2nd Biopsy coming up

holler1 · New User Joined: 07 Aug 2009 Posts: 6

My PSA history is below. A straight line fit on log normal plot shows ~ 7 year doubling time, but the last couple of years may have a higher slope. Not sure why there are ups and downs that make it hard to select the right slope and PSA velocity. Most of the PSA histories I have seen for others seem to have less variation. I think all tests are from the same lab except the 5.5. I asked my urologist about prostatitis and he said it is possible, but that taking strong antibiotics for prostatitis is itself not without risk, and does no good unless one has symptoms (my symptoms are minor), and he recommends another biopsy, which I agreed to. The risk of PC shown on the printout from the free PSA test is in the 23% range for my age (67) and PSA score. My prostate volume was 20 cc as of last summer's ultrasound, so PSA density is fairly high. My sense of the situation is that it is just a matter of time until a biopsy comes up positive.

I live in northern WV, and the nearest high level centers are Cleveland Clinic and Johns Hopkins, about 200 miles either way. Not sure about others, maybe UPMC in Pittsburgh? If the upcoming biopsy is positive, I'm thinking I will get a 2nd reading for staging by an expert, and then possibly go to Cleveland Clinic for next steps. Advice on who to contact to get a 2nd reading would be welcome, as well as the best prostate oncologists/surgeons/etc in the mid-atlantic to midwest region. I'm willing to go farther if necessary, but the two centers above seem to have excellent reputations.

Thanks to this board for a lot of good information. I've been reading awhile. The Primer by Stephen Strum is really excellent.

1-Jan-02 2.3
1-May-04 _2.7
1-Sep-05 ___3.2
11-Jan-06 _2.7
15-Oct-06 ___3.5
15-Oct-07 __3
9-Jun-08 ____ 3.6
16-Nov-08 _____4.1
1-Feb-09 __________5.5
5-Aug-09 _______4.7, free PSA 16.6% (first free PSA)
First biopsy July 2008-negative
DRE Aug 17 2009 -OK, scheduled biopsy Sept 3.

Thanks again,

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

The YANA website has a psa doubling time calculator that may be helpful; it's based on a log scale.
Dr Charles Meyrs in Earlysville Va is probably the best oncologist on the East coast and would be an excellent choice for a 2nd opinion or even for an initial dianostic. 2nd opinion on biopsy pathology should be from Dr Epstien at John Hopkins or Dr Bostick at Bostick Labs in NJ.
A doubling time of over 3 years usually results in a very good prognosis for cure with treatment or even Active Survelience.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

holler1 · New User Joined: 07 Aug 2009 Posts: 6

JohnT,
Thanks very much. I will post back after the biopsy.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

I'm sorry to pick nits, but in case holler1 needs to follow up with those excellent suggestions, it's Charles "Snuffy" Myers, not Meyrs, it's Dr. Jonathan Epstein, not Epstien, and it's Bostwick, not Bostick. Bostwick is headquartered in Virginia, with an international office & lab in London, and domestic labs in Virginia, Arizona, Florida, New York, and Tennessee. They do not have a location in New Jersey, at least according to their website.
https://www.bostwicklaboratories.com/HOME/company-info/locations.aspx
_________________
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

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

Replicant,
Thanks for the correction; I'm away for the summer and my source materials are back home, so I had to use my memory with the expected results.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

Hawk · Senior User Joined: 22 Nov 2006 Posts: 406

I posted this once before but got little or no response. I am open minded but a skeptic.

Dr. Myers seems a bit out of the mainstream. My contacts with his office made it clear he will not even process insurance. Upon asking a prostate cancer oncologist at a center of excellence (Sloan-Kettering) about Myers, I could tell he was hesitant to respond. He did say, "you must have some concerns or you would not have asked". He ended up by saying Dr. Myers has some very strong opinions, but many of his opinions are just not backed up by clinical data or facts."

John, I highly value your opinion. Sometime I wonder if Strum, Myers are not mostly self proclaimed "top shelf prostate oncologists". How does one resolve the conflict between what they say and what other professionals say or elude to especially when these doctors send off a few warning signs like: no insurance, unconventional treatments, theories of treatment with no clinical studies?

Who acknowledges them as great prostate oncologists other then themselves or each other.?

I really want to know how to resolve this. Anyone ?
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

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

Hawk,
That is an excellent question and could and should be asked of all doctors.
Walsh is critized for only operating on selected low gleason patients and won't take a g8 or g9 patient.
I have mixed feelings about data, it takes so long to accumulate by the time it gets to us it is 8 to 10 years old and treatments change so radically in a short period of time. 8 years ago there were few robotic surgeries or IMRT and little data to support them, still a few doctors used them and now they are mainstream. Most urologists say color doppler won't work, yet drs Lee and Bahn had had tremondous success using it to diagnos PC.
My 1st 3 urologists didn't know you could MRI a prostate even though Hopkins and UCSF had been doing it for years. My Slone Kettering trained uro oncologist said color doppler wouldn't work as I was looking at a picture of my tumor that even a layman could see.

20 minutes with Dr Scholz, Strum's ex partner, gave me 10 times the knowledge about my PC than 3 urologists and 2 uro oncologists had given me, and one is now the head of urology at Anderson. All 5 from UCI, UCLA and UCSF got it wrong and Scholz got it right looking at the same info.
I've heard a lot of good things about Myers, he walks the talk as he has advanced PC and uses HT. A guy in another group had a G6 with virtually no psa. The doctors at Anderson told him not to worry, but it didn't jibe with what he had researched and went to Myers a few weeks ago for a 2nd opinion. He was diagonosed with a rare PC varient that was very agressive; it probably saved his life; Myers knew it; the Anderson docs never even thought of it.
I've read both Myers and Strum's books and a lot of their published papers and they make a lot of sense; things they were discussing and doing 10 years ago are now mainstream treatments. Good doctors are always ahead of the mainstream and are bound to generate contraversy.
A lot of the best doctors in private practice don't take insurance because they don't want or have to deal with the BS. Most all do pro bono work for those that can't afford it.
As you have found out PC is a jungle of conflicting opinions, all suported by data. I guess we just have to do our own research and come to our own conclusions about doctors and treatment options and just hope we are right in our own judgement. I know that if I had advanced PC and a treatment from a noted doctor looked good I sure wouldn't wait 5 or 10 years for the treatment to go mainstream before I tried it.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

Hawk · Senior User Joined: 22 Nov 2006 Posts: 406

Thanks for your frank input on this John! So often people take it personal if you question a method or a doc they are sold on.
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

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