What would you do?

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eye4thelinks
New Member


Date Joined Feb 2011
Total Posts : 10
   Posted 2/20/2011 1:49 PM (GMT -6)   
I'm 63 and had a PSA test 8/08 = 2.9, 2/10 = 3.4 & 2/11 = 6.0.  My physician scheduled me to see a Urologist at which time he performed a DRE and took a urine sample. He wanted to schedule me for a biopsy but before I take this invasive action I requested another PSA test in 2 months to confirm the last elevated test.  Of course I'm thinking of all the reasons for the elevation to the last test (ran 5 miles day to blood test, may have had sex, don't remember) and just want some time to digest and research my options.  I will be requesting a Free PSA along with the regular.  Does anyone have any ideas on how I may want to proceed?  Thanks for your comments and suggestions.  Great site.

Mackattack
Regular Member


Date Joined Jan 2011
Total Posts : 78
   Posted 2/20/2011 2:07 PM (GMT -6)   
Personally, I would be getting the biopsy.  While the biopsy sounds gruesome, it is not nearly as invasive as you might think.  The 3.4 alone was almost enough to justify.  4.0 is not gospel.  There are plenty of people with PCa with PSAs lower than 4.0.
PSA 3.9 - October 2010 at annual physical
PSA 4.1 - November 2010 after a month of antibiotic, DRE Normal
Age 41 in December 2010 at Dx of 6 of 12 cores positive T1C and Gleason 3 + 3

Scheduled for open RP on 2/14/11 at Mass General

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/20/2011 2:13 PM (GMT -6)   
No reason not to have the biopsy at this point. It's not all that invasive, I had 3 of them, some men here, even more. If your PSA rise is not do to any kind of infection, I would be concerned enough to do the biopsy. Many of us were found with full blown PC without any symptons, and negative DRE's.

David in SC
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

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3986
   Posted 2/20/2011 2:14 PM (GMT -6)   
my first PSA was 6.8.  my doctor immediately ordered a second test.  i had no symptoms, prostate was not enlarged and DRE was normal.  the second test was 6.1.  my doctor said i had a 50/50 chance of cancer and ordered the biopsy which confirmed PC.
 
ed
age: 55
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2680
   Posted 2/20/2011 2:16 PM (GMT -6)   
How about a course of anitibiotics to rule out prostatitis?  The rather sudden rise in PSA might be due to an infection, and I would think they would want to rule that out first.  If you're looking for a reason for the rise in PSA, I would look first at infection, though without knowing your medical history, they may have other reasons for wanting to do the biopsy.

brampy
Regular Member


Date Joined Jan 2011
Total Posts : 42
   Posted 2/20/2011 2:30 PM (GMT -6)   
Everyone has to make their own fully informed decisions. I'm 54 and was in my regular cycle of training for an ultramarathon when my PSA came back 4.3. This was abnormal for me, so I consulted with my Uro and scheduled a biopsy. My main concern was that the biopsy would be thorough (be definitive and not miss anything). He took 12 samples. I was actually expecting everything to be negative...caused by the same things your thinking. Unfortunately, I got a slap in the face and 3 of the samples were positive and 2 aggressive gleason scores. I certainly didn't have any symptoms and was caught off guard. Since then, I've had robotic surgery and my post-surgery pathology indicated an even higher gleason and positive margins. I was really lucky to catch this when I did. I just got a good <0.1 PSA, but I am still going to do adjunct radiation starting Thursday just to make sure I stamp this cancer out. Incidently...I plan on running 4-6 miles today...lost my marathon edge for now...but plan to run that ultra that I missed next January.
You have to do what you think is best in your situation. I would stay on top of this. I was in denial thinking that this could not happen to me...I ate right, exercised, etc. Little did I know that I would have advanced prostate cancer. I'm not going to let this cancer get me. Don't let it get the upper-hand on you. regards, <bobr>
-------------------------------------
Age: 54
Routine Physical on 10-20-2010 DRE Normal
PSA 4.3, up from 0.6 5 years prior
PSA 0.6 on 10-25-2005
PSA 0.4 on 7-30-2004
PSA 0.5 on 5-9-2002
Followup with Urologist on 11/10/2010 after elevated PSA; DRE noted slight bump
November 30th, 2010 had prostate biopsy.
December 9th, 2010, Biopsy results 3 of 12 cores positive.
LLB: Gleason's 4+3=7, 11 MM Tumor Length/15MM Core Length (73%)
LLM: Gleason's 4+4=8, 12 MM Tumor Length/15MM Core Length (75%)
LM: 0.1 MM Tumor Length (1%)0.1 MM Tumor Length
Urologist recommended robotic removal using da Vinci method.
RALP Surgery 12/27/2010 Released: 12/30/2010
Thunderbird Banner Hospital, Glendale, AZ
Post-Surgery Pathology: GS 4+5=9
Pathologic Staging: pT3a, N0, MX; location: Left Side; Volume: 10%
Margins: Left posterior inked margin focally involved
Extraprostatic Extension: Observed
Seminal vesicles: Not observed
Lymphatic/Vascular Invasion: Not observed
Catheter: Removed 15-days after surgery
Post-OP Followup on 1/11/2011; Catheter/Staples removed
Adjuvant IMRT 8 Weeks Post-OP.
No exercise for 4 Weeks Post-OP.
Radiation Oncologist Initial Consultation on 1/18/2011
Calypso Procedure on 2/17/2011; PSA <0.1; Bone Scan Clear
341 Testosterone

CT Simulation on 2/24/2011.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 2/20/2011 2:44 PM (GMT -6)   
Brampy, has your R-doc mentioned adding 2 years of HT (or whatever) to the treatment plan? It's become almost standard treatment for high-risk guys like us... It improves the outcome of the radiation by about 20%...
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

brampy
Regular Member


Date Joined Jan 2011
Total Posts : 42
   Posted 2/20/2011 2:53 PM (GMT -6)   
Fairwind,
No...and I specifically asked about HT. He didn't think I needed it and was pretty certain in his response (along with my Uro). My case was also subject of the monthly tumor board and HT was not recommended. I feel pretty good about my adjunct radiation at this point and my PSA came in <0.1. I will save the HT bullet for another day (which hopefully will never come).

tedgard
Regular Member


Date Joined Feb 2008
Total Posts : 108
   Posted 2/20/2011 3:58 PM (GMT -6)   

Eye4thelinks,

You know that for the past three years that you PSA readings have been on the rise every time you take one.  Per your post, the Dr’s are recommending that you take action and get a biopsy.  This would already then be assumed that the Dr’s have tested you for an infection that could be causing the rise in PSA.

I know that there are some the recommend “watching and waiting” to see what will happen.  The newer term is “active surveillance” versus “watching, or ignoring the signs, and just waiting for it goes away”.  Why haven’t you taken your Dr’s advice and get the biopsy?  This doesn’t make much sense to me.  I am not at all sure what you are afraid of to do this procedure.  It only takes a few minutes, it is usually done on an outpatient basis, and there are rarely any prolonged issues related to this procedure.

I had my first biopsy after three years of rising PSA, and that last reading was 3.8 versus your 6.0.  That was positive for cancer.  Granted, it was only a low grade of cancer.  I took the aggressive approach and removed the cancer.  Unfortunately, after surgery, it was determined that I had more cancer that had not been uncovered in the biopsy, which would not have been known before having the surgery.  They found that there was cancer on the lower left apex which involved that nerve.  My surgery was successful, and all margins were negative.  A little over three years post-surgery, it has been determined that there are a few residual cells that have caused my PSA to go up from .00 to .13.  Therefore, I am again going to take the more aggressive approach and take radiation therapy to kill those remaining residual cells before they have a chance to grow and metastasize and spread to other parts of my body.

The best prognosis for a long life “cancer free” is to catch it as early as possible and get rid of it.

I wish you well, regardless which choice of treatment that you take.

It just pains me to see so many men wait, wait, wait, then find out that the waited too long.  I see post after post of men that had early signs of a problem, they chose to ignore those early signs out of fear for what the outcome may be, than they end up having real issues.

Good luck,

Ted.


Diagnosis Results – Oct 31, 2007;
•Age – 53 (turned 54 in Nov 2007)
•PSA is 3.83
•Gleason's Grade - 3+3=6, T1C

Surgery Dec 11, 2007;
•Cancer confirmed on Right mid and Left apex
•Both nerve bundles spared, some damage to the Left bundle.
•30 day PSA, .01
•90 day PSA, .00
•Latest PSA, .12
•ED treatments: Levitra, Cialis, Trimix, Erect Aid pump, Penile Implant on 3/12/2009
•Happy

eye4thelinks
New Member


Date Joined Feb 2011
Total Posts : 10
   Posted 2/20/2011 4:05 PM (GMT -6)   
Thanks for all of the quick replies, most helpfull. My next PSA will surely give me my next course of direction which will most likely be the biopsy. I have not read many comments about good biopsies, but will be hopefull. Thanks everyone.

cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 2/20/2011 4:12 PM (GMT -6)   
If possible have a CDU guided biopsy [there's a handful of expert docs who do color doppler] They are in MI, FL,Ca [that I know of]...........Cooper

tigre
Regular Member


Date Joined Sep 2010
Total Posts : 69
   Posted 2/20/2011 4:15 PM (GMT -6)   
eye4thelinks,
like a few others here, i would not put off the biopsy. my psa went from 3.0 to 3.4 to 3.9 over about eighteen months.  long story short, had biopsy and was dx with pc on both sides of prostate with a positive margin. perhaps if i had a more attentive family dr. i would have known that for my age (45 at dx) 3.0 and 3.4 are high psa levels and would have caught this thing before the positive margin.  the biopsy is really not very bad either. good luck with whatever you decide.

rick27
Regular Member


Date Joined Sep 2010
Total Posts : 71
   Posted 2/20/2011 4:22 PM (GMT -6)   
I would also get the anti-biotics to rule out infection. It does sound like somethings cooking though. I waited until my PSA was 8 before my first biopsy. That was five years after my doctor recommended one. It was negative. My doc then wanted to do a repeat biopsy in 3 months. I waited 3 years until my PSA hit 10. I was 55. They found cancer. I did AS for one year and then had LRP, no positive margins, undetectable PSA. I may just have gotten lucky.
(My third biopsy did some kind of damage. It affected my erection. Not ED but the shape of it)
Good luck. You came to the right place. These guys here are great.
History: 2 brothers with prostate cancer
PSA at age 45: 4.7
PSA at age 52: 8.0 . 1st biopsy 12 cores, negative
PSA at age 55: 9.5. 2nd biopsy positive 2 of 14, gleason 3+3. both cores <5%, Start WW
PSA at age 56: 9.2. DRE normal. 3rd biopsy positive 4 of 14, 3 cores cancer<7% Gleason 3+4 in 1 core, prostate 81cc
LRP, no robot, Sloan Kettering 11/4/10,age 56
No positive margins, continent 11/12/10

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 2/20/2011 5:18 PM (GMT -6)   
Eye,
Pick up a copy of "Invasion of the Prostate Snatchers" by Dr Mark Scholz. There is a good chapter on when you should get a biopsy and when you should wait.
JohnT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.
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