reading:
3/08 – 2.0
9/08 – 2.2
4/09 – 4.7
5/09 – 5.0
8/09 – 4.0
11/09 – 3.7
3/10 – 5.0

Biopsy date and results:
5/09 - negative
12/09 - negative, but area of PIN revealed
4/10 - negative

My urologist has suggested, at this point, that I don't have another PSA reading for another six months and consider Proscar or Avodart as medications.

I've decided to get opinions from a medical oncologist and another urologist within the next month after my records are sent to them, respectively.

Please do share comments or recommendations. The insight and courage displayed in some of the posts on this board are quite inspiring -- Thanks!
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Sephie
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Date Joined Jun 2008
Total Posts : 1804
   Posted 4/24/2010 6:42 AM (GMT -6)   
Hope, looks like your PSA is all over the place which leads me to think prostatitis rather than cancer. Generally, with prostate cancer, you see a steady rise over time ... yours is going up and down. Has your doctor discussed medication to see if its prostatitis or an infection?
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!


Tim-from-Maine
Regular Member


Date Joined Apr 2010
Total Posts : 83
   Posted 4/24/2010 8:04 AM (GMT -6)   
I've read that having sex within a day or so before the PSA test can cause PSA to rise temporairly. Also Prostatis (inflamation or infection) can cause it. PCa tends to keep on rising.
Dx age 62 - March 2009 - Gleason 7
Surgery - da-vinci RP on April 29, 2009 Gleason upgraded to 9
Started VEGAN diet June 2009
3 month PSA - <.04
6 month PSA <.04
9 month PSA .05
12 Month PSA  .16
 
 


Hope4Happiness
Regular Member


Date Joined Apr 2010
Total Posts : 63
   Posted 4/24/2010 8:29 AM (GMT -6)   
Thanks for the info!

medved
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Date Joined Nov 2009
Total Posts : 1100
   Posted 4/24/2010 9:09 AM (GMT -6)   
As you probably know, biopsies can miss cancer (the "needle in a haystack" problem).  That is less likely with a saturation biopsy.  You might ask your doc about a PCA3 test.  Also you should be measuring free psa as well as total psa. If your free psa percentage is low and/or your pca3 test suggests high probability of CaP, then further investigation would - in my layman's view - be appropriate (color doppler?  saturation biopsy?).
 
What is the doc's estimate of your prostate size?  (PSA density is potentially relevant).   Would you be taking dutasteride or finasteride for BPH or chemoprevention?    I have considered the latter and done extensive reading on it.  Sadly, there is no consensus on whether taking these medications for prevention purposes makes sense -- very highly regarded experts come down on both sides.  IF you do decide to take these meds, make sure your psa is monitored regularly afterward AND that your results are adjusted appropirately to account for your taking these meds (they reduce total psa).  
 
Best wishes,
Medved
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 4/24/2010 9:37 AM (GMT -6)   
Your psa is worrisom. There is a consistant rise over time and this indicates a probability of PC. Did you get a free PSA? You should also get a PCA3.
I went through the exact same situation for 10 years and had biopsies from 4 different doctors, a total of 12. The last biopsy in OCT-08 picked up 1 small core of G6 out of 24 samples. I guess I had over 150 samples over the 10 years. I went to a noted prostate oncologist for a 2nd opinion and he said that just by looking at my history he was certain that I had a significant cancer, not just the one core that was found, and sent me to Dr Bahn for a color doppler ultrasound. Dr Bahn found a large tumor G7 in the transition zone and explained that most urologists don't know how to sample the transition zone which contains 25% of all prostate cancers and that 12 more biopsies would have also missed it.
After 3 negative biopseis I would get a color doppler biopsy from Dr Duke Bahn, Fred lee or Doug Chin.
I only whished I had know about this 10 years earlier.
Your psa has doubled in 2 years and that is not a good sign. The standard protocol after 3 negative biopsies is to over sample the anterior and this is best done by an expert in Color dopler ultrasound even if you have to travel to get one. It will be well worth the piece of mind. I have found that urologists are good at picking up and Dxing normal run of the mill PC tumors, but are totally lacking when it comes to anything out of the normal.
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


Sharp18
Regular Member


Date Joined Mar 2010
Total Posts : 78
   Posted 4/24/2010 10:26 AM (GMT -6)   
I agree with John. I would seriously consider taking another biopsy...

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 4/24/2010 11:09 AM (GMT -6)   
First, welcome to the Forum. I can't add much to the replies you already have, so I'll just say I hope you hang around and continue to share your journey with us..
James C. Age 63
Gonna Make Myself A Better Man www.youtube.com/watch?v=a6cX61oNsRQ&feature=channel
4/07: PSA 7.6, Recheck after 4 weeks Cipro-6.7
7/07 Biopsy: 3 of 16 PCa, 5% invloved, left lobe, GS3+3=6
9/07: Nerve Sparing open RRP, 110gms, Path Report- Stg. pT2c, 10 gms., margins clear
32 Months: PSA's .04 each test since surgery, ED continues: Bimix- .3ml PRN, Trimix- .15ml PRN


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 4/24/2010 11:50 AM (GMT -6)   
My first biopsy showed high grade pins, no PC.

My second one, a year later showed Gleason 9 PC.

Like the rest , I am guessing where there is smoke, there is fire. I would agree that pursuing further testing would be advisable. I often think of John T's story when I hear of cases like yours.

Good luck, and keep us in the loop. NOt sure where you are located, but I would think a trip to a major cancer center would be in order. Mutilple opinions are really adviable, especially in cases like yours, where results are confusing .
Goodlife
 
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 injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01


Hope4Happiness
Regular Member


Date Joined Apr 2010
Total Posts : 63
   Posted 4/25/2010 9:32 AM (GMT -6)   
"Saturation biopsy" and "color doppler ultrasound" -- I've got to get on top of both of those. Thanks!

Hope4Happiness
Regular Member


Date Joined Apr 2010
Total Posts : 63
   Posted 5/7/2010 1:47 PM (GMT -6)   
I've gained some important information here, and I appreciate it.

I had an appointment with a medical oncologist yesterday, and he suggested starting with two courses of action:

1. A three-week perscription of Cipro (antibiotic).
2. A blood draw to determine total PSA and free PSA.

I reminded the oncologist that I just had a prostate biospy three weeks ago, but he still ordered the PSA blood test.

I'm due to see the oncologist again in three-weeks time.

My questions are:

Wouldn't a PSA reading be skewed if it is taken three weeks after a prostate biospy?

I thought I read (on this board, most likely) that one should wait about 12 weeks after a prostate biopsy to get an accurate reading?
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RayPat
Regular Member


Date Joined Apr 2010
Total Posts : 104
   Posted 5/7/2010 1:57 PM (GMT -6)   
A month after my biopsy I asked my urologist about getting PSA checked one more time and he said no use in that it would still be elevated from the biopsy.
Age 63
Frequent urination for 10 years but never saw a doctor.
01/26/10 talked to doctor who did blood work...PSA 9
Referred to urologist
Met urologist on 2/26/10....DRE normal new PSA test was 11. Taken after DRE.
Biopsy on 3/26/10. 14 samples...3 positive on right side...all 11% Gleason 3+3
Urologist said stage T-1c.
Advised treatment. Discussed surgery and set appointment with radiologist for 4/26/10
4/26/10 Met with radiologist. Confirmed urologist's opinion that it's gland confined but suspects real stage is T-2. Thinks IMRT or Brachytherapy would be good choice.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 5/7/2010 5:58 PM (GMT -6)   
Hope,
A medical Oncologist is worthless unless he is an expert in diagnosing prostate cancer. Those are not the steps I would have expected a prostate specialist to take.
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


Hope4Happiness
Regular Member


Date Joined Apr 2010
Total Posts : 63
   Posted 5/7/2010 7:21 PM (GMT -6)   

Thanks for the responses so far.

 

John T - The oncologist was surprised that my urologist never prescribed antibiotics originally when my PSA first rose. That was the reason for this step – to firmly rule out any infection affecting my PSA. In addition, he felt it important to test for my percentage of free PSA because that wasn’t previously done either.

 

After three biopsies (a total of 41 samples) in less a year with the most recent three weeks ago, he felt I should wait at least three to six months before considering another.

 

Is it because he did not suggest the color Doppler ultrasound that you feel these were the wrong steps? I’ll be seeing him again in three weeks and another urologist in two – I’ll definitely suggest it.

 

Do you think the PSA test three weeks after my last biopsy will be skewed because it is too soon after?


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 5/8/2010 11:10 PM (GMT -6)   
Yes, I think a psa test that soon will be highly inaccurate. I think he was prudent to give you antibiotics and another biopsy in 6 months is reasonable. My only problem was with the psa being taken so soon after a biopsy, as it will be elevated and not normal. I have found out the hard way that most doctors don't know how to diagnos an unusual case unless they are specialists in PC. It would have been better to have a psa test after you finish your antibiotics.
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


Hope4Happiness
Regular Member


Date Joined Apr 2010
Total Posts : 63
   Posted 5/28/2010 11:55 AM (GMT -6)   
Quick update:

*It's been six weeks since my last negative biopsy and two months since a PSA reading of 5.0.
*I just finished a three-week prescription of Cipro.
*I went for a PSA reading yesterday and the result was 3.6 (I’m still waiting for the free PSA percentage as this will take a few days).
*This PSA reading is a 1.4 drop from my last reading of 5.0.

I know a 3.6 PSA is still high, but does this significant drop indicate that the Cipro had an effect on some type of infection at play?
 
Any insight is always greatly appreciated.

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 5/28/2010 2:21 PM (GMT -6)   
Down is certainly better than up! But I would want to see the free psa percentage and the results of a PCA3 test too. If the free psa percentage were low and/or the PCA3 is high, then I would remain concerned.
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 5/28/2010 9:45 PM (GMT -6)   
GET A PCA-3 TEST.
 
That is not effected by infection, etc.and is an excellent tool to determine if another biopsy is warranted.
 
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.

Update: since late March all is well in that area. I would say 99.9% continent (a spurt here and there, maybe 5 spurts per week).

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


Gregz263
Regular Member


Date Joined May 2010
Total Posts : 140
   Posted 5/29/2010 5:28 AM (GMT -6)   
Hope
Sounds as if we are in the same boat. Please feel free to email me and we can stay in touch. Perhaps one of us can help the other find the right DX.
Greg
PSA 1/06 at age 40 = 1.0
PSA 4/09 at age 43 = 2.9
PSA 4/10 at age 44 = 4.6
 
FPSA 4/09 = 4.7 and 6%
Biopsy 5/11/10 12 out of 12 negative


Hope4Happiness
Regular Member


Date Joined Apr 2010
Total Posts : 63
   Posted 6/10/2010 9:04 AM (GMT -6)   

Further update:

I went for a PSA reading right after a three-week round of Cipro and it dropped to 3.6 (from 5.0) and my free PSA percentage was 19%.

The oncologist thinks this signals a chronic asymptomatic infection.

I recently consulted another urologist and he recommended an MRI and a PCA3 test in August.

Again, any comments would be surely appreciated. Thanks!

 

Gregz263 -- I still consider myself fairly new to this complex process of diagnosing prostate cancer, but I'd surely answer any questions about my experiences you might have. Good luck to you.


PSA date and reading starting at age 42:
3/08 – 2.0
9/08 – 2.2
4/09 – 4.7
5/09 – 5.0
8/09 – 4.0
11/09 – 3.7
3/10 – 5.0
5/10 - 3.6 (after three weeks of Cipro); Free PSA = 19%

Biopsy date and results:
5/09 - negative
12/09 - negative, but area of PIN revealed
4/10 - negative


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 6/10/2010 11:27 AM (GMT -6)   
Hope,
I would agree with your doctor. Also a color doppler is less expensive than an MRIS. If you do get an MRI make sure it is with a 3 Telsa and not a 1.5 Telsa as a 1.5 is just not powerful enough to see many PC tumors.
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

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