Dime-Sized Prostate Lump - Father Going for Biopsy

serenity08 · New User Joined: 20 Jun 2008 Posts: 5

My father is 63 and hadn't had a prostate check since he was around 54. When he did have one a week or so ago (a UTI prompted a referral to the urologist) they found a dime-sized lump on his prostate. Can a lump on the prostate be benign? From what I've researched, an *enlarged* prostate could be Benign Prostatic Hyperplasia, but I've not found any information on a benign *lump*. If the lump does turn out to be cancerous, what is the likelihood that it is still contained within the prostate with the lump actually being palpable on a DRE?

Replicant · Moderator Joined: 01 Nov 2006 Posts: 244

I don't think there's enough information to say at this point. He should probably have a biopsy, and the information from that (Gleason) combined with his PSA history and clinical stage of disease (IF he has cancer) can be used with the Partin tables on the Johns Hopkins urology website to determine various probabilities.

What's going on with his PSA?

An abnormal DRE alone does not reliably predict cancer. This is especially true if BPH is present. The combination DRE + PSA trend over time is more reliable, but cannot by itself diagnose cancer--only a biopsy can provide that information.

"In men with suspicious PSA readings, regardless of DRE findings, biopsy revealed cancer almost half the time, while in men with suspicious DRE tests, regardless of PSA levels, biopsy found cancer about a third of the time."
http://mednews.wustl.edu/news/page/normal/4912.html

Best wishes. I hope you keep us informed.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, 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 <0.1, 12/07 <0.1, 4/08 <0.1, 11/08 <0.1
http://pcabefore50.blogspot.com

serenity08 · New User Joined: 20 Jun 2008 Posts: 5

I don't think my father has ever had a PSA test. I don't know why the urologist did not do one while he was at the office. In general, the process seems to be going very slowly. The biopsy is taking a long time to schedule and we've received almost no information. The Partin tables, however, are exactly what I was looking for at this point. Thank you! Hopefully, we'll get some more information soon.

Frankly, I had hoped he would have been given more information about the lump's characteristics and a PSA value by now. Sad

serenity08 · New User Joined: 20 Jun 2008 Posts: 5

He did have a PSA test back in 97. At that point it was around 2.4. He hasn't had one since. Sad

But shouldn't he have one BEFORE the biopsy?

Replicant · Moderator Joined: 01 Nov 2006 Posts: 244

If there's no blood draw for PSA before biopsy, he'd have to wait some time (at least a few weeks) afterwards, since the biopsy can elevate PSA.

In my layperson's opinion, it's odd that the doctor is not even looking at PSA right now. It's also very odd that the doctor did the DRE without doing a PSA test first.

JohnW100, what do you think about this situation?
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, 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 <0.1, 12/07 <0.1, 4/08 <0.1, 11/08 <0.1
http://pcabefore50.blogspot.com

serenity08 · New User Joined: 20 Jun 2008 Posts: 5

He was referred to the urologist by an ER doc after a UTI. The urologist made sure the infection was clear and did a DRE. However, once he felt a lump and suspected cancer, I'm curious why the PSA test wasn't performed.

The biopsy has now been scheduled as well as a pre-admission visit a few days prior to the biopsy. Maybe they will do a PSA then? I've told him to ask about it because I think that his PSA level before the biopsy would be a crucial piece of information to have to determine what treatment course to follow IF the biopsy does show cancer.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 244

I agree completely. If the biopsy shows cancer, it would be good to have the big pieces of information all together: PSA, Gleason, DRE in order to use tools like the Partin tables.

Of course, a PSA can be done after some post-biopsy time has passed, but it would make more sense to do it before.

DRE's can also elevate PSA, unfortunately...so it would have been much better to have the PSA before that as well.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, 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 <0.1, 12/07 <0.1, 4/08 <0.1, 11/08 <0.1
http://pcabefore50.blogspot.com

johnw100

With PSA figures and DRE, the trend is usually more relevant than one individual figure or finding.

Without the benefit of a history of regular tests and DREs it's now not possible to know if there has been a slow indolent growth, or whether there's been a more recent sudden change (which could suggest something more agressive).

DRE findings are highly subjective, and like many aspects of PC, a 2nd opinion by a very experienced doctor would be worthwhile.

You can now maintain detailed information, including a written report on the suspicious area or nodule found by DRE, including the location and opinion on the nature of it.

What ultrasound indicates during biopsy will hopefully clarify what was found by DRE.

serenity08 · New User Joined: 20 Jun 2008 Posts: 5

My father had the biopsy. His PSA before the biopsy (I told him to request it at the pre-admission) was 5.4. The urologist said the area felt pretty suspicious and that both the left side of his prostate and his bladder felt enlarged. Results of the biopsy should be back within a week. Sad

Allison · New User Joined: 28 May 2008 Posts: 7

[quote="serenity08"]My father had the biopsy. His PSA before the biopsy (I told him to request it at the pre-admission) was 5.4. The urologist said the area felt pretty suspicious and that both the left side of his prostate and his bladder felt enlarged. Results of the biopsy should be back within a week. Sad

[/quote]

Serenity...all my best to you. I will be thinking of you and praying for your dad and family. My dad goes in for his prostatectomy on Wednesday and I am scared to death. I know he is too, so I am the one trying to be all positive for everyone but deep down inside I just want to scream in panic. Please keep us updated on your dad's condition.

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