Help required - do I or dont I have PCa - & how will we find it - if I do?

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mcgerkikal
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Date Joined May 2011
Total Posts : 3
   Posted 5/18/2011 5:21 AM (GMT -6)   

 

I should appreciate any helpful advice & suggestions from the very knowledgable & experienced contributors to this forum.
My details are as follows:
Brief Time & Event Line:
Age: 65/Health: excellent
Country: UK
Medical system: State funded
22 April 2010 Hospital A & E – Urinary Retention – Overnight stay
Catheterised
DRE - normal but enlarged Initial Diagnosis - BPH
Prescribed: Tamsulosin (Flowmax) No subsequent issues
6th October GP -
DRE- normal - enlarged
22 December 2010 GP -
PSA Test: Result 25.6
DRE - normal - enlarged
Referred to Hospital Urology Department
4th January 2011 Hospital Urology Department
Urodynamic Test - ok
DRE - normal - enlarged
11th January 2011 12 Core Biopsy - Pathology result: no evidence of PCa - only HG
PIN
11th March 2011 GP –
PSA Test: Result 25.9 - no significant difference
29th March 2011
MRI Scan - result – “indications” of - tumour within prostate - & possibly enlarged seminal vesicle & obturator lymph node
26th April 2011 Saturation Biopsy
Pathology result: 48 cores of prostate & seminal vesicles
59 samples tested - no evidence of PCa

Currently there are no further reccomendations for action other than a possible follow up
MRI & PSA test when the Biopsy inflamation has died down.

Comments & views appreciated.....


Steve n Dallas
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Date Joined Mar 2008
Total Posts : 4849
   Posted 5/18/2011 6:24 AM (GMT -6)   
Welcome to the site no one wants to be a member of shocked
 
Two negative biopies is a good thing. Probably just need to do frequent PSA tests to keep an eye on things.
Moderator - Prostate Cancer
Age 56 - 5'11" 215lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6
06/25/08 - Da Vinci robotic laparoscopy
05/14/09 - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
05/18/10 - 24 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 5/18/2011 10:47 AM (GMT -6)   
I see you posted this on another forum too....somebody else will answer....I could answer with stuff too....but letting someone else jump in on this.

Sagittarian
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Date Joined May 2011
Total Posts : 546
   Posted 5/18/2011 11:35 AM (GMT -6)   
Do you know what your Free PSA percentage , or number is ?
DOB=DEC-1957, NJ, PSA HISTORY, FPSA=7%,
2002=1.83, 2006=3.18, 2007=3.09, 2008=3.20
2009=3.50, 2010=3.50, 2011=4.70, 2011=4.20
DRE, CT-SCAN, Bone Scan, =All Negative
BIOPSY, 12 Cores, APR 2011, 4 POS, 2(3+3), 2(3+4) All Left Side
% on Positive Cores, 2(40%) 1(70%) 1(90%), PNI=Not observed

Da-Vinci Surgery=23 May 2011

Sagittarian
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Date Joined May 2011
Total Posts : 546
   Posted 5/18/2011 11:41 AM (GMT -6)   

Sagittarian
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Date Joined May 2011
Total Posts : 546
   Posted 5/18/2011 11:54 AM (GMT -6)   
http://www.sciencedaily.com/releases/2008/05/080501062750.htm
DOB=DEC-1957, NJ, PSA HISTORY, FPSA=7%,
2002=1.83, 2006=3.18, 2007=3.09, 2008=3.20
2009=3.50, 2010=3.50, 2011=4.70, 2011=4.20
DRE, CT-SCAN, Bone Scan, =All Negative
BIOPSY, 12 Cores, APR 2011, 4 POS, 2(3+3), 2(3+4) All Left Side
% on Positive Cores, 2(40%) 1(70%) 1(90%), PNI=Not observed

Da-Vinci Surgery=23 May 2011

John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 5/18/2011 11:59 AM (GMT -6)   
Boy, this is a tough case. Did you get a PCA3 test? Was the MRI a Telsa 1.5 or a Telsa 3. Be sure your next MRI is with a T3. You can also consider a color doppler ultrasound. I don't know anywhere in Europe that gives them. You could also contact Dr Jelle Barantsz at St Radboud University in Neimegan NL. He is the formost expert on imaging prostates and lymphnodes and he may have some suggestions.
I went through the same issues for 10 years and my cancer was only found by a color doppler; but I did not have a saturation biopsy like you did. Someone has to explain why your psa is so high.
JohnT

mcgerkikal
New Member


Date Joined May 2011
Total Posts : 3
   Posted 5/18/2011 1:05 PM (GMT -6)   
A very appreciative thank you to all of you for your current input.
As a brief update:
The UK Public medicine system does not currently recognise the concept of
Free/Bound PSA or PCA 3 tests.
I think it is possible to get these privately - which I will be exploring - a few hundred sterling pounds  - probably.
There is no recognition of colour Doppler Ultrasound in UK - & I am trying to find out whther this exists in Europe - as although I have many friends in USA  I was not planning a visit for the forseeable future - but its a possibility.
The MRI was (I believe) the latest all singing & dancing Tesla 3 - but I may get a repeat - if not I may get a private one - around a thousand sterling pounds - I think .
My prostate size was estimated at 75cc. & with a PSA of c. 26 we all thought that there must be something somewhere!  
Maybe there is - but its hiding very successfully - we will see - I suspect in due course - hopefully before things get out of hand. 
But as we ALL know we can only establish PCa by pathology!
So its still possibly "hunt the needle in the hay stack!"
All further suggestions welcomed.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/18/2011 1:09 PM (GMT -6)   
Wow, you would think with that 48 core saturation biopsy, if there were cancer there, it would have found it. You do indeed have a puzzling situation on your hands.

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 margin
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, 4/11 3.81
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

Sagittarian
Veteran Member


Date Joined May 2011
Total Posts : 546
   Posted 5/18/2011 1:41 PM (GMT -6)   
Expression of the PTOV1 gene in HG-PIN lesions (HSCORE higher than 100) = 90% PCa probabiltiy
Lack of expression of the PTOV1 gene in HG-PIN lesions = very low PCa probabiltiy
 
High Free PSA = High probability BPH
Low Free PSA = High probability PCa
 
Findings above are stated in papers on needing further studies before it is
concluded as being factual.

DOB=DEC-1957, NJ, PSA HISTORY, FPSA=7%,
2002=1.83, 2006=3.18, 2007=3.09, 2008=3.20
2009=3.50, 2010=3.50, 2011=4.70, 2011=4.20
DRE, CT-SCAN, Bone Scan, =All Negative
BIOPSY, 12 Cores, APR 2011, 4 POS, 2(3+3), 2(3+4) All Left Side
% on Positive Cores, 2(40%) 1(70%) 1(90%), PNI=Not observed

Da-Vinci Surgery=23 May 2011

logoslidat
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Date Joined Sep 2009
Total Posts : 6087
   Posted 5/18/2011 1:51 PM (GMT -6)   
This is out of the box thinking , not sure anyone would prescribe. But if antibiotics are not bringing psa down, why not a short regimen of HT to see if IT does and if it does, its telling me cancer , but no medical tng here.
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

John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 5/18/2011 6:33 PM (GMT -6)   
There are rare cases of "psa leak" in which certain individuals just leak a lot of psa, but the psa usually stabalizes at some point. Dr Bahn told me that he has a patient with a psa of 40 that hs no sign of PC and Dr Bahn is the expert in finding hard to discover prostate cancer.
JT
66 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, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 5/19/2011 6:51 AM (GMT -6)   
logo- I like your thinking.  cool cool cool
 
ohn T- have you seen Dr. Bahn's PCRI type video on color doppler useages and estastology testings.....most enlightening as to what he can summarize with his experiences in PCa...the focal cryo therapy for primary or salvage PCa is very interesting too, especially with his known experiences added. I can understand your reference as to why Dr. Bahn is that kind of expert, I learned alot in that video that was worth seeing. idea

Post Edited (zufus) : 5/19/2011 9:38:04 AM (GMT-6)


logoslidat
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Date Joined Sep 2009
Total Posts : 6087
   Posted 5/19/2011 9:28 AM (GMT -6)   
Thanks brother Zufus I really needed that . Im not a lone ranger, I need a tonto too.
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

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 5/19/2011 10:46 AM (GMT -6)   
logo- like it is illegal to try casodex, proscar, estradiol patch for a short time (LOL), I have seen some out of the box thinking on forums over the years...Einstein has some great words of wisdom....'it is a miracle my curiosity survived formal education'.
 
Tonto- has a feather in his head band 
 

Post Edited (zufus) : 5/19/2011 9:50:24 AM (GMT-6)


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3893
   Posted 5/19/2011 12:24 PM (GMT -6)   
Investigate the genetic 4-gene urine tests...They exist...The labs are sitting on them...
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

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6087
   Posted 5/19/2011 2:55 PM (GMT -6)   
I want to be Tonto, I want to be Tonto, What neck of them there woods in the back are you from any way?
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

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 5/19/2011 3:17 PM (GMT -6)   
I really disagree with that HT argument.
 
Why subject yourself to HT for diagnostic purposes? First of all, it is NOT diagnostic!
 
So if the PSA goes down, it still would not identify cancer. It would certainly butress the argument that cancer is present, but then you still need a biopsy 
 
Mel

mcgerkikal
New Member


Date Joined May 2011
Total Posts : 3
   Posted 5/23/2011 7:28 AM (GMT -6)   
Thanks to all for your additional input.
As I said all contributions always welcome.
I am still awaiting further medical input & still "thinking about things".
Things move slowly here in UK.
That's probably why we "Brits" are usually stoical.
If anything new & interesting turns up I'll post it.
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