Gardnerella? Elevated PSA Prostate Biopsy done

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Robyn1973
Regular Member


Date Joined Nov 2005
Total Posts : 30
   Posted 10/31/2010 2:09 PM (GMT -6)   
I am writing about my husband who is 47. He had an elevated PSA at 4.67. We are monogamous and I have had several infections of Gardnerella the past couple of years. His DRE was only slightly assymetrical. He has no family history of prostate cancer. Mother, grandmother with breast cancer. He had a biopsy that came back two of twelve with Gleason score of 3+3 on each(bilateral). I am wondering if he should have a second opinion of his biopsy results. Could he have asymptomatic Gardnerella that is causing abnormality of his prostate and recurrence of infection in me?

At this time we have chosen active surveillance. He does not want to have surgery due to risks and side effects and we feel he is too young to undergo radiation which eliminates surgery as an option in the future and runs near the same amount of risk and side effects.

Anyone with thoughts? Experience with gardnerella, or prostatitis. I don't know if a low grade prostatitis could have been missed on exam of the biopsy?

Thanks

Post Edited (Robyn1973) : 11/10/2010 9:25:20 PM (GMT-7)


clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2679
   Posted 10/31/2010 2:30 PM (GMT -6)   
First and foremost, I'm sorry to hear about the diagnosis, and welcome to the forum.  Here's my non-medical opinion.  I can see where an infection might cause a PSA reading to fluctuate (maybe).  But I can't see how it can change a normal prostate cell into one showing adenocarcinoma under magnification.  I can't imagine how a pathologist could be fooled into giving a cancer diagnosis.  But, I'm neither a doctor nor a pathologist.

Post Edited (clocknut) : 10/31/2010 1:33:54 PM (GMT-6)


Jazzman1
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Date Joined Sep 2010
Total Posts : 1162
   Posted 10/31/2010 3:06 PM (GMT -6)   
Hi Robyn,

I too am sorry to hear about the diagnosis, but welcome to the forum.

I agree that it would be difficult for a pathologist to see cancer where there is none, particularly when two cores are positive. While I too am not a doctor or pathologist, I would think that no competent pathologist would mistake cancer for prostatitis. That mistake is sometimes made by urologists prior to biopsy, but a positive biopsy is generally considered pretty definitive. That said, you can get a second opinion on the pathology, and people do sometimes get second opinions, but it's generally to re-confirm grade and not positivity.

You mention that two of your husband's core samples were positive, but you don't mention the extent of the sample that was positive. If it was more than 50 percent in one or both cores, you may wish to reconsider active surveillance. My numbers are similar to your husbands, and that's what drove me to seek treatment for my PCa. The commonly accepted criteria for active surveillance are:

* having a stage T1a tumor
* having a Gleason score of 6 or below
* having a PSA level below 10 ng/mL
* having fewer than 3 positive biopsy cores (with <50% cancer in each)
* having a PSA density below 0.15 ng/mL per gram.

Best of luck to you and your husband. I've found this forum to be an excellent source of support and information, and I hope you'll spend some time here. Also, Dr Patrick Walsh's Guide to Surviving Prostate Cancer is highly recommended. Information is power.

Jonathan
Age 55

PSA:
8/09 2.69
7/10 4.00
8/10 4.11

Biopsy 8/10
Three of 14 cores positive: 10%, 60% & 80%
Stage T1C
Gleason 6

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 10/31/2010 4:05 PM (GMT -6)   
I would agree that your husband has PC. The second opinion on the biopsy slides is good just to confirm the Gleason score. Generally, a Gleason 6 with low volume is a good candiate for AS, but be sure that it is a Gleason 6.

He should be doing AS with a doctor who is experienced in AS monitoring, including 3 month PSA's and annual biopsies. Wth his age, certainly it is a good thing to waiti until it is determined to be medically necessary for treatment.

On the other hand, if it becomes too stressful to have the PC going on, Brachytherapy is a great option for low grade PC that should allow for a high quality of life of many years.

Good luck, and welcome to HW. There are no dumb questions here.
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
15 month PSA <.01

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 10/31/2010 6:26 PM (GMT -6)   
Yes, have the slides analyzed by a second, expert lab..This is especially important with Gleason 6 ..Also don't rely on one 12 core biopsy that came back Gleason 6 to feel comfortable about "Active Surveillance" Many biopsies miss a small spot of high-grade PC that makes relying on one biopsy risky..Further tests to verify the results of your biopsy are needed before "AS" becomes a safe strategy..

As for the Gardnerella, that's a secondary issue to the PC...A simple culture of your husbands semen might provide useful information about any possible infection..

Obtain a copy of Dr. Walsh's book "Guide to surviving prostate cancer" Any library, Amazon, eBay, anywhere..Read and learn what you are dealing with....You want the second, 2007 edition..
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
age 61: 5.2
age 64: 7.5, DRE "Abnormal"
age 65: 8.5, " normal", biopsy, 12 core, negative...
age 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
age 67 4.5 DRE "normal"
age 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2679
   Posted 10/31/2010 8:22 PM (GMT -6)   
Robyn, I've been thinking about your situation all day and finally hit the "search" button  for "Active Surveillance" and re-read a thread started by "Optimist" back on September 16th.  It was quite a thorough discussion with a variety of perspectives on Active Surveillance.  I thought you might find it an interesting read.  As I recall, Optimist, after about 18 months of AS, will now be having surgery on November 3rd.  I learned quite a bit about the subject from that two-page discussion.  My takeaway from all that is that "active" is the keyword in the term.  The cancer has to be monitored carefully because a "3" can become a "4" without warning.  Also, 12-core biopsies that only turn up grade 3 cancer sites can miss localized spots of grade 4 cancer. 
 
AS was never an option for me and wouldn't have been something that fit my way of thinking, but we each have to make our own decisions.  Good luck to you.  Read everything you can get your hands on and keep a watchful eye. 
 
 
Age 65
Dx in June 2010.
PSA gradually rising for 3 years to 6.2
Biopsy confirmed cancer in 6 of 12 cores, all on left side
Gleason 7 (3 + 4)
Bone scan, CT scan, rib x-rays all negative.
DaVinci surgery late August at Advocate Condell, Libertyville IL
Negative margins; negative seminal vesicles
Smooth recovery; 18 holes of golf at 4 weeks.
Continence OK after 7 weeks. ED continues

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 10/31/2010 10:13 PM (GMT -6)   
Robyn1973 said...
At this time we have chosen active surveillance....
clocknut is right about being "active."
 
There was a recent discussion with some guidance which is particularly relevant for men on AS or men concerned about rising or potentially rising PSA after primary treatment; unfortunately some goofiness led to that thread being shut down and can't be added to, but here is some of the noteworthy dialogue about some of the things you can "actively" do to help "stack the odds in your favor":   diet, stress reduction, exercise...see below
 
 
 
===========================================================================
----------------------------------------------------------------------------------------------------------------------------------------
BobCape said...
Dr Samadi, who I understand to be a most respected doctor, should be addressing his conclusions about diet to young children, or their parents (us) - becaus as "patients".... his theory comes a little too late.
 
I'd like to see a single-factor experiment run to see if it is too late, or not...
 
 
 
If I were to design the experiment, I would structure it this way:
 

·         Start with a group of men with biopsy-verified PC who would agree to forego conventional treatments for at least one year.

·         Check each participant’s PSA…the “before” number.

 

·         Split the group randomly into two groups.  Ask one group to make significant diet/lifestyle changes, and ask the other group not to make any changes.

 

·         Check each participant’s PSA again after one year…the “after” number.  Compare to the "before" for trends.

 

------------------------------------------------------------------------------

 

 

 

JohnT said...
Casey,
The UCSF study on AS is doing just that. They haven't published official results yet, but preliminary results are that no one in the diet group has yet to have a progression and there was the normal rate of progresson in the control group...
 
John, you caught me.  Yes, the experiment has been done (and I knew that), in exactly the way I described above, and the result showed that it is not too late to affect change.
 
All of the men in the study already had prostate cancer.  The control group that was asked to not make changes in their diet & lifestyle saw their PSA predictably increase.  The PSA of the study group decreased.  Since these men already had prostate cancer, their goal was to control...it was not too late for their diet & lifestyle changes to be effectiveIs there anyone here at HealingWell who is trying to control their prostate cancer??
 
You ask, "What diet & lifestyle changes were the study group asked make?" 
  • Cut red meat & dairy, eat lots of fruits vegetables, whole grains.  Stress reduction through yoga-based stretching, meditation and relaxation exercises for an hour per day.  Exercise by walking 30 minutes at a moderate pace 6 days per week.
 
You ask, "Is it 'all or nothing'?"  
  • No, the study found that there was a direct correlation between the degree of lifestyle change and the inhibition of prostate tumor growth.  The more you do, the better; but it's not "all or nothing."
 
 
... the preponderance of evidence is rising to the top.
 
 

 


cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 10/31/2010 11:01 PM (GMT -6)   
confused  This is what I wonder...........how many men in their 50s and up have some indolent cancer cells in their prostate & if biopsied would they be diagnosed with PCa? I have wondered this since my husbands slightly elevated psa in the last 2 yrs. He was cleared of having PCa by Dr Lee this summer.I also read about the Gardnerella connection to elevated psa while reading relentlessly for a few weeks last spring. I really worry alot of men are being overdiagnosed because of elevated psa without looking at prostatitis,gardnerella and just going to biopsy......something just doesn't sit right with me about the rush to biopsy as a definitive answer,when actually it isn't all that definitive in the end.....I remember posting with my husbands psa and holy crap I got all these dire warnings that with the velocity etc he surely had PCa,even when cleared w/Dr Lee some still persisted that maybe he was wrong!!!! Just some thoughts............especially for some just starting out with ?'s about psa etc.......            Cooper

tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 495
   Posted 11/1/2010 2:36 PM (GMT -6)   
The comments about trial mentioned above, both the theoretical and the actual one, are misleading. For men on Active Surveillance, I am convinced that significant lifestyle changes, particularly in respect to diet, can affect PSA. It may often slow the rise or even cause it to decrease in absolute number. This DOES NOT mean that the tumor is growing less or that the cancer has diminished. It may have converted to a higher G tumor, it may grow while producing less antigen, psa may be responding to changes in testosterone or DHT. It may be an infection that resolves. There are other issues also.
We know that psa is not a cancer marker. It is affected by numerous other bio-chemical issues. It is also not linear. That is, a tumor twice the size may not produce twice the psa. It may produce nearly none.
That said, I am convinced about diet and healthy lifestyle (lower cholesterol) to reduce psa in men who have recurred, and even in men before primary treatment if it will allow them to follow an AS program suitable to their needs and in accord with their medical team.

Jazzman1
Veteran Member


Date Joined Sep 2010
Total Posts : 1162
   Posted 11/1/2010 3:32 PM (GMT -6)   
While I understand the concern about the appropriate time to biopsy, what we have here is a gentleman whose had his biopsy, and it showed that he has cancer. I'm not sure I agree with the notion that men are being overdiagnosed; a high PSA score isn't a diagnosis. A positive biopsy is a diagnosis, and a definitive one at that.

While reasonable people can disagree about whether there's a "rush to biopsy" going on, a positive biopsy is quite definitive. A negative one may not be, but I suggest that we not confuse newbies into thinking that positive biopsies are just opinions that are part of some mendacious rush to treatment. This stuff is confusing enough for the uninitiated.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 11/1/2010 3:39 PM (GMT -6)   
i agree fully with you jazz, a positive biopsy is evidence of PC, no way to down play that, or to confuse it with any other issue
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Robyn1973
Regular Member


Date Joined Nov 2005
Total Posts : 30
   Posted 11/1/2010 10:11 PM (GMT -6)   
Thanks for all the replies. The positive is a very tiny spot less than 1 mm spot in each. And yes, the keyword being ACTIVE surveillance. The physician is comfortable with AS and we have a follow up appointment and lab at 3 months (every 3 months) and re-biopsy in 9-12 months.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 11/2/2010 12:12 PM (GMT -6)   
Someone pointed this out...Cancer is like pregnancy..You can't be "just a little bit pregnant"..

Alegar
Regular Member


Date Joined Oct 2010
Total Posts : 91
   Posted 11/2/2010 1:16 PM (GMT -6)   
Hi, Robyn:

My regrets for your husband's recent finding.

I also had 2/12 cores come up positive at 3+3/Gleason. For me, I wanted to verify the pathologists findings so I had the samples analyzed two more times by two different pathologists. With the initial diagnosis verified, my doctor and I talked through A.S. as a possible option. The first thing he made me clear on is this: you HAVE time to make your decision (even 24 months in my case).

Eventually I chose surgery because I found that "worry" had become a quality of life issue.
54 year old 188 Lb. 6 ft.
Diagnosed July 1, '10 with PC,
PSA 3.88 Gleason 3+3=6, 2 out of 12 samples positive
DaVinci Oct 1 '10
Cath/JP Drain out Oct.16, '10

AIRBORNE ALL THE WAY!

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2679
   Posted 11/2/2010 2:17 PM (GMT -6)   
I'm 18 years older than Robyn's husband, and my situation is quite a bit different, but I really should have had my biopsy and surgery at least a year before I did.  My family internist had recommended I see a urologist a year prior.  I wish I had.  Sure, the post-surgery pathology  report  indicates it was organ contained, but by the time I did anything about it, the doc could feel the tumor on the left lobe.  If I never have a recurrence, I'll be a very lucky guy.
 
My family history has most folks living into their 80's, and I'd like to get there, too.
 
The biopsy showed all six cores of the left lobe containing cancer, and none of the cores on the right containing cancer.  The pathology AFTER surgery, however, found cancer in the right side as well.  My understanding of PCa is that it usually doesn't present itself as a well defined tumor, as certain other cancers are, but that threads of it can often extend throughout the organ, and that it's a lucky shot if the biopsy needle hits those threads.
 
So, while I can say my cancer was contained within the capsule, the final path report also mentioned extensive PIN. 
 
I visualized the cancer as a time bomb in my body, and I didn't know when the fuse was set for it to really explode.  Finding cancer while it's potentially most curable was a blessing which I was never in the least tempted to pass up.
 
Every situation is different, but I'll deal with my ED after-effects and hope for zeroes on future PSA's.  My beautiful R.N. wife absolutely agrees. 
 
Good luck, Robyn.  I hope this works out well for you and your husband.  I hope you'll continue to share your experiences here on the forum.
Age 65
Dx in June 2010.
PSA gradually rising for 3 years to 6.2
Biopsy confirmed cancer in 6 of 12 cores, all on left side
Gleason 7 (3 + 4)
Bone scan, CT scan, rib x-rays all negative.
DaVinci surgery late August at Advocate Condell, Libertyville IL
Negative margins; negative seminal vesicles
Smooth recovery; 18 holes of golf at 4 weeks.
Continence OK after 7 weeks. ED continues

tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 495
   Posted 11/2/2010 7:07 PM (GMT -6)   
clocknut:
You will make it

Robyn1973
Regular Member


Date Joined Nov 2005
Total Posts : 30
   Posted 11/4/2010 11:57 PM (GMT -6)   
Alegar: How are you feeling since your DaVinci?
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