My PSA increased 1 ng/ml over a year

goggoga · Regular Joined: 22 Sep 2009 Posts: 11

46 yr. old, white, no family history for PC. For the last few years, 2004-2008 my PSA was between .6 - .75 with the last values on June 2008 .61. Free ratio was .57. Annual check up on June 2009 said PSA 1.75 and frees ratio .27. Seeing the urologist on July 2009 he said that I should have a biopsy, which it is coming on October 5th, 2009. In the last six years, I had asymptomatic microhematuria in urine, which disappeared for a while and coming back. Always traces no small amount. The specialist performed cytoscopy on July 2005 and June 2009 and he did not found any reason for hematuria. I have a discomfort on my pelvis, no back pain, no joint pain only burning on urethra after urination. That happens when I drink a lot of water on short time and I need to go to washroom more often. Over night going out one time and not on every night. Starting with 2005, the specialist put me on Flomax which helped to remove the symptoms on the beginning but on 2007 the doctor said to take one in the morning and one in the afternoon. I am still on Flomax, once a day for now how the specialist prescribed. End of July 2009 the urologist performed DRE and he told to me NAD - supposed to means that nothing detected. I will go for transrectal ultrasound on next week. Now, on September 09, 2009 I ask my family doctor for one more PSA and free ratio to see the evolution over three months. The result scared me like crazy because PSA came back 2.25 and frees ratio .33 - this values bigger than June 09 does. The first result did not scared too much because I supposed that I was lucky to catch something pretty earlier, but the second one make me crazy. I am taking prescribed pills for sleep and also pills for days, so I can be able to concentrate at work. The DRE was done on July 25, 2009 and it was a hard one because the doctor used a lot of pressure to try to catch something on my prostate. As I already told you, NAD. Can the result from September 09, 2009 be not so accurate because of the DRE done on the end of July 25, 2009? Or the disease is aggressive? Also, can I have other symptoms? I asked urologist couple of years for a biopsy but his answer was NO because my entire test. This year, he asked me directly if I want to have a biopsy or I want to stay and watch. I choused biopsy but I am really scared. Can somebody tell me something from own experience and has an advice? I am dealing very hard with this situation. Thanks a lot

johnT · Senior User Joined: 27 Apr 2009 Posts: 177

I would get a free PSA and a PCA3 test frst. If these are abnormal then a biopsy is necessary.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

goggoga · Regular Joined: 22 Sep 2009 Posts: 11

The test was for tPSA and fpsa so I got PSA ratio. Is any difference according with your answer? The other test I heard about it last week and I am going to ask for. The urologist ask me on July 2009 if I want a biopsy or I want to wait and watch. What do you think? I worry for the PSA velocity and I did not take any medication.
Thanks,

goggoga · Regular Joined: 22 Sep 2009 Posts: 11

Free PSA ratio was .27 on June and .33 - increased - on September

So,

June 2009 fpsa - 0.4725
September fpsa - 0.7392

What do you think?

goggoga · Regular Joined: 22 Sep 2009 Posts: 11

Hello everybody,
I am back with a lot of news, bad or good and also a lot of question.
Before the biopsy, like a week, I had an transrectal prostate ultrasound stating that prostate is normal in size and echogenicity with a volume of 29 cc. No suspicious lesions were identified. The seminal vesicle demonstrated some cystic change but is otherwise unremarkable. The urinary bladder appears normal.
First of all, I had my biopsy on October 5, 2009. I would like to ask people here what they think about how the procedure was done and also how the pathology report was obtained. The biopsy was performed with a flex cysto and it was a finger guided prostate needle biopsy. My concern is regarding the accuracy of the biopsy.
The specimens were from right and left prostate sides.
Gross examination:
A. Specimen: right prostate biopsy, consists of seven strips of biopsy tissue ranging in size from 0.4 to 1.6 cm in length. All tissue is embedded in one cassette.
B. Specimen: left prostate biopsy, consists of seven strips of biopsy tissue ranging in size from 1.4 to 2.1 cm in length. All tissue is embedded in one cassette.
Microscopic Examination:
A. B) Slides examined.
Pathological Diagnosis
A. Right prostate, needle core biopsies: Portions of benign prostatic tissue; no tumor seen.
B. Left prostate, needle core biopsies: Portions of benign prostatic tissue; no tumor seen.
Comment: Immunohistochemical stains are performed using antibodies to AMACR and CK34BE12.
I am asking you people if you can help me with some advice regarding my whole procedure. How accurate can be? Do I need to take another one, biopsy? I am thinking to schedule an appointment with Dr. Lee on Rochester in order to have a color Doppler US and maybe biopsies on necessary point. Does anyone have experience with color US? Also, should I retest my PSA and fPSA ratio because I have the latest from beginning of September 2009 and I am almost 6 weeks from the biopsy? If I will have biopsy with color US I will not be able to get another PSA for two months from now.
I still have problems when urinating, pain around the base of penis which is gone after urination, sometime burning after urination. They are worse when I'm sitting or laying on the couch but not so bad when I am standing. The urologist prescribed me Flomax and Xatral and he told to me to take the one doing better job. It is looking for me that Flomax is doing better, but I am concerned about the Flomax and the PSA value. Also, I used to take Flomax for a while but when I stopped it the symptoms coming back. The concern for me is the PSA velocity but my GP and urologist does not pay to much attention to it.
Please, I need some answer because I already into depression so I do not really what can be the right thing to do. My wife and my friends keep telling me do not worry how long the doctors said that is no cancer and they keep telling me that I have a head problem and everything is generating inside of my head.
Thanks,
Gog Goga

Otago · Experienced user Joined: 20 Jan 2008 Posts: 64

Gog,

1.) between June 09 and Sept. 9, 2009, how many weeks did you spend on Cipro or other antibiotic? Also, how many of those weeks did you spend on anti-inflammatory drugs such as ibuprofen (Advil etc)..?

In other words, how often and for how long were your doctors treating you for prostatitis of either bacterial or non-bacterial origin during that time between tests?
---------------------------------------------------------------------
2.) You state------
Free PSA ratio was .27 on June and .33 - increased - on September
What do you think?

Both are just fine
-----------------------------------------------------------------------
3.) You had a 14 core biopsy done... which showed nothing.

Still you ask, "Do I need to take another one, biopsy? "

NO

You should not get another biopsy now. You should not get a color Doppler now.
----------------------------------------------------------------------
4.) Your friends and wife sound correct in their assessment of your condition being located above the shoulders.

At this point, you should probably wait more than 3 months for another PSA or fPSA. I'd think your doctor would advise something like 6 months.

But I'm still curious as to just how many steps you took to rule out or reduce prostatitis as being the most obvious cause of your PSA rise.

You did not indicate any such treatment or pills, prescription or over-the-counter, for inflammation or for potential infection.

AS to your focus on PSAV (velocity), perhaps you might find this November 2009 study interesting, where they conclude there is not very much predictive value in using PSAV to indicate the need for a first biopsy.

http://www.europeanurology.com/article/S0302-2838(09)00795-7/fulltext#tbl2

Also, take some time to read the following page

http://www.diagnosis.prostate-help.org/psa.html

Sleep well,

Otago

PS... BTW, I see you posting on another forum which I don't post on.
There you ask about getting a second opinion/reading of your samples.

I have to suggest that would be a complete waste of time and money if you are paying for it.
Why?
Because your results are not about whether a reading is a 3+3 Gleason 6 or a 3+4 or a possible 3+2 versus a 2+3 etc...

Your report read all the 14 samples and said all were benign.
Others may respond here, but I don't think you even have any close calls, certainly no 3's in your samples...

I'm wondering if any of your samples could even include some 2's and still be said to be benign?

In other words it doesn't appear you have any close calls that a second opinion could re-label as even a Gleason 5 total score.
Second opinion/reading would only seem to waste money.

As to a second biopsy, ultrasound guided, or with color doppler..
At this stage, with your PSA and fPSA numbers, it also seems like another waste of money and time.

Wait 3 to 6 months, retest your PSA after giving probable prostatitis a chance to calm down, then should you need to have a second biopsy, THEN, you can do a ultrasound guided biopsy. Not now.

goggoga · Regular Joined: 22 Sep 2009 Posts: 11

Hello Otago,
To answer to you:
1. No Cipro, no antibiotics, no anti-inflammatory
2. Txs
3. Txs
4. Txs

Otago · Experienced user Joined: 20 Jan 2008 Posts: 64

Gog...

Note, while you were posting your most recent reply I was adding a PS to my prior above post..
You can go back and read my PS addition with some additional commentary.

Now, as to your response here...

"1. No Cipro, no antibiotics, no anti-inflammatory "

Do you realize what you are saying?

No, wait a minute.....Do you realize what you are saying?

You are saying that nothing was done to address the most obvious and common cause of your heightened PSA test results in June and September.

Instead, you were put on some crazy train down the biopsy tracks and have worried yourself silly.

Do you not realize that prostatitis is by far the most common cause of a sudden jump up in PSA scores, especially when accompanied by very good fPSA scores.

I'd have to wonder who is doing your repeated PSA scores without even a mild attempt to treat probable prostatitis.

This latest answer of yours only further suggests you don't need an second opinion on your biopsy samples....
Nor do you need a color doppler, nor do you need a second biopsy.

Right now you just need some time, and possible measures prior to a future PSA test to calm down prostatitis.

BTW, there are many types and causes of prostatitis.
Most are not bacterial and as such will not be helped much by anti-biotics.
Also, often prostatitis can be and is "asymptomatic" ...meaning you don't even know you have it. However its seems you've even had some things that might be called symptoms.

All in all, it seems you've let this entire affair get completely out of hand, leading to excess worry and testing.

Hard to believe there has been nothing at all done to reduce the probability that all this is due to simple prostatitis.

Reconsider everything you've been thinking and worrying about over the past 5 months.

Otago

goggoga · Regular Joined: 22 Sep 2009 Posts: 11

Hi everyone,
My main concern right now is about the way the biopsy was performed. Somebody from other forum pointed out about my concern. I just realized that the urologist performed a transurethral biopsy. I am really confused because I asked him before the procedure how he will perform and he said that he would use the fingers. Are the doctors still using this type of biopsy and is it any reason do not perform the most common one? Are the samples taken on this way from whole prostate or they are covering a limited area of it? Can I find out how accurate this procedure is and can be compared with the transrectal one? Now, should I go and have a transrectal one or I should wait? Regarding the medications, I am taking two Flomax daily and I do not need to go so often to the toilet and the pain is mild right now.
Thanks, Gog

Otago · Experienced user Joined: 20 Jan 2008 Posts: 64

Gog, I've read your various posts here and there.

You seem completely confused and I have no idea what your doctor actually did. It doesn't sound like you really know.

1. Call your doctor's office. Ask them "exactly" what they did to take the biopsy. Make sure you get the precise process they used.

2. Your communication with your urologist and perhaps even your primary care doctor seems very dismal. Either you or they have a problem with passing on or understanding information.

3. It may be better for you to start all over with a new urologist.

4. That does NOT mean you need a new biopsy.
You seem to fail to grasp the fact that no one seems to have made any attempts to calm any prostatitis. Had that been done, you very well may never have had any need to have a biopsy in the first place.
None of this issue about which biopsy procedure would be best would even be in question.

You see, you are putting the WRONG question in front of the primary question. That is whether you merely had a raised PSA due to simple prostatitis.

You are flailing about, worrying, and its all seems based on confusion about what really happened and what your true PSA is under calm conditions.

Start with step #1.... finding out what your doctor actually did.

Get a appointment with another local urologist. Before going in, ask what kind of biopsies they do so so that should.....you need another biopsy you will be happy.

Lastly you seem intent on ignoring your fPSA results, each of which was excellent.

I'd say you are safe waiting 3 months for that next appointment with another urologist. Make sure you choose one who meets all your criteria.
Ask other men who they use and who they like. Most older men have seen a urologist. There may be a local prostate cancer support group who would have some suggestions.

I doubt you have prostate cancer.
Calm down.

Otago

goggoga · Regular Joined: 22 Sep 2009 Posts: 11

Hi Otago,
Calling the doctor office today, I understood that he performed a transurethral biopsy. I do not know if it is a standard procedure and it has the same result like a transrectal one. Checking around, I saw that it is not giving the same result like a transrectal one. That why I do not know what should be my next step for now. I am taking your advises but it is very hard for me to calm down. I am trying very hard.
Thanks,
Gog

Otago · Experienced user Joined: 20 Jan 2008 Posts: 64

Gog, something you seem to miss. Quite aside from whether you ever needed a biopsy in the first place, you seem to think that a TRUS biopsy will confer "certainty" whereas the one you got is "uncertain".

You are going to have a very difficult next 20 years if you expect any certainty in this area of psa's, biopsies, and prostate cancer.
You see, even if you had received the kind of biopsy you feel is superior, it would have given you no assurance you did not have some prostate cancer lurking where the needles did not go.

If you choose your current mode of always worrying about the "certainty" of a given PSA or a given biopsy, you will be filled with dread for the next 20 years. You could have the very best urologist who gives you the very best TRUS biopsy and still easily miss prostate cancer. That's just how it is.
Currently you seem intent on removing even the slightest doubt, when the reality is there will always be doubt in whatever process you use.

Thus you will be worried sick for the next 20 years regardless of whether you have prostate cancer or not.
You'll drive yourself and your wife nuts.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

You're going to drive yourself crazy with undue anxiety.

As Otago noted, your free PSA looks great, but you seem to be overlooking this, or worse, getting it backwards. The higher the fPSA percentage, the less likely the source of the PSA is cancer.

I would just relax, get a regular PSA and DRE, and watch the trend. A good urologist will know when you should have a biopsy, when you should wait, and when you should try things like antibiotics and/or anti-inflammatory meds. If you don't trust your urologist to take care of you, find another.

Best wishes.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

goggoga · Regular Joined: 22 Sep 2009 Posts: 11

Updates after meeting with GP
Now I am clear because I have the operative report. The biopsy was transrectal and guided by rectal exam. The samples were from suspicious area and random areas from lateral medial apex, middle and base from both sides. Total of 12 biopsies. The report specifies that digital rectal exam found irregular prostate!
Can somebody tell me what irregular prostate means because the biopsies came back negative for cancer but benign portion of tissues?
Also, the ultrasound done a week before the biopsy did not show any abnormality in the prostate.
What you guys think about this?
Thanks,
Gog

Otago · Experienced user Joined: 20 Jan 2008 Posts: 64

Gog, Sounds like everything was done correctly and that every single one of the 12 biopsies came out clear...

Do you know what the word benign means? Check the dictionary so you are clear on the meaning.

"The report specifies that digital rectal exam found irregular prostate!"

I like your exclamation mark, but it really is nothing unusual to find such "irregularities".
What this means is the doctor felt something "irregular" so he investigated that specific area and found nothing bad in those biopsy samples.

Humans have all types of "irregular" features all over their body. No one is made perfect. We have warts, calcium deposits, scars, bumps, unequal feet sizes, and irregular heart beats.
You probably have lots of "irregular" features in your body.

There is nothing else to be done except to wait 6 months, take another PSA, and see what the trend is. If you have prostatitis it may have calmed down by then, returning your PSA under 1.0...
Or it may not.
You can choose to see everything in the worst way, or you can look for the excellent outcome that is more probable in your case.

Its going to be a long 6 months if you choose to dwell only on the worst possible outcome.
In fact its going to be a long 40 years if you continue to always fear the worst about everything that may befall you.

You should be relieved at this point rather than more concerned.

Otago

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