dropping in for some help with questions

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d-in-sc
Regular Member


Date Joined Mar 2011
Total Posts : 33
   Posted 3/20/2011 7:27 PM (GMT -6)   
Hello all,
 
I have been referred to this group by my best friend that recently has PC surgery and is a member here. I am impressed with the support and compassion of everyone here. Additionally, he has graciously shared his experience so I can learn how to better take care of myself.
 
Friday, 3/18/11, my urologist ordered a PSA test and a biopsy for my next visit. His communication skills leave much to be desired. This has resulted in me spending the last 48 hours scouring the internet becoming more anxious, confused and frustrated. I have learned that 4.0 used to be the threshold for normal, now the range max for the 40's age group is 2.5. So overnight I went from "acceptable" to over the max with no change in my PSA. Now I'm fearful I will miss my 5 year old daughter growing up.
 
Below are the stats and details as best I know right now. I will be getting records to create the full history in the next couple days.
 
Age 49, will be 50 in about a month.
PSA
Apr 2011 pending results
Sep 2010 - 3.1 (Urologist)
May 2010 - 3.1 (Internist annual checkup)
May 2009 - 3.0 (Internist annual checkup)
2008 - 3.0 (Internist annual checkup) best I can remember
2007 - 3.0 or 2.5 or ?? I do not remember when or what the first PSA test was, so I don't know the benchmark. Will be getting the records this week to find out.
 
In 2009 I asked the Internist about the PSA level, the reply was "it's acceptable, but your prostate is slightly enlarged. I started taking Saw Palmetto when I can remember it.
 
other tests/history
- May 2010 annual checkup urinalysis showed high white cell count
- Sep 2010 Urologist visit showed blood in urine (I recall having to delay urinating until very painfull about 1 hour before the test, stuck in traffic)
- Oct 2010 Urologist follow up bladder scope - no blood, bladder normal
- Same urologist removed a spermodicil at my request in 2005
symptoms
- weak flow which improves with extra hydration, or reduced work stress (desk job), but not fully "normal"
- 4-6 months in 2009/2010 of dribbling, no issue now
- several episodes of "buzzing" vibrating or tingling feeling deep in groin about 5 months ago, none lately
- feeling of pressure when sitting
 
Questions
- what affect does weight lifting have on PSA? I read that stress/strain in the groin can have an affect
- is it possible for BPH to cause a 3.1 PSA?
- what is the range that BPH can cause a PSA to be?
- is there any long term sexual activity that can cause an enlarged prostate, BPH or elevated PSA?
- is it possible that an OLD injury could cause elevated PSA?
- Has anyone had similar PSA results to these?
- What kind of risk does my stats indicate?
- what things should I do to prepare for the next PSA test to make it accurate?
 
Any insight or suggestions of how to direct my investigation  and education would be appreciated. 
 
I realize the questions are mostly about causes other than Prostate Cancer, but I have not been able to find the answers to these questions. I do realize there is the risk of PC.  I trying to balance emotion, fear and axiety with some true possible causes.
 
 

Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 665
   Posted 3/20/2011 8:06 PM (GMT -6)   
Hey D - welcome to Healing Well.
There is a very good book that I highly recommend. Dr. Patrick Walsh's Guide to Surviving Prostate Cancer. It has several chapters in it that deal with non-cancer-related ailments of the prostate, which should answer most of your questions. You sound like someone that would welcome the detail that is in the book.

The fact that your PSA has hardly changed for at least one and maybe several years is encouraging. It is possible that there is something else that is wrong, rather than PC. It sounds like your doc is on the right track - and that a biopsy may be in order. In your case, I would want one for peace of mind.
I wish you well.
Take care, Jeff
Gleason,3+4;PSA 7.9,Nerve-sparing RRP,03/2008(Age 48 then),pT2c, 60g, neg margins; perineural & lymphatic invasion;3 lymph nodes removed,clear; seminal vesicle invasion:absent;Gleason 4 was 5-10%; PSA <0.1 until Oct 09:0.1; retest <0.1; scans clear;monthly results from Jan 2010:0.2,.2,.17,.17,.24,.31,.29,.41, IGRT SRT started 8/4/2010, PSA@5 weeks in: .17,after:.12,.10

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 3/20/2011 8:22 PM (GMT -6)   
Hi D-in-sc. Ok I will try to answer the questions I can! 1st question, imo absolutly none. though riding a bike for periods arguably will cause a rise. 2 and 3, I do not know. 4, Most experts will advise you to abstain from sex for 48hrs prior. 5, no 6, Im not being sarcastic here, but Im sure hundreds if not thousand. Mine was 8.1@ 66, not sure of the relevance of question. 7, You know, The psa is a little high, but it couldn't get much more stable. What docs are looking for Is a high psa relative to age group or an increase of .75ng per year even if low psa #. With a psa of >10.0, stats say 25%/75% cancer/ no cancer. there are tests you can take that will tweak that. others will chime in on that. 8. Dont have sex on a bicycle, lol refer to 1 and 4. Having said that, IMHO and gut feeling, the very stable psa is from BPH. I certainly wouldnt be doing a biopsy and bet ur uro hasn't suggested it. Im not sure if at this point I would be that concerned with research, but internet is great as is this forum. I really don't think You have cancer, I mean I really don't, but what do I know? Bet all your finger waves have been negative. Even if you do, it would almost assuredly be low risk. Trust us all on this, you will not only see your daughter grow up but most likely her's. Ask your uro for a free psa test, not in the monetary sense, but in an unattached sense. Its one of the tweakers I mentioned above. Really d-in-sc you are and will be fine. Aloha. On another note, I am so happy to be back and find it synchronistic that it's from a poster who's tag is d-in sc, that prompted it. Indulge my craziness its crazy good.
age 67 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of Washington Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci, extensive PNI, That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " Francois de la Rochefoucauld, source courtesy of Tatt2

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 3/20/2011 8:24 PM (GMT -6)   
D in SC

The following article on the PCRI web site by Dr Stephen Strum will answer all of your questions. It can be found in the PCRI papers in the Undiagonosed section. "What Every Doctor That Treats Male Patients Should Know"
http://www.prostate-cancer.org/pcricms/node/119
First, your psa is not rising and has been stable for 3 years. Prostate Cancer is almost always indicated by a rising psa caused by the increasing number of cancer cells that grow at a very constant rate. PC is indicated by a steady rise in PSA over time. BPH is stable psa and prosti*** is indicated by psa fluctuating up and down.
BPH is the most usual cause for psa in low psa situations. The prostate gland secretes between .066 to .1 psa for every cc of prostate volume. A psa of 3 would indicate a prostate size of 30cc which is normal for a man your age to a 45cc prostate which would be considered slightly enlarged.
Any manipulation of the prostate, including sex can cause a temporary rise in psa, but not a permanant rise.
Your stats indicate no or very low risk.
If you read the above article you will know as much if not more than your doctor about how to distinguish BPH from PC and will be able to ask your doctor intelligent pertinent questions.
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.

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 3/20/2011 8:28 PM (GMT -6)   
oops see that uro has scheduled biopsy, ur choice, he may be doing that be cause of your concern rather than his. Ask him about the free psa test and get results of that and then biopsy based on that. Biopsies arent that bad , I actually giggled once in mine. Pls stay with us on this, we're part of ur family now.
age 67 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of Washington Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci, extensive PNI, That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " Francois de la Rochefoucauld, source courtesy of Tatt2

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 3/20/2011 10:15 PM (GMT -6)   
so, d-in-sc,

welcome here. can i assume you are from south carolina also? I am in the Easley area, are you close by. If so, there's getting to be quite a group of us just here in Upstate SC, at least 4 not counting you.

you have been getting some great answers so far. The old 4.0 threshold is still used by many family doctors and Gps, so that's not an uncommon line in the sand. We have men with PC dx of less than 4.0, and many above that. I was never sent to a urologist until my own psa crossed over back in 2007, despite high rises in each of the previous years.

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 2/11 1.24
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 9/10,

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 3/21/2011 5:48 AM (GMT -6)   
John T- mentioned a book every PCa patient should read, along with others. Dr. Strum wrote about this back in his book and article that John pointed out....wisdom from knowing the biology of PCa...he reinstructed doctors and patients as to the thresholds and monitoring of psa, via psadt (doubling times), psav (velocity) and other things. This is why he is and was miles in front of the medical community. Other tests to think about doing as indicators for PCa (PRIOR to a BIOPSY) :   fPsa testing, PCA3 urine testings, color doppler ultrasounds and there are some other tests possible too. Hopefully you don't have PCa.
 
Since you are getting biopsies: get an anesthetic as it can be painful some in getting biopsies, tell the doc you want a copy of the actual pathology report (asap), it would be very useful information to go over. Find out whom does the pathology and maybe ask to have it sent to the best known in this field. (e.g. Bostwick, Oppeheimer, Epstein, Bonkhoff, Grignon et al)
 
Cyber college is open (LOL): www.yananow.net     www.marinurology.com (all urological conditions mentioned)

Post Edited (zufus) : 3/21/2011 6:14:07 AM (GMT-6)


davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 3/21/2011 5:49 AM (GMT -6)   
sex and running can affect your psa, but not that much. I had 3 psa tests before my biopsy at they went from 2.2 to 1.9. I made sure to do less gym/cardio and no sex for longer periods between each test but although diminishing, the difference was negligible. I ended up having the biopsy which was my biggest concern at the time and thank God I did, they found early pc cancer which was promptly treated.

In other words, whatever you do, your PSA will probably remain high enough where a biopsy is advisable.

ou can have high PSA without having prostate cancer. a biopsy will confirm this.

your psa isn't high vis-a-vis cancer growth/spread. So even if you do have prostate cancer, which is very treatable, it is probably at its infancy.

get docotrs that are really good and communicate well.

d-in-sc
Regular Member


Date Joined Mar 2011
Total Posts : 33
   Posted 3/21/2011 9:04 AM (GMT -6)   
Wow! you guys are great, thanks for all the information, resource referrals and support. The feedback given is much appreciated and right in line with what I was hoping to receive - ideas and sources to learn what to ask and what to pursue in continueing my investigation.

I have begun my data collection this morning - calling the Internist and others for copies of my record so I can actually know how long ago and the results of the first PSA test, then be able to see the full history.

Im- Patient, thanks for the book referral. I will be looking for it today.

Logoslidat, thank you for taking the time to address each question. The urologist is ordering a biopsy, which is what made me start getting anxious. The question about others with similar PSA levels, was intended to gain perspective how many actually was diagnosed with PC with what appears to be a stable, but low elevated PSA level. Thanks for your perspective, and humor.

Purgatory - yes, I am in the Upstate of SC. Thanks for your reply. I am interested if you are satisfied with your Urologist.

Zufus - thanks for the links, and ideas for other tests, I really appreciate the knowledge of other options for testing that will give a more complete profile.

Davidg - finding a doctor that is good and communicates seems to be one of my bigger challenges at this stage. Thanks for your reply.

Thank you to everyone.

GTOdave
Regular Member


Date Joined Oct 2010
Total Posts : 175
   Posted 3/21/2011 9:43 AM (GMT -6)   
D in Sc.
firstly, if you get the dreaded phone call about a positive PC diagnosis, remain calm. You will likely have plenty of time to gather info, make a decision and get cured! (like me).

Unlike many of the respondents to this post, I am nowhere near the experts that they are. But your steady PSa levels look more like BPH than Pc. It has always been told to me that it is when there is "noteworthy" change to your PSA that an indication of cancer is possible. You've held steady at 3.0 now for 4 years. Thats good!.

The biopsy is not fun (and I certainly didn't giggle during mine), but it will confirm a diagnosis.

Relax......take a breath.......and maybe find a new urologist with whom you are more comfortable. My first Uro was awful, #2 is the best.

Dave
52 yr old, PSA 3.5, Gleason 6 with 3 of 4 top nodes (0%;1%;10%;1%) cancerous. Bottom 2 floors are clean.

DaVinci surgery at Yale 3/4/11.

45 gram gland weight
Gl 3+3
T2C
margins clear
no metastis
5% of gland aedenocarcinoma

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 3/21/2011 10:37 AM (GMT -6)   
d-in-sc,

that's great. there must be 5 of us just in the upstate, we can make our own local HW group, seems like a higher than normal concentration of folks here at one place, especially since we live in a somewhat small state.

i would highly reccomend my uro/surgeon and his practice, been seeing me since 2007. Just email me, and I will send you the particulars.

good luck

david
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 2/11 1.24
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 9/10,

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 3/21/2011 1:47 PM (GMT -6)   
d-in-c. Ahh, got ya on the psa point, makes sense, just couldn,t get my head around it, thanks. Again keep us informed, Aloha!
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 > 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 3/21/2011 1:49 PM (GMT -6)   
BTW, just curious, whats your friends tag and how is he doing, post op?
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 > 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

d-in-sc
Regular Member


Date Joined Mar 2011
Total Posts : 33
   Posted 3/21/2011 7:54 PM (GMT -6)   
Oddly, I forgot to ask his tag, and he didn't offer, so I don't know. He is one of the guys in Upstate SC. I'll let him know I've posted so he can drop in and ID himself if he wishes to, and can update his status as well. I wouldn't want to share incorrect info since I am just learning the lingo or share someone else's info.

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 3/21/2011 9:12 PM (GMT -6)   
roger that!
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 > 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 375
   Posted 3/21/2011 9:34 PM (GMT -6)   
Frankly,
     Its not so much what your psa is as to the direction that it is going. I started psa testing at 35 due to paranoia about cancer, both of my parents died of cancer, father at 59 from colon cancer, mother of breast cancer at 68. My psa was at 1.9 for  like 17 years, then it jumped to 2.85 in one year. Still way below the old 4.0 threshold. Sure enough it was diagnosed as prostate ca after 2 biopsies.  So your psa doesnt seem to be changing that much, the important thing is the psa velocity (change in psa over time). Take your time and see where it goes.........
My age= 52 when this all happened.
DRE=negative,
PSA went from 1.9 to 2.85 in one year, biopsy ordered,
Second biopsy on 08/14/08 found 2/12 cores positive for CA on R side, 1 core=5%CA, other core=25% CA, Gleason score= 6 both cores,
Bilateral nerve sparing robotic surgery on 09/11/08, pathological stage T2A,
No signs of spread, organ confined,
6 0's in a row, still use trimix for ED

Alegar
Regular Member


Date Joined Oct 2010
Total Posts : 91
   Posted 3/22/2011 6:56 AM (GMT -6)   
logoslidat said...
BTW, just curious, whats your friends tag and how is he doing, post op?


Hello, Logo:

d-in-sc is the buddy I referred to many weeks ago who I was concerned about. I'm glad he is following up with his prostate health. I pointed him over to this site because of the great expertise that exists here.

As for me, I have been totally dry since mid-January, have worked-out, and changed my diet to lose 29 lbs. Started an alkaline diet on top of that. I now weigh 181 lbs. and maintaining it. Making some progress in the ED department, but it still has a ways to go.

Thanks to all you gentlemen who are helping d-in-sc.

Alex
Diagnosis:
July 1, '10
PSA 3.88
Gleason 3+3=6
2 out of 12 samples positive

Solution:
DaVinci Oct 1 '10, UNC Chapel Hill
Cath/JP Drain out Oct.16, '10

Personal Statistics:
Age: 54
Weight: 184 lbs.
Height: 6 feet

AIRBORNE ALL THE WAY!

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 3/22/2011 4:51 PM (GMT -6)   
Alegar, what a guy, right with the response, tanks eh? Your stats look great, looks like a cure to me! My wife and I will be in Chapel Hill from June 2nd to 16th visiting my middle son. He's finishing his 1st year in their epidemiology
doctoral program, full ride wit da stipend!! Looking for the gig , like our brother Mel. You take care of yourself my brother, Aloha!
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

Alegar
Regular Member


Date Joined Oct 2010
Total Posts : 91
   Posted 3/23/2011 6:45 AM (GMT -6)   
Thanks, Logo!

Congrats on your son's accomplishments.

Good health!

Alex
Diagnosis:
July 1, '10
PSA 3.88
Gleason 3+3=6
2 out of 12 samples positive

Solution:
DaVinci Oct 1 '10, UNC Chapel Hill
Cath/JP Drain out Oct.16, '10

Personal Statistics:
Age: 54
Weight: 184 lbs.
Height: 6 feet

AIRBORNE ALL THE WAY!

natural44
Regular Member


Date Joined Dec 2010
Total Posts : 172
   Posted 3/23/2011 8:52 AM (GMT -6)   
I would suggest maybe ask for a "free" PSA test prior to the biopsy.. to check for the actual free psa cells in the system. this is much more accurate for detecting likelyhood of cancer than just the average PSA test.
age 44 when diagnosed 45 now
RRP 9-28-10
gleason 3+3
pathology report clear
11-1-10 PSA 0.02
3 month 0.00
pump works ok
12-1-10 noctural erections, not very strong maybe 20%
tried all oral meds and nothing yet
Dr. R. Saint in Tulsa did my procedure, I do NOT recomend him!!
2-28-11 ED seems to be getting worse, no nocturnals for a week, and nothing spontanious at all still
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