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Geekything
New Member


Date Joined Jun 2018
Total Posts : 15
   Posted 6/3/2018 6:14 PM (GMT -6)   
Hi.

A year ago I challenged my GP on why I hadn't had a PSA yet. Where I come from (not Canada where I live) you'd be getting PSA tests by this age (45). Based on an enlarged prostate found under DRE, she humoured me and my PSA came back at 2.9 and free % 15%.

She didn't want to send me to a urologist because "anything under 4 is normal". I challenged her on that because I'd already read lots of urologist use a lower cut-off for my age. I won the battle and got shipped off to a urologist.

The urologist wanted to take a wait-and-see approach and ordered a PSA and free PSA test 1-year into the future. I've just done these tests and now have a PSA of 5.2 and a free % of 7%.

So, I'm a little anxious and don't see the urologist for a few weeks. Does this sound like anyone else's story to PCa?

Also, am I right in thinking that aggressive PCa is more likely in younger men? I am also right in thinking that treatment tends to be aggressive due to the potential to save life expectancy (versus someone older who might not die from having a tumour for a number of years).

Thanks in advance.

Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10121
   Posted 6/3/2018 6:22 PM (GMT -6)   
Geekything said...
Also, am I right in thinking that aggressive PCa is more likely in younger men?


No. The opposite is true.

Geekything said...
I am also right in thinking that treatment tends to be aggressive due to the potential to save life expectancy (versus someone older who might not die from having a tumour for a number of years).


Treatment should be based on physiological age, not chronological age. If you're 90, there's probably no need for treatment.

Since an enlarged prostate can explain your results, no need for biopsy yet. Ask for a Prostate Health Index (PHI) next time. Take finasteride if your enlarged prostate is causing problems peeing.
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

Geekything
New Member


Date Joined Jun 2018
Total Posts : 15
   Posted 6/3/2018 6:25 PM (GMT -6)   
Doesn't the free % help filter out benign rather than cancerous outcome?

InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 8618
   Posted 6/3/2018 8:44 PM (GMT -6)   
Welcome to HW.

This story also leads to BPH (enlarged prostate). All the free % does is give you a risk factor.
Your PSA is low and possibly explained by enlarged prostate.

You have no reason to rush into anything but a planned monitoring program.

A basic rule is that you don't consider PC until you rule out all other possibilities.

Andrew
I'll be in the shop.
Age 58, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17, .3 10/17 .3 4/18
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10121
   Posted 6/3/2018 9:28 PM (GMT -6)   
Geekything said...
Doesn't the free % help filter out benign rather than cancerous outcome?


It helps. It's better than PSA alone, but it's still not very good. Prostatitis and BPH still affect it. PHI is better, but its far from the screening tool we'd want. If you can't get PHI in Canada, you can take finasteride for a few months to see if that affects the PSA. If it keeps going up while on finasteride, it's a good sign that a biopsy is warranted.
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

jmadrid
Regular Member


Date Joined Sep 2017
Total Posts : 153
   Posted 6/4/2018 6:20 AM (GMT -6)   
IMO, "Anxious" is not a very well chosen title for a thread here, most of us are anxious for one reason or another. Welcome to "anxietyland".
More seriously, low or borderline % free PSA is not usually associated to BHP, only to prostatitis or PCa. A big jump in PSA in a short period of time is usually due to prostatitis while PCa shows a smoother bur clear and constant increase. Therefore, further checks are probably needed at this point.
Any PSA below 10 alone cannot indicate if you have an agressive form of PCa or not or if you have any kind of PCa. Low free PSA is not related with high risk PCa as far as I know. It is better that you relax and, in the meantime, you learn enough about this complex stuff to detect if your urologist is giving you a reasonably good advice (there is a very good chance this will be the case) or if he indicates something that does not make much sense (it happens sometimes).
67 years old.
PSA: 2008:2.8; 2012-2016: 4.5-5.5. 2013: two biopsies (ASAP and neg) and a neg mpMRI.
Feb, May, July 2017: 5.5, 6.1, 7.6; free: 25%-20%
mpMRI, July 2017: PIRAD5 5.
Dx August 2017,Gleason 3+3, 2 cores, left 5%, right 3%.
Prostate more than 100 g. DRE +.
Manual LRP, november 6, 2017.
Bilat., 30% and 5%. G 5+3. Clean margins, not other features.
psa 2018: 1-31:0.08; 4-16: 0.05.

hrpufnstuf
Regular Member


Date Joined Mar 2012
Total Posts : 412
   Posted 6/4/2018 10:21 AM (GMT -6)   
I'd be anxious too in your shoes. At age 45 a PSA of 2.9 and free PSA of 15 warranted further consultation with a urologist. A year later your PSA has almost doubled and your free PSA is half; worrisome numbers for sure. The enlarged prostate determined by the GP could certainly be a contributing cause, as could prostatitis. I assume you haven't seen the Uro yet, only gotten the PSA results. When you do, ask about having a mp-MRI. More men are having one in cases like yours before having a blind biopsy. The MRI will give you an accurate measurement of your prostate, report any finding of prostatitis and, most importantly, determine if any cancer is seen that is worth doing a biopsy. If nothing is found on the MRI then you have more assurance that your condition is benign or caused by low level indolent cancer, not worth knowing and worrying about. If the radiologist thinks a biopsy is in order you'll get a fusion, targeted biopsy rather than random.
Age 69 DX 06/14 1 of 24 cores positive, 5% involved, (3+4), psa 6.2
2nd opinion from JH (3+3)
3rd opinion from UFPTI (3+4)
mpMRI Duke: 50% chance of SV spread
SV fusion biopsy Duke 10/2014 negative
proton at UFPTI 11/14-01/15
PSA:
07/15 2.5
01/16 1.2
07/16 2.5
01/17 .7
01/18 1.4
04/18 .7

Post Edited (hrpufnstuf) : 6/4/2018 11:46:59 AM (GMT-6)


Geekything
New Member


Date Joined Jun 2018
Total Posts : 15
   Posted 6/4/2018 11:47 AM (GMT -6)   
Thank you, everyone, for your input. Sorry if my subject title was a bit insensitive.

The only real prostatitis symptom I have (and I understand it can also be asymptomatic; I could have it still) is frequent/nighttime urination. I take lithium for bipolar disorder which encourages thirst, which the urologist felt was likely the cause (I drink 4-6L of fluids a day!) of this.

I suspect he'll immediately order another PSA test and take things from there. I'll definitely mention mp-MRI and fusion biopsy. I'm not sure either is part of our health system, but fingers crossed.

Thanks again.

Artist Mark
Regular Member


Date Joined Apr 2016
Total Posts : 319
   Posted 6/4/2018 2:37 PM (GMT -6)   
I will only tell you my experience......my case was a bit out of the ordinary. This is not intended to cause more anxiety although it probably will and I apologise if it does.
If you look at my signature you will see that my PSA was 3.42 with a %fPSA of 7.6. I am older than you and was Dx at 59yrs. My DRE was somewhat inconclusive as I had 3 different opinions from 3 Ds. My PCP thought he felt a hard ridge and firmness on one side. The other 2 weren't sure. All 3 drs thought that I was in the standard range and didn't think a biopsy was necessary. One dr. did state that if I wanted one, he would order it. After posting my situation here on HW I received many responses. I balanced those responses and more guys said they thought a biopsy was called for . Some said wait, others weren't sure. I decided to ask for the biopsy.

When I got to the appointment for the Bx, the uro that performs them in the group I see asked why I was having it done.... to him my PSA was normal. I persisted and he told me he would give me one if I wanted. (Like I was only there to experieince the thrill of it all) His words were" Ok.......if you want one...I'll give you one.
I will tell you ...I felt like most everyone thought I was crazy.

My Bx came back G9 with 8 of 12 cores cancer..... exactly 2 yrs ago yesterday.

So..... That is my story...... You are the one in charge of you health. You are the one that must be your advocate.
I followed my gut. I did research and asked a lot of questions.

So here you are, in much the same boat I found myself in. I can't and won't tell you what you should do about getting a biopsy. You now know a bit about my expereince .........take from it what you will.


I will tell you.....Stay on this. Take what suggestions that have already been given and those that will follow. Be your own Advocate.


I wish you the best going forward. It might be something very minor but you want to be sure.


Battle On Brothers!


The Artistic One - Mark
Age/Dx 60
Dx 6/3/2016 PSA 3.42 %fPSA 7.6
Bx 6/1/2016 G9 ... 8 of 12 cores positive (70% - 60% - 30% - 30%)
4+5 =G9 (4 cores) 5+4 =G9 (2 cores) 3+4 =G7( (2 cores) PNI..
4/16 ct scan neg 6/13/16 Bone scan..neg
Stage T2c Grade 5
6/16 Zoladex,Lupron 9/16-12//17
8/30/16 IMRT 79gy 39 fractions
PSA 1/17- 3/17 0.02, 4/5/17-11/17 0.01
1/17Docetaxel,4 infusions
18 months HT completed 12/17

Geekything
New Member


Date Joined Jun 2018
Total Posts : 15
   Posted 6/4/2018 3:47 PM (GMT -6)   
It doesn't give me more anxiety. What gave me anxiety was the cute message on my lab reports (I think this leftover from when doctors only got the reports) that said I had a 44-56% probability of cancer smile

Thanks for sharing.

Geekything
New Member


Date Joined Jun 2018
Total Posts : 15
   Posted 6/5/2018 7:43 AM (GMT -6)   
Am I right in thinking that my good bloodwork, lack of white cells in my urine, and lack of culture of my urine start to rule out prostatitis? Is the next step massage (boy am I not looking forward to that) and possibly imaging?

InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 8618
   Posted 6/5/2018 8:05 AM (GMT -6)   
Imagining would be the next logical thing to do. Find out the size of your prostate to evaluate for BPH. If the PSA isn't due to enlargement, then you move on to the next test.

Prostatitis is inflammation, not always infection, which is why antibiotics aren't effect in the treatment of it. Actually the word, "prostatitis" translated from the Latin to mean, "Irritated prostate" The suffix, "itis" just means irritation, as in gastritis or "upset tummy." Prostatitis is often hard to diagnose and hard to treat. Most times you just live with it.

A PHI test would be a better blood test to get. Gives much better information.

Andrew
I'll be in the shop.
Age 58, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17, .3 10/17 .3 4/18
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

Geekything
New Member


Date Joined Jun 2018
Total Posts : 15
   Posted 6/13/2018 9:53 AM (GMT -6)   
Saw my urologist this morning. Given my age, he is quite concerned about the latest PSA levels, especially that my free PSA % has halved in a year and my total PSA has more-or-less doubled. He acknowledged my prostate was slightly enlarged.

He said best case scenario is this is a "blip" and that I could go back to the vicinity of my last total PSA of 2.9 (still outside the reference range for my age) and then he'd definitely be less concerned.

I have my biopsy on August 15th. He explained the risks in detail (gave me stats). It was refreshing to have a doctor not downplay the risks of a procedure.

Artist Mark
Regular Member


Date Joined Apr 2016
Total Posts : 319
   Posted 6/13/2018 10:28 AM (GMT -6)   
Thanks for the update. Keep moving forward and keep us up to date on the Biopsy.
For me the Bx was uncomfortable and not painful after the first needle poke to numb things. Didn't last very long and I didn't have any issues following aside from the blood in urine and semen that didn't last past the first day and the first ejaculation.
Age/Dx 60
Dx 6/3/2016 PSA 3.42 %fPSA 7.6
Bx 6/1/2016 G9 ... 8 of 12 cores positive (70% - 60% - 30% - 30%)
4+5 =G9 (4 cores) 5+4 =G9 (2 cores) 3+4 =G7( (2 cores) PNI..
4/16 ct scan neg 6/13/16 Bone scan..neg
Stage T2c Grade 5
6/16 Zoladex,Lupron 9/16-12//17
8/30/16 IMRT 79gy 39 fractions
PSA 1/17- 3/17 0.02, 4/5/17-11/17 0.01
1/17Docetaxel,4 infusions
18 months HT completed 12/17

Geekything
New Member


Date Joined Jun 2018
Total Posts : 15
   Posted 6/13/2018 10:47 AM (GMT -6)   
Artist Mark said...
Thanks for the update. Keep moving forward and keep us up to date on the Biopsy.
For me the Bx was uncomfortable and not painful after the first needle poke to numb things. Didn't last very long and I didn't have any issues following aside from the blood in urine and semen that didn't last past the first day and the first ejaculation.


I am really not looking forward to the Bx. Dumb question, the anesthetic goes into the prostate?

Am I being over anxious taking a pair of adult diapers for afterwards?

fiddlecanoe
Regular Member


Date Joined Oct 2016
Total Posts : 323
   Posted 6/13/2018 11:06 AM (GMT -6)   
You won't need diapers. But remember to take the antibiotic pill in advance to reduce risk of infection. It was uncomfortable and strange to contemplate what the Dr. was doing in there. But it didn't really hurt. When it was done there was no lingering discomfort.

Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10121
   Posted 6/13/2018 12:09 PM (GMT -6)   
You should ask for a "periprostatic nerve block" or a "pelvic plexus nerve block." The anesthetic is injected into specific nerves that your doctor can find using the ultrasound probe. They will block all sensation in the prostate, and leave you awake and alert.

You may see some blood spots in your poop and in your urine at first, but that should disappear quickly. You will have blood in your semen for several weeks. It looks scarier than it is. You won't need diapers at all - who told you that?
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

Geekything
New Member


Date Joined Jun 2018
Total Posts : 15
   Posted 6/13/2018 12:12 PM (GMT -6)   
Tall Allen said...
You should ask for a "periprostatic nerve block" or a "pelvic plexus nerve block." The anesthetic is injected into specific nerves that your doctor can find using the ultrasound probe. They will block all sensation in the prostate, and leave you awake and alert.

You may see some blood spots in your poop and in your urine at first, but that should disappear quickly. You will have blood in your semen for several weeks. It looks scarier than it is. You won't need diapers at all - who told you that?


Nobody told me I need diapers, but figured they were good for rectal bleeding?

I will find out about the nerve block. Thanks!

jmadrid
Regular Member


Date Joined Sep 2017
Total Posts : 153
   Posted 6/13/2018 1:23 PM (GMT -6)   
Maybe you will observe some blood in the bathroom activities for a few days, but not in your clothes. In the rare case you observe significant rectal bleeding look for inmediate medical assistance. Semen will show strange and variable colors for as long as a month. Nothing permanent to be sure. Above all, you will need urgent medical help if you have moderate or high fever a few days after, but this is also rare. Usually, a prostate biopsy is not such a big event as most people fear and it does not require important adjustments in your daily activities.
67 years old.
PSA: 2008:2.8; 2012-2016: 4.5-5.5. 2013: two biopsies (ASAP and neg) and a neg mpMRI.
Feb, May, July 2017: 5.5, 6.1, 7.6; free: 25%-20%
mpMRI, July 2017: PIRAD5 5.
Dx August 2017,Gleason 3+3, 2 cores, left 5%, right 3%.
Prostate more than 100 g. DRE +.
Manual LRP, november 6, 2017.
Bilat., 30% and 5%. G 5+3. Clean margins, not other features.
psa 2018: 1-31:0.08; 4-16: 0.05.

convertible68
New Member


Date Joined May 2018
Total Posts : 16
   Posted 6/13/2018 1:41 PM (GMT -6)   
I will say I just had my biopsy Monday and didn’t get any blood in my urine a little the next morning on the backside when taking care of business. But OMG I can’t stress enough that when they say a little blood in your semen they mean nothing but BLOOD. I swear it was worse than any horror movie scene I have ever seen. Maybe my case is one of the extreme ones but don’t panic.

Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10121
   Posted 6/13/2018 2:27 PM (GMT -6)   
The rectal bleeding, if any, is minuscule, and is nothing to worry about. I never had any myself, and I had 3 biopsies.
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

garyi
Veteran Member


Date Joined Jun 2017
Total Posts : 799
   Posted 6/13/2018 2:57 PM (GMT -6)   
fiddlecanoe said...
.....remember to take the antibiotic pill in advance to reduce risk of infection. /quote]

OK, but not blockbuster Cipro, which causes more harm than good. You want the most benign antibiotic possible. Good luck!

MacroMan
Regular Member


Date Joined Aug 2017
Total Posts : 58
   Posted 6/13/2018 5:34 PM (GMT -6)   
convertible68 is right.

I too had a couple ejaculations that looked like a cheap ketchup and lots of it! They didn't concern me at all but I did 'enjoy' the experience! The next few looked like a cheap chocolate milk like liquid.

I took my cipro as instructed but failed with delivering the morning enema. Having had a BM a couple hours before, I had no ill effects. I was however very concerned about the entire procedure beforehand.

Afterwards, I did have cramping for a few hours after the biopsy but after a walk that quickly dissipated.
DOB: Oct 1955
PSA 4.4 May '16
5.79 Oct '16
5.0 Jan '17
7.1 Apr '17
6.1 Sept '17
4.2 Mar '18 T337ng/dl
MRI Jun'17 Prostate Fusion Biopsy late Sept '17 Prostate Size ~30cc
Dx Oct. 16, 2017
1 core (Right Side -Mid medial) of 13 showed cancer (adenocarcinoma) GS 8 4+4 40%
IMRT 23 sessions Start date Dec. 18, 2017. End date Jan.18 2018
Brachy Feb 1st 2018 Iodine 125 84 seed

Geekything
New Member


Date Joined Jun 2018
Total Posts : 15
   Posted 6/13/2018 5:56 PM (GMT -6)   
MacroMan said...
convertible68 is right.

I too had a couple ejaculations that looked like a cheap ketchup and lots of it! They didn't concern me at all but I did 'enjoy' the experience! The next few looked like a cheap chocolate milk like liquid.

I took my cipro as instructed but failed with delivering the morning enema. Having had a BM a couple hours before, I had no ill effects. I was however very concerned about the entire procedure beforehand.

Afterwards, I did have cramping for a few hours after the biopsy but after a walk that quickly dissipated.


I was prescribed Cipro, but I have to check I can take it.

The enema sounds like fun ;)

Thanks for letting me know not to panic about cramping. My wife is concerned about the whole thing, and is taking the day off to transport me and generally keep an eye on me.

Paxton
Veteran Member


Date Joined Aug 2016
Total Posts : 1051
   Posted 6/13/2018 6:57 PM (GMT -6)   
While having the wife along is great for moral support, do not for a minute believe that this will be anything but a quick, annoying few minutes. After my biopsy, I took my wife out to lunch, then went back to work for the afternoon. With the proper nerve block, as TA mentions, it is a big non-issue.

One thing to ask your uro about -- mine routinely does a rectal swab a week or so in advance of the procedure. Lab analysis of the swab allows them to know if your body harbors any (benign) critters that would be immune to the Cipro. If you do (as I did) have any Cipro-resistant bacteria in your system, they can give you a supplemental shot of an appropriate antibiotic.

Just an anecdote - I had that antibiotic shot a couple of days before my biopsy, and the shot hurt worse than the biopsy itself did.

Hang in there. The biopsy is just something that has to be done to get the answers we need.
Age 68 at Dx
PSA history: 2000-2012 0.9-1.2; 06/2012 started T replacement
2013-2015 3.0-3.3 (new normal); 11/2015 4.6; 05/2016 5.7
Biopsy: 12-core biopsy 07/2016; 3 cores G3+3, 5% or less; 1 core 3+4, 15%; 1 core HGPIN; 2% of gland involved. Summary G3+4.
CyberKnife SBRT with Dr. Hirsch; start 11/15/16, finish 11/23
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