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Regular Member

Date Joined May 2010
Total Posts : 21
   Posted 8/11/2010 3:47 PM (GMT -6)   
Deliberating on whether to have surgery this month due to my job.  I may have to wait until January, so I thought I would monitor my PSA to see if it rises.
My initial PSA was 1.5 - 2008
                             3.0 - Jan- 2010
                             3.7 - May 2010
Does any one know if your PSA can fluctuate depending on different factors? such as sex, riding a bike etc.... I am just wondering if I am taking a big risk by waiting until January....... How do you know how quickly the cancer is spreading? Is there a way to tell?  Should I have another biopsy?  Would that help? 
Diagnosed with Prostate Cancer 4/10/2010
Age 58
Stage: T2B
Greason Score: 3+ 3 = 6
PSA: 3.0
Prostate volumne 19cc
Tumor present in 3 of 5 cores on both the right and left with 6 of 55  mm or 11% on the right  and 4 of 59 mm or 7% on the left
No angiolymphatic or perineural invasion.  No high grade prostatic intraepithelial neoplasia.

Veteran Member

Date Joined Nov 2009
Total Posts : 1100
   Posted 8/11/2010 3:59 PM (GMT -6)   
Only a doctor can tell you whether to have another biopsy. But my guess is the doctor will not recomend a second biopsy. Yes, PSA can vary depending on certain pre-blood-draw activities, such as ejaculation, maybe intense bike or horse riding, or manipulation of the prostate, such as from a DRE. There is also some normal variation day to day. PSA test results can also vary dependng on which assay is used for testing. This variance is more substantial than most people would think. So you should use the same lab, and the same assay, for each test.
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

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 8/11/2010 4:07 PM (GMT -6)   
Diagnosed in April of this year probably won't require a re-biopsy until April of next year...based on that most folks on Active Surveillance have annual biopsies.
We have been told that PCa is a slow growing cancer, so I doubt that waiting another 4 months would be a very big deal. But always ask your doctor, he is the one in the best position to make a definitive advise. Take mine with a grain of salt.
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 
                 18 month April 2010   .19

Regular Member

Date Joined Aug 2010
Total Posts : 54
   Posted 8/11/2010 4:40 PM (GMT -6)   
I monitored my PSA without really knowing why for about 18 years. It slowly rose from 0.9 to 2.98, then jumped to 4.6 in a year. That triggered the biopsy, which came back 3+3=6, T1c, which triggered treatment. The urologist was really impressed with my records, which made his job easy. So, based on my experience and some very recent literature, I'd recommend periodic PSA tests starting at age 50, biopsy on sudden rise, or PSA above 6, and Gleason score of over 6, T1c or T2a. PCa can be a very slow growing cancer -- they say that all men will die _with_ PCa, but most will not die _of_ it -- but OTOH, it can grow aggressively under some conditions. If I saw a rise from, say, 3.0 to 3.7 in 4 or 5 months, with Gleason grade 6, Stage T2b (Tumor involves more than half of a lobe, but not both lobes) in a small (19cc) prostate, I would be scheduling treatment now. I would at least want another PSA, and probably a biopsy, in 3 or 4 months. Note: I am not a doctor, nor do I pretend to be one on TV.

Tracked PSA over last 19 years
Diagnosed 9/2009 at sudden PSA rise to 4.6; Biopsy Gleason 6, Clinical T1c
Proton Beam Therapy March-April 2010
Now back to normal, everything works, no side effects.

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 8/11/2010 7:06 PM (GMT -6)   
Some docs will even say take casodex or flutamide drug to control or halt PCa while you are looking, analyzing and deciding. The only down side is it could make removal of gland a little more difficult(shrinkage and related), of course if you go other than surgery, no problems. The gleason score and volumes you have are typical of low rate of growth PCa, towards but not identical to the new definition of indolent PCa. (google indolent PCa John Hopkins- Brady Urology and read such). Best to your decisions.
Youth is wasted on the Young-(W.C. Fields)

Veteran Member

Date Joined Jul 2010
Total Posts : 3891
   Posted 8/11/2010 8:28 PM (GMT -6)   
You already know you have PC..Now you know it might be getting worse more quickly than is tolerable. You are only 58, not 75..With cancer, outcomes don't improve by waiting longer...You could do another PSA in 30 days just to be sure, then get your treatment started if it bumps up again...
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..

DS Can
Regular Member

Date Joined May 2009
Total Posts : 195
   Posted 8/11/2010 8:39 PM (GMT -6)   


My thought for my own case was to have treatment sooner than later.  My wife's preference was for me too have treatment even sooner than that.  After seeing the pathology results of the post-surgery biopsy I'm happy with the decision to have had the surgery even sooner.  The tumor was right up to the edge of the prostate capsule wall but not into it or through it.  My wife works in the cancer screening field and we are aware of the importance of having negative margins.  You can see from my signature that I had fairly low psa with some velocity. Original biopsy gleason was 3+3, changed to 3+4 final.

Take the time to make the best decision for your treatment.  Please don't panic, I don't mean to add any more stress to your situation either.  There are no easy answers.

Best wishes for successful treatment whenever it is,



PSA Jan'07:1.2,  Jan'08:1.9,  Jan'09:2.5
BIOPSY Feb'09  PCa DX, age 52
Right: 3+3=6, 3/6 cores 10% involved,PNI-Y
Left:  3+3=6, 1/7 cores <5% involved,PNI-N
LARP April 9,2009 nerve sparing. Final pathology:
GS 3+4=7, Margins uninvolved, 2 lymph nodes negative
Catheter 8 days, Last pad May 2,2009
latest PSA: April 8,2010 <0.1

Worried Guy
Veteran Member

Date Joined Jul 2009
Total Posts : 3741
   Posted 8/12/2010 5:00 AM (GMT -6)   
You will never be younger and the tumor will never be smaller than right now.
You already had a biopsy and it showed 3 out of 5 with tumor in both lobes.

Before you decide to wait, set an internal threshold for action and then follow through. For example "I will do something when my PSA hits x.x".

Good luck,
Married 34 years, DX Age 56. First routine PSA test on April 8, 09: 17.8. Start 2 weeks of Cipro to rule out protatitis. May '09 PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, 20%-70%, Gleason 3+4=7, 3+3=6. Bone and C/T scans neg.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7, Tumor size: 2.5 x 1.8 cm, location: both lobes and apex.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots next See Uro 1/22/10 Trimix #1. Try 0.08- 25%, 0.12-25%, 2/26/10 try 0.16 First Success! 90%. 8/9/10 Now at 0.24 still 90%
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day. Try controlling fluids.
12/11/09 5 months: 3 pads per day, 400-450ml/day
02/26/10 7 months: 3 pads but leak is now 320 ml (5 day avg.)
03/22/10 8 months: 3 pads per day, 280 ml/day (5 day avg.) PT says all muscles are tight and working properly. "There must be another issue."
5/22/10 10 months: 2 pads per day, 190 ml/day Scope on June 15 "Short sphincter"
7/15/2010 one year: 2 pads per day. 140 ml/day, dry in bed.
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04
1/14 6 months - 0.05 (Siemens Centaur)
4/14 9 months - 0.04 (Siemens Centaur) and <0.01 (Roche ECLIA).
7/12 1 year - 0.03 (Siemens Centaur, direct chemilum); <0.01 (Roche Cobas 601 ECLIA)
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