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Do I need a second opinion?

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Do I need a second opinion?  
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Posted 1/13/2007 3:06 PM (GMT -7)
For the last 18 months, my PSA has been rising, from 5.5 to 8.5.  Free PSA a year ago was 14.  Two biopsies.  First showed PIN and second was negative.  Last week had my sixth PSA and it was 4.4 so my urologist told me to wait a year to do the next PSA since it was "back to normal."  Am I wrong to think he's nuts?  I'm 60, caucasian
Posted 1/13/2007 4:39 PM (GMT -7)

There is no such thing as a "normal" PSA, and an isolated reading is less important than the overall trend. 

Lots of things can influence it, including size of your prostate which is why "free PSA" is tested and why it's worthwhile doing the simple calculation of your "PSA Density" (PSA divided by gland size) to determine what % of the PSA is due to benign enlargement.

There is low grade PIN and high grade PIN which is more relevant. High grade PIN does not mean that you'll inevitably develop PC, but it is a signal to improve life style, and undertake closer monitoring.

Biopsies are not 100% accurate: they can miss  small cancers, although this is far less usual with two being done,  and readings are subjective: what might seem normal to one could seem more suspicious to another.

With some gray areas, I'd be having another PSA and "free PSA" in a few months, improving lifestyle, exercise, diet, nutrition etc where possible, monitoring more closely, and if there's concern, have biopsies sent for another opinion.

John

Posted 1/13/2007 5:47 PM (GMT -7)
Most of the folks here have more knowledge than I, but that 14% free would worry me.

Bill
Gleason 3+3=6, T1c, one core in twelve, another pre-cancerous.
62 years old and good health.  Married 37 years.  To same woman!

Posted 1/13/2007 8:51 PM (GMT -7)
Peace of mind wouild drive me to demanding another PSA in three months. There have been so many cases of prostate cancer reported on this forum and other web sites when the PSA was in the "norm" that I would not trust waiting a year. As pointed out the biopsy needle misses a lot of prostate cells and if there is the start of an agressive cancer that was not sampled your PSA could rise rapidly within a year.

Tamu
Diagnosed 7/6/06
1 of 10 core samples, 40%
Stage T1c, Gleason 3+3
Da Vinci on 11/01/06
56 Years Old
Post Op Path
Gleason 3+3
Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06

Posted 1/13/2007 8:54 PM (GMT -7)
Hi CaptainDan,

PSA free of 14% sounds a bit low to me. Here is an exercept that I pulled from the website

http://psa-rising.com/medicalpike/fpsa.htm

"Now we can figure with more accuracy who not to biopsy," Dr. Alan Partin said. Partin said: "The study demonstrated that men in the diagnostic gray zone should probably be biopsied only if their percentage of FPSA (free PSA) is at or below 25 percent." "At that level," he said, "we can detect 95 percent of cancers while excusing men with benign diseases from the need for a biopsy."

Since your PSA free of 14% is less than 25%, it would seem to indicate the need for another biopsy. However, given that you have already had two biopsy's (one or more within the last six months I assume) I am less certain what you should do next. At a point like that, a second opinion might not be a bad idea. On the other hand your doc might be right and you might just want to wait but I would certainly be getting my PSA and PSA free tested fairly often (three to six months) if I were you.

Maybe wiser minds than mine in this chat room will have better advice.

Good luck.

Ben

DIAGNOSIS: 09/25/06. Age 49. PSA 4.6. PSA free 2%. Clinical pathology: Gleason 10. Stage 2a.           
 
SURGERY: 11/08/06. RP at Johns Hopkins. Surgical pathology Gleason 10. Stage T3a (positive margins.) Negative seminal vesicles, lymph nodes, and bone scan.
 
POST OP: First post op PSA was 0.00 in 12/06.

Post Edited (BenEcho10) : 1/13/2007 9:01:32 PM (GMT-7)

Posted 1/14/2007 12:48 PM (GMT -7)
Cap'Dan:

As Tamu pointed out, yep, the biopsy can miss some of the cancer. In my case, the pathology report on the prostate indicated that the cancer was much more widespread than the biopsy indicated. If you haven't decided what procedure to take, at least get a PSA every few months to keep an eye on it.

George
        Age 59 -  psa 2.5 to 4.5 in 11 mon.
 9-17-06: DRE - enlarged prostate & nodule L/S
10-10-06: Biopsy
10-17-06: Biopsy Report: 3+3, 3+3, 3+4 
10-30-06: CT & Bone Scan - OK
11-13-06: 2nd CT & chest X-ray - OK
11-28-06: Physical Therapy - Intro to Kegals
11-30-06: Pre-Op for Surgery
12-06-06: Robotic surgery
12-11-06: Catheter out - Total Control
12-12-06: Path report - more cancer area than biopsy indicated. Right nerve bundle saved. Appears confined to prostate. Nodes & Vessels clean. 
Cancer is what we HAVE
"Cancer SURVIVORS is who we'll be!!"

Posted 1/14/2007 3:53 PM (GMT -7)
Hi ~ Capt’ Dan…                           Sending a “Warm Welcome” …to You!   Personally ~ we would not wait a year, we wouldn’t wait 6 months…   The information in the postings above give you lots of food for thought…and aren’t there other areas that can be checked … like maybe an infection…   Peace of mind……… I’d be checking out another urologist to see if s(he) comes up with the same response as the 1 st and then I’d still not wait too long to follow up.   Wait a year??? I don’t think so!!!   Hopefully ~ we will be sending you on your way with no diagnosis of prostate cancer….   David’s Wife signed on and we followed her through tests that determined an infection.   Truly a happy moment for all of us!!!!   Because ~ we become a family of friends on this forum.   So ~ there’s always hope ~ and something you need to remember ….”You” are important to us and we would like to follow you on your search for answers.   Stay with us and know we care!!   In Friendship ~ Lee & Buddy mama bluebird - Lee & Buddy… from North Carolina Link to our personal journey…>>>      Our Journey ~ Sharing is Caring   April 3, 2006  53 on surgery day RRP / Radical Retropubic Prostatectomy with "wide excision" PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate June 29th ~ PSA Less than 0.1 Non-detectable
Posted 1/15/2007 12:52 AM (GMT -7)
Captain Dan,
I am new to this forum and have PC. I can only lend my opinion. When my first PSA was 19, I was told to wait 5 weeks and we'll test again. Now that I know I have the disease, I hate that I waited 5 minutes for the possibly unnecessary biopsy. Tamu is right, the biopsy can miss the target. But waiting a year can miss the target, too. You're young and should be tested once a year no matter what your PSA is. But since it's above the 4.0 that is clinically recognized as higher risk, getting a second look at it is only prudent. Good luck. I believe you are just fine, and I hope you the best.

tc
Posted 1/15/2007 11:31 AM (GMT -7)
Dear all:

I can't believe how many kind and concerned responses I have received! Thank you all. I have today made an appointment with another urologist for 1/29 to get the second opinion. I'll let you know what he says. Thanks again.

Captain Dan
Posted 1/31/2007 9:00 PM (GMT -7)
Hi Captain Dan,   Yes ~ this is truly a wonderful forum with very kind souls.      We’re waiting for you to check in with us with results from your January 29 th appointment.   Keeping you close in thoughts and prayers… In Friendship ~ Lee & Buddy mama bluebird - Lee & Buddy… from North Carolina Link to our personal journey…>>>      Our Journey ~ Sharing is Caring   April 3, 2006  53 on surgery day RRP / Radical Retropubic Prostatectomy with "wide excision" PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate June 29th ~ PSA Less than 0.1 Non-detectable
Posted 2/2/2007 10:14 PM (GMT -7)
47 year old, psa went from 2.5 to 4.1 in 6 months. Dr immediately said biopsy. Diagnosis PCa T2c. Gleason score 3+3=6 on both lobes. Get a second opinion. My husband even spent a week in hospital following biopsy secondary to an infection ( we were in mexico for new years) and we both would still recommend early diagnosis. We are still in early stages, dx one week ago. Good lick to you
Posted 2/3/2007 6:31 AM (GMT -7)

Captain,

IMHO a doctor who suggests you can wait a year given the criteria you have shared, is dangerous to mankind. I'm so glad to see you have sought out a second opinion. Let us know how it goes.

Reminds me of my brother (age 61). When he went to have his last physical his doctor asked "do you want to have your psa checked? Lots of guys are not doing it, because the cancer is slow growing." Such a paradigm and comment will likely send some men to an unnecessarily early grave.

Markus


Age, 53
PSA 3.76, Gleason 6, T1c, scans negative
psa doubling time 35 months
Still researching and deciding treatment options.  Leaning towards da vinci robotic.

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