Template Biopsy -negative, diagnosed Prostaitis, but PSA still rising

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roger w
New Member


Date Joined Jun 2010
Total Posts : 4
   Posted 6/29/2010 6:54 AM (GMT -6)   
 
Hi,
 
New to this so hopefully someone can give me some feedback on my situation.
 
I am now 49 years old.
 
During a routing medical aged 38 my PSA was shown to be high about 4-5.
 
So back in 1999 i had a 4 core biopsy and nothing was found. I then monitored my PSA for about 5 years and it hovered 4-5.
 
Earlier this year was getting up often during night and had PSA tested. It came back at 9.5!On measurement my prostate was enlarged to 50cl.
 
I had a template biopsy February this year, and 40 cores were taken. The Urologist saw me and my wife subsequently and assured us it was not cancer but prostaitis. He said there were" no signs of pc or even pre malignant disease"He used descriptions such as fine tooth comb and all encompassing.He did caveat that diagnosis by saying I may not have PC today, but tomorrow...........
 
Obviously I was delighted with this diagnosis. He prescribed 6 week course of Ciproxin and 2 weeks of Voltarol and told me to come back in 5 months.
 
During this period, my nocturnal visit to pee varied from 5 to once  a night. There seemed to be no direct link to the visits being less often during the antibiotic course.
 
Yesterday 5 months later I returned with my new PSA test and it was 10.25!
 
He was surprised my PSA had not gone to 6-8 with the antibiotics and is now advising another template biopsy!
 
I was actually quite shocked and upset at this situation, as he was so very confident it was not PC when I met with him after biopsy, and gave us such reassurance. I remember leaving the hospital and saying to my wife "I could not have hoped for a better result!"
 
Are there any other tests i should consider,should i get a 2nd opinion, should i leave it a while longer or should i just go for another biopsy.
 
Thanks to anyone who can give me some advice or guidance
 
All the best to all.

ejn
Regular Member


Date Joined Jun 2010
Total Posts : 87
   Posted 6/29/2010 8:46 AM (GMT -6)   
I had a biopsy 3 years ago nothing was found.  I remember saying the exact thing to my wife as we were leaving but there was one thing my Uro said that stuck with me for 3 years."just because I did not find it doesne mean it is not there".  So I went for another biopsy after the 3rd year in which he put me out and took 36 samples.  He hit pay dirt and found what he was looking for.  Of course I did not have to go back for the 2nd biopsy but I could not stand the unknown or having any doubt.  I guess I looked at it like this...another biopsy cant hurt me so I did it.  Now that I know I have PC I can deal with it easier in the early stages rather than wait until it is more aggressive.  Of course this is my personal experience and you will have to make your own decisions, but the not knowing drove me crazy.
 
Good Luck,
Ed

 

Age @ DX  53

Dx Date  April 2010

Gleason:  3+3=6
Biopsy: This was my 2nd Biopsy.  The Uro put me out and took 36 samples.  3 samples positive 1%, 2%, 2% no evidence of perineural invasion.
Stage:  T1c
CT Scan: Negative
DaVinci:  Coming up 8/11/10, Dr David Bryan, SSM DePaul-St Louis
 


Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 209
   Posted 6/29/2010 10:22 AM (GMT -6)   

Roger, I had two 10 core biopsies (2005 & 2008) but PSA kept going up from 3.0 to 6.4 so Mayo urologist in 2009 did a 28 core saturation biopsy and found 5 cores (mostly in transition zone) with Pca, two of which were aggressive Gleason 8. He was actually surprised that I had Pca, particularly an aggressive type.  I had surgery and PSA started going up again so I had 38 sessions of IMRT.

In your case, 40 cores is a very large amount and if cancer was not found, I would certainly think you do not have Pca.  My doc also said that since I had a total of 48 cores in 4 years, I was reaching the limit on how many biopsies he felt were enough.

You have a tough decision to make.  The Old Sailor

  


Dx 07/09 Age 67  -  28 core saturation biopsy w/5 positive  (2 gleason 8, 2 gleason 7, 1 gleason 6)
RRP 8/13/09 Mayo Clinic Jacksonville
Path report upgraded gleason to 4+5=9
Negative margins/extraprostatic extension/seminal vessicles/ lymph nodes but perineural invasion present.
Two month post surgery PSA 0.022
Five month post surgery PSA  0.081
Seven month post surgery PSA 0.190
Eight month post surgery PSA 0.217
Started 38 sessions IMRT at Mayo Jacksonville on 4/12/10,  completed 6/4/10.  Few side effects except urinary urgency and  frequency during the day and some rectal discomfort near the end of therapy. 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 6/29/2010 10:37 AM (GMT -6)   
Prostatitis is very difficult to control at times; It may take years to get it under control. Was infection found on your biopsy? This does not preclude the posssibility of PC. Since you already had a saturation biopsy my next step would be a color doppler ultrasound by a skilled doctor even if it involved travel to get one. Another option would be an MRIS with a 3 Telsa, but is more expensive and can't see the transition zone as well as the doppler
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


roger w
New Member


Date Joined Jun 2010
Total Posts : 4
   Posted 6/29/2010 11:01 AM (GMT -6)   
 
 
Thanks for your replies to date.It really is helpful to have some sounding boards from people who have been through this.
 
John T
 
The actual wording he used after carrying out template biopsy were:
 
"There are no signs of any prostate cancer or even pre malignant disease.The was however some bilateral patchy prostaitis that is perhaps  the cause of the elevated PSA"
 
The problem is my urologist fully hoped the anitbiotics would take the PSA down but in fact it has gone up .75 in 5 months and that concerns him
 
Best

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 6/29/2010 11:58 AM (GMT -6)   
There are 2-3 types of prostatitis and some don't get cured via drugs like Cipro and such, but your own body might heal them over some time period. John T gave good example of considering the color doppler ultrasound method, it is not a big deal to go through Dr. Fred Lee or Dr. Bahn could do such and maybe some others. It is possible to have prostatitis, BPH, and PCa combined at the same time or any combo thereof, likeliness is another question.

Urology info on prostatitis found at:
www.marinurology.com
www.wfmurology.com


Youth is wasted on the Young-(W.C. Fields)

Post Edited (zufus) : 6/29/2010 11:01:09 AM (GMT-6)


roger w
New Member


Date Joined Jun 2010
Total Posts : 4
   Posted 8/10/2010 10:46 AM (GMT -6)   
I went for a second opinion here in London with Mark Emberton, and it was suggested I had a PCA3 test and MRI. They are also going to review my pathology from the saturation biopsy.
The PCA3 result came back today at 52-not good!
Still waiting for pathology and MRI.
The urologist was not keen on proceeding straight to another biopsy given the negative template saturation undertaken in February, but with this latest result he may now change his mind!
Anyway going back to see him on 9/23.
Best regards,

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 8/10/2010 11:07 AM (GMT -6)   
In the U.K. you supposedly are not allowed to get copies of your medical records??? You need to see what is written on the pathology report and question whom did it, perhaps seek the few experts Dr. Strum often mentions, one guy is in Germany and considered maybe the best in the world on PCa. Why do biopsies before having it reviewed. Maybe HG PIN is miss diagnosed in your pathology and it actually is PCa....alot is possible in the PCa world.

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 8/10/2010 12:03 PM (GMT -6)   
rOGER:
 
Yes, I was going to suggest a PCA-3 test. When I got mine back, I pretty much knew I had PC. Mine was worse than yours. See my signature below.
 
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). As of 6/22/10, I would say I am 100% continent, but I do have (controllable) significant urgency.

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

Second post-op PSA on 6/21/10--0.02--Not too bad!


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 8/10/2010 10:09 PM (GMT -6)   
I can only offer this..You said:

"Earlier this year was getting up often during night and had PSA tested. It came back at 9.5!On measurement my prostate was enlarged to 50cl."

If a 40 core found nothing, perhaps you should try a drug like Proscar or Avodart to shrink your prostate and lower the PSA number. Has your U-doc discussed BPH with you??...But be warned, this can lead to a false sense of security..See my history...
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third 12 core biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. I'm also looking at seeds combined with IGRT which seems to be having good results with high-risk patients..

roger w
New Member


Date Joined Jun 2010
Total Posts : 4
   Posted 8/11/2010 7:36 AM (GMT -6)   
Does anyone know about HIFU. High intensity focused ultrasound.
I don't think it has been approved by FDA, but is carried out privately in Europe.
It seems this may be a breakthrough for tumors caught early, and seems to be minimally invasive.
It does seem odd that the entire prostate is removed rather than the diseased portion. as in most other cancer treatment.
After all,ullitmately if HIFU not succesful the gland can be removed later anyway.
Just interested to hear any views on it, and why FDA not approved as yet?

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 8/11/2010 3:37 PM (GMT -6)   
Roger,
HIFU has been around for a while and has many ardent supporters. I have read many studies on HIFU and am not convinced that this is better than conventional treatments. A recent study pointed out that 22% of all HIFU had to have a 2nd procedure; this doesn't instill a lot of confidence. Most other studies show an effectiveness rate lower than conventional treatments. Side affects may be lower than those of surgery, but I haven't seen any side affect issues that have an advantage over conventional Brachytherapy. As doctors and equipment gets better over time it may provide results equal to or better than conventional therapies, but I think that is a few years away. Also there is a scarcity of long term data as to side affects and effectiveness.
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


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 8/11/2010 4:16 PM (GMT -6)   
Roger,
There is a very lively discussion going on right now on HealthBoards, Prostate Cancer, concerning the recent released studies on HIFU. There is a very good detailed analysis of the study by one member and it is very difficult to argue with his conclusions. The results are not nearly as good as conventional treatment especially in the low risk classes. Where surgical and radiation reoccurrances level off after 5 years the same does not seem to hold true for HIFU.
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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