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Posted 7/5/2018 7:59 AM (GMT -7)
Thanks all for the replies! One more question, maybe it is too early to ask, what is the best way to find a good doctor for the second opinion? I am in great Boston area and I know there are lots of good ones out there.
Posted 7/5/2018 9:00 AM (GMT -7)
You should have your urologist's office send the biopsy slides to Johns Hopkins to review the slides. Your urologist's office would know how to do this. Unfortunately, it's most likely out-of network, so the cost is $250.00 to JH but well worth it.
Posted 7/5/2018 12:34 PM (GMT -7)
Don't worry too much about getting a second opinion until you have the first one. After that, IF you come back positive, then have your slides sent down to Johns Hopkins for a second read.

THEN, for second opinions about treatment options, you have a great place to go in Boston--Dana Farber. They are as good as it gets with treatment options.
Posted 8/3/2018 7:04 AM (GMT -7)
Did biopsy on July 31. Got a call from doctor this morning and the pathology report comes back with negative. No cancer found this time. The ultrasound detects my prostate size 58cc, which is large. This might explain the elevated PSA and PHI (there are some limited studies showing the larger prostate volume is the key factor of the higher PSA and PHI). As for BHP, doctor decides not to teat for now. Set up a follow-up blood test and visit in 6 months. Temporary relief for now.

By the way, the biopsy is an easy part and the anxiety is the main 'killer'.
Posted 8/3/2018 8:45 AM (GMT -7)
The biopsy result should be a BIG relief. Are you still anxious about the size of your prostate?
Posted 8/3/2018 8:45 AM (GMT -7)
That was kind of expected, but still good. BPH would explain the rise. The monitoring plan sounds good.

If it gets worse, you can get some meds for BPH.

Some day (years) you may need to repeat the biopsy, maybe, possibly.

Andrew
Posted 8/3/2018 9:28 AM (GMT -7)
I am not so worry about BHP but lots of reports of 'first biopsy negative' with repeated ones that find out cancer is something I need to watch for. My doctor said they will do genomic screen on the tissue and report back with risk level in few days.
Posted 8/3/2018 9:57 AM (GMT -7)
That's a prudent thing to do. Unless you come back high risk, you likely could wait a couple of years for a repeat biopsy, depending on any PSA rises.

Let us know what the tests say,
Andrew
Posted 2/8/2019 9:12 AM (GMT -7)
6 month passed. I did my PSA and PHI on Monday. PSA is 5.8 (6.22 last July) and PHI 35% (38% last July). Doctor is happy about the result. He did finger exam on prostate and nothing changes. He explained to me that last biopsy was negative and they did DNA (genomic test) which can tell if the surrounding cells are exposed to cancer or sort of things. The result is also negative. As my prostate size is 59cc he thinks it is possible the elevation is due to BHP. No treatment for now. Redo lab in 6 months and if it goes up he will ask me do MRI. Office visit in one year.

Post Edited (Jiangkong) : 2/8/2019 9:18:27 AM (GMT-7)

Posted 2/8/2019 10:26 AM (GMT -7)
That's good news!
Posted 2/8/2019 10:53 AM (GMT -7)
congratulations on the great news.

larry
Posted 2/8/2019 10:56 AM (GMT -7)
Breathe a big sigh of relieve, there is no concerning data or trend. Congratulations on great news
Posted 8/8/2019 7:53 AM (GMT -7)
Another 6 months. The lab comes back: PSA is elevated to 6.4 but PHI drops to 24% which puts the lowest risk to be cancer. My doctor is happy and will re-check in 6 month with a office visit.

JK
Posted 8/8/2019 7:56 AM (GMT -7)
Good news👍
Posted 2/14/2020 10:12 AM (GMT -7)
Another 6 months go by. PSA 6.46, PHI 32.18. Dr. says it is still at low risk range so repeat lab in 6 months.
Posted 2/14/2020 10:17 AM (GMT -7)
Sounds like good news to me.
Posted 8/10/2020 8:08 AM (GMT -7)
Another 6 months go by. PSA 5.4, PHI 38, which is a little higher. Dr. says it is still at average risk range so repeat lab with office visit (once a year) in 6 months.
.........................................................................................................................................................
2013, age 50, PSA 3.5
2014, age 51, PSA 3.6
Sept 2016, age 53, PSA 3.9
Dec 2017, age 54, PSA 5.1
Jan 2018, age 54 1/2, after two weeks antibiotic, PSA 5.89, PHI 33
Jun 2018, age 55, PSA 6.22, PHI 38.23 (biopsy cut-off 36). 12 sample biopsy negative, ultra sound detects prostate size 59
Feb 2019, age 56, PSA 5.8, PHI 35
Aug 2019, age 56, PSA 6.4, PHI 24
Feb 2020, age 56 1/2, PSA 6.46, PHI 32.18
Aug 2020, age 57, PSA 5.4, PHI 38
Posted 8/10/2020 9:03 AM (GMT -7)
Hi. I was in your boat with a 30 yr. history of BPH, but with a slowly rising PSA. I had 9 negative biopsies over the years, until the 10th came back with G 10 cancer. Have you discussed having an MRI to screen for suspicious lesions?

The problem, as you know, is that conditions like BPH that cause a rising PSA do not exclude a PSA contribution from PCa. Both MRIs and biopsies can miss existing cancer. The remedy is to repeat these over time when PCa is suspected. I am a surprised if you have never had either a biopsy or an MRI, even if it's to have a negative baseline for future reference. Biopsies diagnose conditions other than PCa too.

Djin
Posted 8/10/2020 9:48 AM (GMT -7)
Djin,

Thanks for the reply. Yes I had biopsy in Jun 2018 and it was negative. My Dr. told me to follow up and I might have to do RMI but it seems now the level of PSA and PHI don't trigger him to take that action just yet. I will have another lab check in 6 month with office visit. Or I shall ask him now?

Thanks again!
Posted 8/10/2020 12:25 PM (GMT -7)

Jiangkong said...
Djin,

Thanks for the reply. Yes I had biopsy in Jun 2018 and it was negative. My Dr. told me to follow up and I might have to do RMI but it seems now the level of PSA and PHI don't trigger him to take that action just yet. I will have another lab check in 6 month with office visit. Or I shall ask him now?

Thanks again!

Remember we are not doctors! Sometimes a uro will tell a patient something like "We can do X now, or we can wait Y months and do it." In those cases my instinct would be to do it earlier -- if you wait and don't get good news, you may be haunted by the "What if I had acted earlier?" question.

Djin
Posted 2/19/2021 10:02 AM (GMT -7)
Ok, another 6 months go by. I did my 6 month lab check. This time the PSA is 5.18 and PHI is 28.94. My urologist is happy to see the trend is stable and not creep up. He thinks this confirms that the BPH is the main cause of the PSA elevation. He will keeps checking at annual base. Usually after biopsy they recommend two yeas 6 month lab and annual physical exam. Now he suggests me go with normal annual lab with physical exam. I will keep posting the results here.

Jk
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