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MR123
New Member


Date Joined Nov 2017
Total Posts : 11
   Posted 11/10/2017 5:55 AM (GMT -7)   
Hi,

My PSA has been jumping around for the past couple of months. Don't know at what point it started to rise from what was a steady 1.6 (9/2016 and prior) to 2.3 9/2017. I have been experiencing frequent urge to urinate, some burning pre/during/post urination. My Urinalysis and Urine Culture are both negative. My PSA density is .07 (have been told I have BPH for at least 10 years now...I am 61 years old). My % free PSA is 17%...here is my most recent PSA results released yesterday:

PSA, FREE (ARUP) 0.9 ng/mL ng/mL (Is there any significance to this particular value or is it just used to compute the % Free?)
PSA (ARUP) 5.4 ng/mL 0.0 - 4.0 ng/mL
% FREE PSA (ARUP) 17 %


I am scheduled to have blood drawn today for 4K test. My Urologist says:

"The rapid rise and fall is more consistent with inflammation and not cancer. Nonetheless, I would obviously rather have the PSA remain low and stable. Knowing that you had a relatively normal prostate MRI and low PSA density is also reassuring."

Am I missing any steps here or am I on the right track working this up? Also...what will the 4K test reveal and what are the values (and significance of the numbers low/high) that will produced? Any insight from this most learned membership would be greatly appreciate...you are a great bunch of supportive individuals...thank you.


History:

Sept 11, 2016 1.6
Sept 11, 2017 2.3…and then 1month later…
Oct 12, 2017 … 5.6…and then 12 day later…
Oct 24, 2017 …2.5…and then 7days later…
Oct 31, 2017 …4.68…and then 10 days later (yesterday)
Nov 9, 2017 5.4...last value...current...

3T MRI...

October 18, 2017 MRI of prostate
CLINICAL STATEMENT: Elevated PSA.
TECHNIQUE: Axial T1-weighted; axial, coronal, and sagittal T2-weighted;
and axial diffusion-weighted images were obtained.
1 mg of Glucagon was given subcutaneously.
COMPARISON: None.
CORRELATION: None.
FINDINGS:
PROSTATE MEASUREMENTS: 5.4 x 5.2 x 5.4 cm; volume 75.8 cc
TUMOR location(S): Ill-defined areas in the bilateral
Peripheral zone are nonspecific.
EXTRACAPSULAR EXTENSION: None.
SEMINAL VESICLE INVASION: None.
MEMBRANOUS URETHRAL
LENGTH: 1.2 cm.
PELVIC NODES: No adenopathy.
BONES: Unremarkable.
OTHER: None.
IMPRESSION:
1. No focal suspicious lesion. PI-RADS v2 score 2.

MR123
New Member


Date Joined Nov 2017
Total Posts : 11
   Posted 11/10/2017 6:30 AM (GMT -7)   
Hi...I would like to add that the PSA values I posted have been from three different labs:

Sept 11, 2016 (Internist...lab 1) 1.6
Sept 11, 2017 (Internist...lab 1)) 2.3…and then 1month later…
Oct 12, 2017 (First Urologist seen...sent blood out...lab 2)… 5.6…and then 12 day later…
Oct 24, 2017 (Internist...lab 1)…2.5…and then 7days later…
Oct 31, 2017 (First Urologist...lab 2)…4.68…then 10 days later...
Nov 9, 2017 (Second Opinion Urologist...lab 3)...5.4...most recent value

I understand from reading the forum that values can differ lab to lab...but would we expect to see such wide swings just attributed to using different labs (3 labs defined above)? I have seen 2 different Urologists since this event started in September 2017. I would also like to add that I have some starts and stops and dribbling post urination. I went to the second Urologist for another opinion...it is his comment that I posted in my original email. The first Urologist told me he didn't need to see me for 6 months. I was not completely satisfied with this POA and sought the second opinion. Thank you again.

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3726
   Posted 11/10/2017 6:51 AM (GMT -7)   
Are you aware that sex/ejaculation or a DRE will make the PSA rise?
To be consistent, you should abstain from sex for 24 hours (some say 48 hours) before having your blood drawn.
Good luck.

Howard3569
Regular Member


Date Joined Nov 2014
Total Posts : 298
   Posted 11/10/2017 8:20 AM (GMT -7)   
I have been told that I should try to use the same lab.
Surgery Nov, 14 2014 Negative margins, negative lymph nodes, negative vessels
Gleason 3+7 PSA .08 Dec 14, 2004; <0.05 on March and July 2015; 0.05 on Oct 2015 and 0.07 on January 2016, .06 on July 2016 and .10 on Oct 2016

MR123
New Member


Date Joined Nov 2017
Total Posts : 11
   Posted 11/10/2017 10:29 AM (GMT -7)   
Hi Worried Guy and Howard...thank you...

Abstained on most of the dates (not all but had blood drawn AFTER DRE on a few of these...I abstained and now DRE for 96 hours for the 4K today. I will be using the same lab from this point forward...really weird if that is part of the problem...swings in the range of 3 points...could see a point but 3...labs 2 &3 seem to be more in sync with each other then lab 1 is with labs 2&3...these are reputable labs my doctors are using...oh well...waiting for the 4K to be process...being told most likely a week or a bit more...thank you.

MR123
New Member


Date Joined Nov 2017
Total Posts : 11
   Posted 11/10/2017 10:31 AM (GMT -7)   
sorry...meant to say...

*NO DRE or relations for 96 hours prior to blood being drawn today for 4K...

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 9117
   Posted 11/10/2017 11:33 AM (GMT -7)   
Your urologist is right that your sudden rise in PSA and your urinary symptoms are consistent with prostatitis rather than prostate cancer. Your low PIRADS score also tells you that if there is any cancer in there, it is most likely low grade. In contrast to prostatitis, prostate cancer is usually asymptomatic until very late stages, and PSA rises more slowly and steadily at first.

4Kscore is a test for a few kinds of PSA . PSA and free PSA are two of a family of proteins called kallikreins- that's the "K" --and there are 4 different ones they test for. The 4Kscore is better than just PSA and % free PSA at discriminating for prostate cancer. It's less affected by prostatitis, but it's not completely unaffected by it. It is somewhat expensive (around $400) and it is not FDA-approved so insurance/Medicare may not cover it - always get preauthorization. There is a very similar test called Prostate Health Index (PHI) that is cheaper and is FDA approved, so if your insurance won't cover 4Kscore, ask for PHI.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

MR123
New Member


Date Joined Nov 2017
Total Posts : 11
   Posted 11/10/2017 2:31 PM (GMT -7)   
Hi Tall Allen,

First I would like to thank you for taking the time to post a reply to me. You and others on this board are helping countless numbers of people (especially us newbies) navigate their way through this daunting situation we find ourselves in. Many thanks from me to you and the other contributing members...

I have a question regarding my % Free PSA which has been calculated at 17%...if my PSA is elevated secondary to prostatitis or UT infection and it goes into remission...is it a safe assumption to say that my % Free PSA will go "UP"? I understand that my value puts me in the "gray" zone and from reading the forum, a safe percentage is around 25. I guess I am asking "if" this an infectious process and "if" we can bring it somewhat under control, would I assume that my % Free PSA will change for the better?my values should come into a more normal line...correct?

Also...when you say:

" In contrast to prostatitis, prostate cancer is usually asymptomatic until very late stages, and PSA rises more slowly and steadily at first."

My PSA was 1.6 (Internists office) in September 2016. Then in September 2017, it was 2.3(Internists office)...I am wondering if it was going up slowly September 2016 to September 2017 to 2.3 ...but I will never know since there was no other values documented between those two time periods. Or, I guess the increase could have just begun in September of 2017 and, has been spiking up and down since only then. I am a bit concerned that my internist's numbers are the low ones and the two major (different) hospitals that my Urologists work out of have reported the high values.

So...I gave the blood for the 4K test before I read your comments...I did not ask for a pre-authorization so I guess I will have to wait and see what the damage is...when you say that this test is more discriminating then a PSA and % free PSA do you mean that the results will actually show if I have a cancer and what the grade of that cancer is (meaning slow growing as opposed to aggressive). Can the test tell you one way or the other if you have cancer?

Regards

ejc61
Regular Member


Date Joined Dec 2016
Total Posts : 32
   Posted 11/10/2017 2:45 PM (GMT -7)   
Hello MR123,

My PSA had been 0.9 to 1.9 over a period of 15 years. My signature line shows the rest. Prostatitis and BPH have been ruled out. Just absorb as much information as possible.
PSA:2/16-5.2; 5/16-2.8,FPSA-13.2%;10/16-4.6,FPSA-11.5%; 1/17-4.4
dx:3/17;age 55
bx:3/12 positive; all 3+3=6;5%,5%,20%
PSA density 0.16; volume 28; T1c; non-palp DRE
bx confirmed by Johns Hopkins
OncotypeDX-GPS-19 (GPS+NCCN classification)-Very Low Risk
mpMRI: 7/17 Emory/Atlanta;(2) lesions(Pi-Rad 3, Pi-Rad 2),otherwise none or normal results.
PSA:7/17-1.9; 10/17-2.08
AS Program-Emory/Atlanta

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 9117
   Posted 11/10/2017 3:29 PM (GMT -7)   
All the tests that are PSA dependent -- PSA, Free PSA, PHI and 4Kscore -- are affected by prostatitis. None of them replace a biopsy. Their point is to show if it is safe to forgo a biopsy. None of them are very good, but PSA is the worst biomarker and % free PSA is a bit better. Neither of them have cutpoint where one can say with any confidence that a biopsy is highly likely to be positive or negative. PHI and 4Kscore, unlike those, have a cutpoint that simultaneously predicts the necessity of a biopsy reasonably well, or at least better than the other two. For example, if your PHI is over 35, your odds are 2/3 of a positive biopsy, and 1/3 negative due to a false positive. If your PHI is under 35, your odds are 2/3 that you can safely forgo a biopsy, but 1/3 that it will be unsafe to forgo a biopsy due to a false negative. See what I mean? Not great, but better than the others.

If your prostatitis goes into remission and your spike disappears, % free PSA will go up, PHI and 4Kscore will go down. There is a correlation between Gleason score and PHI or 4Kscore, but not % free PSA. The correlation is not strong enough to give it any grade-predictive value.

You are right to put "if" you are able to control the prostatitis in quotes. It is extremely hard to control. Antibiotics usually don't work and pathogens can rarely be identified. It is often relapsing and remitting for a lifetime. You just have to wait it out, treating the symptoms.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4161
   Posted 11/10/2017 9:33 PM (GMT -7)   
You also have a 78cc prostate. At .066 to .1 of psa per cc an expected psa of 4.8 to 8 would be considered normal for you.
70 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. 6 years of psa's all at <0.1.

MR123
New Member


Date Joined Nov 2017
Total Posts : 11
   Posted 11/11/2017 9:18 AM (GMT -7)   
Tall Allen...thank you again...

Hello ejc61...thank you....

John T...thank you...so I see from your calculations that...although unnerving...my current PSA of 5.4 "could be" an expected finding with a prostate of my volume.

My urologist told me there is a medication that he could put me on that would shrink my prostate...anyone have any information on this...success rates...side effects...etc? Thanks...

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 9117
   Posted 11/11/2017 11:50 AM (GMT -7)   
He's talking about either of two medications - Proscar (finasteride) or Avodart (dutasteride). They are excellent for BPH, and actually make PSA a better indicator for prostate cancer. Side effects include hair regrowth and sexual side effects in about 20% of men. They sometimes combine it with an alpha-blocker like Flomax that increases the relaxation in the urethral sphincter to allow more flow-thru.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

MR123
New Member


Date Joined Nov 2017
Total Posts : 11
   Posted 11/12/2017 2:29 PM (GMT -7)   
Hi Tall Allen,

When you say:

"Your low PIRADS score also tells you that if there is any cancer in there, it is most likely low grade. In contrast to prostatitis, prostate cancer is usually asymptomatic until very late stages, and PSA rises more slowly and steadily at first."

Can you help me understand better :

"...if there is any cancer in there, it is most likely low grade"?

Awaiting results of the 4K test...probably not till end of this week or next week.

Thank you,

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 9117
   Posted 11/12/2017 4:46 PM (GMT -7)   
mpMRI evaluated using PIRADS scoring shows suspicion for significant and high grade PC. "Significant" means larger than about 4 mm. High Grade means Gleason scores of 7-10. A PIRADS score of 2 means there was nothing found that was suspicious for significant or high grade PC.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

MR123
New Member


Date Joined Nov 2017
Total Posts : 11
   Posted 11/12/2017 5:39 PM (GMT -7)   
Thank you Tall Allen...

Sono
Regular Member


Date Joined Oct 2017
Total Posts : 26
   Posted 11/21/2017 8:19 PM (GMT -7)   
Hello...it is MR123...I could not get back into the forum no matter what I tried...so...I needed to re-register...sorry for any confusion...

I wanted to sent this follow up and ask a few questions...

I received the results of my 4K blood test today. The Urologist told be I had a score of 7. I am confused with the way he is explaining the significance of the results. During our conversation he seemed to be indicating that I had a 7% chance of having a cancer (and a 93% chance of not having one)...and that I should consider a biopsy. On the 4K website it seems to me that having a score lower then 7.5 indicated a low incidence of cancer with the chance of developing metastatic cancer in 10-15-20 years as low (I think in the neighborhood of 1-2% from this test and at this time and place). Does the 7 above equate to an actual percent possibility of cancer or is this the Score...meaning...is it possible the Urologist is confusing the score with a percent possibility of having cancer at this time? Does the 4K score equal a percentage of probability? I though (from reading) that the scores from the 4K websites broke down as such:

4Kscore Test Biomarkers
> 7.5% (N = 1,510, 62%)
5 year = 2.4%
10 year = 5.6%
15 year = 9.9%
20 year = 16.4%
all men PSA ≥ 3
4Kscore Test Biomarkers
≤ 7.5% (N = 922, 38%)
5 year = 0%
10 year = 0.2%
15 year = 1.0%
20 year = 1.8%

RESULTS INTERPRETATION:
Based on the 4Kscore Test US validation study, prostate biopsy should be considered in most men
with a 4Kscore result of 7.5% or higher. Reference ranges are as follows:
• Low Risk: 4Kscore result <7.5%
• Intermediate Risk: 4Kscore result 7.5-19%
• High Risk: 4Kscore result ≥20%

Does the %'s above mean...

<7.5% is equal to a 7.5% chance or less of a cancer being present?
>7.5%-19% equates to a 7.5% to 19% chance of a cancer being present
> 20% equates to a 20% or greater chance of a cancer being present...
W H AT D O Y O U R R E S U L T S M E A N ?
• Low Risk: Your probability that the prostate biopsy will be diagnosed as
aggressive disease is less than 7.5%. Your risk for cancer spreading to other
parts of the body within 10 years is less than 0.5%.
• Intermediate Risk: (7.5-19%) Your urologist will evaluate the 4Kscore test
results in conjunction with additional clinical information to decide on
the appropriate next step.
• High Risk: (>20%) Consider prostate biopsy to detect aggressive
prostate cancer.
4Kscore has been shown to predict risk for distant prostate cancer metastases
occurring up to 20 years later from a blood sample in otherwise healthy
men who have PSA ≥ 2ng/mL. A population-based cohort in Västerbotten,
Sweden followed 12,542 men to determine their risk of distant prostate
cancer metastases. Results, as illustrated in Figure 1, show that a group of
men who had a 4Kscore of 7.5% or lower were found to have 1% chance of
developing metastatic prostate cancer by year 15.


Does the number 4K score go higher then 20%...again though...does this percentage translate into probability of cancer (20%=20% chance of cancer)?

Sorry for this long winded post but I am very confused with the way the results are being interpreted and then explained to me.

Finally...and to cut to the chase...with my bouncing PSA over the past couple of months...(4K PSA component of todays test is reported at 4.51 down from 5.4... 22 days ago)...my PSA Density of .07 and my PI-Rads 2 score of 2...and as well as my documented BPH would you feel that I am a candidate for a biopsy at this time? Thank you very much for any responses...



History:

Sept 11, 2016 1.6
Sept 11, 2017 2.3…and then 1month later…
Oct 12, 2017 … 5.6…and then 12 day later…
Oct 24, 2017 …2.5…and then 7days later…
Oct 31, 2017 …4.68…and then 10 days later (yesterday)
Nov 9, 2017 5.4...and now 22 days later....
Nov 21, 2017 4.51...this is the PSA number that was included along with the other values reported in the 4K results



3T MRI...

October 18, 2017 MRI of prostate
CLINICAL STATEMENT: Elevated PSA.
TECHNIQUE: Axial T1-weighted; axial, coronal, and sagittal T2-weighted;
and axial diffusion-weighted images were obtained.
1 mg of Glucagon was given subcutaneously.
COMPARISON: None.
CORRELATION: None.
FINDINGS:
PROSTATE MEASUREMENTS: 5.4 x 5.2 x 5.4 cm; volume 75.8 cc
TUMOR location(S): Ill-defined areas in the bilateral
Peripheral zone are nonspecific.
EXTRACAPSULAR EXTENSION: None.
SEMINAL VESICLE INVASION: None.
MEMBRANOUS URETHRAL
LENGTH: 1.2 cm.
PELVIC NODES: No adenopathy.
BONES: Unremarkable.
OTHER: None.
IMPRESSION:
1. No focal suspicious lesion. PI-RADS v2 score 2.

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 9117
   Posted 11/22/2017 6:48 PM (GMT -7)   
Congratulations on that good result. A 4K score of less than 7.5% means that your risk of aggressive prostate cancer is less than 7.5%. It is incorrect in that assessment only 5% of the time. Only 1.8% of men with 4K scores that low went on to develop metastases in the next 20 years. So it is telling you that you can safely forgo a biopsy now.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Sono
Regular Member


Date Joined Oct 2017
Total Posts : 26
   Posted 11/23/2017 11:40 AM (GMT -7)   
Hi Tall Allen...first a Happy Thanksgiving to you and all here on this forum...

Thank you! That is the way I thought it should be interpreted...however, I have been on the phone with Urologist #2 a few times over the past 2 days, (he was my second opinion who ordered the 4K from a major NY Hospital), after initial consultation with Urologist #1 (again...major NY Hospital...). I have to say that they both are confusing me! When this workup began. Urologist 1 said he didn't need to see me (after reviewing results of the MRI he ordered) for 6 months...no repeat PSA even though it was at its high then of 5.6...which...on my internists advice bought me a trip to Urologist #2 for a second opinion. #2 ordered the 4K and, after receiving the results (1.5 weeks later) he called me to discuss the findings. Although he did not say a biopsy needed to be done quickly...still, after several conversations over the past 2 days...he is saying that he recommends a biopsy...adding he could see how I may feel that the results did not warrant a biopsy but that "I was at the upper limits of the 7.5% cut off point and that I am (as he considers it) still young and might have a different recommendation (no biopsy) if I was 70+ years old. Questions. I was focusing on the positive number...93% no cancer...an less on the negative number 7%. 7% seems to be too high for him...I guess he was hoping for a lower number...I am feeling insecure that he doesn't seem to be happy with the odds that my number (7%) represents.

If you don't mind...a couple of questions...

1) Does the 7% mean that there is a 7% chance that I have cancer...meaning...does the number represent an absolute...ex: in the group of men scoring 7% on the 4K test...7% out of 100% will have cancer?

2) How does the score distinguish between aggressive/slow growth Pca...meaning...does the 4K test have an ability to distinguish between having an aggressive cancer or a slow growing cancer? Above you said that I had a less then 7.5% of having an aggressive cancer (with a very low likelihood of developing metastatic disease from any cancer I might have to 1.8% in 20 years) how does the test distinguish aggressiveness? Urologist #2 said that he received the results of another 4K test the same day as mine and that person had a score of 32%...again...does the number define the aggressiveness or just the probability of having any type of cancer?

3) When your PSA goes down...such as mine has since last check (see bouncing history below over the past couple of months but may be secondary to the fact that the values have be derived from 4 different labs although there has been two values from the same lab and...of course...the last value is from the 4K lab...). Can these values be recalculated using the new PSA number, i.e.PSA density, % free...etc? If I use 4.51 to calculate my PSA density now, it is .06 as apposed to .07 when it was higher.

I greatly appreciate your response...

Regards...





I would like to add that the PSA values I posted have been from three different labs:

Sept 11, 2016 (Internist...lab 1) 1.6
Sept 11, 2017 (Internist...lab 1)) 2.3…and then 1month later…
Oct 12, 2017 (First Urologist seen...sent blood out...lab 2)… 5.6…and then 12 day later…
Oct 24, 2017 (Internist...lab 1)…2.5…and then 7days later…
Oct 31, 2017 (First Urologist...lab 2)…4.68…then 10 days later...
Nov 9, 2017 (Second Opinion Urologist...lab 3)...5.4...then 12 days later...
Nov 21, 2017 (Second Opinion Urologist...lab 4)...4.51 most current this value included in the 4K test done at the 4K lab

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 9117
   Posted 11/23/2017 2:04 PM (GMT -7)   
First, let me state that I find Uro #2's ageism offensive and without merit.

Why did you get the test if the outcome won't make a difference? Your score tells you you can avoid a biopsy.

You are asking some of the same questions I already answered. No, you can't play with the numbers like that - they use an algorithm that involves all the readings, not just PSA. The fact that you've had 2 uros and spent several days on the phone suggests that your anxiety is driving him to recommend you go ahead with it. The problem seems to be with you, and I suggest you take steps to work on your anxiety - psychotherapy and Mindfulness worked for me.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Sono
Regular Member


Date Joined Oct 2017
Total Posts : 26
   Posted 11/23/2017 3:21 PM (GMT -7)   
Thank you...

Sono
Regular Member


Date Joined Oct 2017
Total Posts : 26
   Posted 11/23/2017 3:53 PM (GMT -7)   
And...I am sorry but...just for the record...he is the one who brought up having a biopsy...not me. I think he suggested it within the first two minutes of "his" call to me. And, if I were to tell you his name...I suspect you would have heard of him (as well as Urologist #1). Other calls after the first one mentioned above over the 2 days were initiated by both of us equally...not just me.

The truth of the matter is that I expressed to him my desire to stay away from that procedure unless it was felt that I had some clear indication that I needed it. He is/was the one recommending it...in my conversation with him he would clearly know that I was on the opposite side of the room regarding this recommendation. Initially his timeline for scheduling a biopsy was somewhere within the next month. It was I who talked him down from this...and then him saying...it was my body and he could understand my desire to wait...after that...he agreed with my request to put me on antibiotics times two weeks to see "if" my PSA spikes are from an infection or prostatitis (accepting your counsel that antibiotics may not change anything in my PSA number).

Anxious...perhaps...good advice...but I would say that I had no significant anxiety until he told me that I needed a biopsy...I agree...he ordered the test...and does not seem to accept what the results are meant to mean. I had never even heard of it of a 4K test until he suggested it.

Finally...sorry for the redundancy...I am just trying to learn about this test and have come to this forum in hope of educating myself since the MD who ordered it has a difference of opinion...one that I am hoping is wrong...

Regards

Paulsch
New Member


Date Joined Feb 2015
Total Posts : 16
   Posted 11/23/2017 6:23 PM (GMT -7)   
First time posting. I am 62 ...other then a 90 year old prostate I’m very healthy....deal with both bph and prostitis. Psa is erratic.
4.5 years ago had 7.1 psa neg biopsy
2.5 years ago 5.4 psa 2nd neg biopsy
Psa had starting trending in mid 3s and I had a flare up and a psa of 4.375...repeated psa 6 weeks later and came down slightly to 4.29.
Dr.wants to do another psa and psa free in late January of 18.
Says psa needs to be 4.1 or less or we need to repeat biopsy..
Definitely starts wearing on your mind.
Dr.says his feeling is still related to bph and but we need to monitor it closely.....his thoughts are if we are dealing with pc it’s early stage but we need to stay on top of it,,,grateful for a good doc.

Sono
Regular Member


Date Joined Oct 2017
Total Posts : 26
   Posted 11/24/2017 8:55 AM (GMT -7)   
Hi Paulsch,

Sounds like we have some things in common...

Questions...was the determination to perform your first and second biopsy based solely on your PSA values at that time? Did you have any other testing that added to decision to perform a biopsy? I understand that 7.1 and 5.4 are values over he limit (although reading the post on this forum reveals that many have much higher values then you and I...and...disturbingly...much lower but still turned out to be Pca).

Sono
Regular Member


Date Joined Oct 2017
Total Posts : 26
   Posted 11/24/2017 9:07 AM (GMT -7)   
Paulshc...Sorry got cut off...

What symptoms have you experienced (or are currently experiencing) that lead to the diagnosis of Proatatitis? Does your doctor feel that performing serial biopsies is the only way to "stay on top of this"? Some repondents to my posts have said that PSA does not go up and down with cancer...but I suppose if your PSA is elevated due to Prostatitis...there could be a "hidden" component of the PSA value that is due to Pca that is difficult to cull out. I understand that the 4K test is suppose to give doctors a more definitive way to base the decision on whether or not to do a biopsy if your score is 7.5% or lower...but...as you have probably read above...the doctor who ordered that test on me is still recommending a biopsy because my 7% is "close" to the 7.5% threshold...this is confusing me...

Regards
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