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Thread: High PSA and enlarged Prostate!!

  1. #1
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    PSA level of 128 and enlarged Prostate!!

    Hi, My name is Dave, will be 62 next month. Sept. 10 went to my primary Dr. for annual check up. Also, told me about a prostate test. I said yes as I don't think I've ever had one (my wife said I had one several years ago). The Dr. office call me the next day, PSA was 126. They had already made me an appointment for the next day (Wed., Sept 12th) to see an Urologist.

    9-12-2012; While at the urologist office, they drew blood, Dr. did the prostate DRE test. He said my prostate was enlarged 4X the normal size. While in the office, he scheduled me for a biopsy for the following Wed. 9-19-2012. He called me the next day (Thursday, 9-13-2012) told me my psa level was now up to 128. Next Wed. (10-03-2012), I go see him for the lab results. I'm a very patient person and my wife and I have been through a lot in our 42 years of marriage (All we can say is: God has been so good to us). The pass few weeks, been having sore lower back, right hip\butt\upper leg and ribs have been sore at times. Getting up at least once a night, frequent need to urinate and at times, painful or burning sensation during urination. I've been on this site the past couple days and really like it. So tired of the wait. Any information or advice would sure be helpful. Thanks, Dave
    Last edited by grandpaof4; 10-26-2013 at 10:37 PM.

  2. #2
    Moderator Top User HighlanderCFH's Avatar
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    Hi Dave,

    Sounds VERY similar to what I went through exactly 1 year ago. I also was 61 and about to reach 62. I already knew I had BPH (enlarged prostate) and was having severe urination problems -- took 10-15 minutes to do what formerly took 15 seconds. I refused a couple suggestions over the past few years to have a biopsy from a couple different urologists here at home in Northwest Indiana. My PSA in 2009 was only a bit over 4 and the urologists explained that, although BPH causes a rise in PSA, so does prostate cancer -- which meant there was a chance that the BPH could be masking the presence of PC.

    Fast-forward to August 2011 and a general physical showed my PSA had risen to about 6.41 at the age of 61. My family doctor faxed this reading over to my urologist and I went to see him. A very thorough DRE (digital rectal exam) revealed that my prostate was still very large (larger than in 2009), but still no lumps detected. He gave me another pitch about needing a biopsy -- especially with the PSA spike and also that I have a family history of PC.

    So I agreed to a biopsy and got a malignant diagnosis a few days later.

    I already had happened to have scheduled a general physical at Mayo Clinic (I do this every year, along with my Mother), so I decided to see their urology department. They required me to provide the original slides from my biopsy before seeing me and they subsequently agreed with the original diagnosis (you can see these stats in my signature at the end of this email).

    I met with one of their surgeons, a very talented younger man, who agreed to do my surgery if I decided to have it done there (as opposed to having it done back at home). We had already agreed that DaVinci was the route for take for my particular case. A day earlier, a Mayo radiation oncologist told me that removing the prostate was better in my case (although radiation could have cured the cancer) because the prostatectomy (removal of the prostate) would eliminate my urination troubles along with the tumor.

    After thinking about it for a couple weeks back home, I ultimately chose to return to Mayo. The surgeon scheduled me for Nov. 1 surgery. The day before, he performed a cystocopy to examine my urethra and bladder. Due to the size of my prostate, he wanted to have an advance idea of what he & the robot would be dealing with. This was NOT painful -- just so you know if they perform one on you. He told me everything was clear (no bladder tumors, etc., but also said "You have a whopper of a prostate" and confirmed that removing it was really the only logical choice for me. He also said he expected to cure me with the surgery. I did not mind hearing that at all. LOL

    I had the surgery the next day. I was pleasantly surprised to find out that I did NOT need to take that stuff to empty my bowels, etc. the day before. In fact, I was allowed to eat as usual until midnight the night before.

    It was a 4-hour surgery and I never really had any pain afterward. I stayed in my motel room for the next week until they removed the catheter. I recovered pretty quickly from the surgery. I had a small amount of leakage for the first couple weeks, but really did not need pads very much. And I was again able to urinate very strongly and finish in 10 seconds as when I was younger. So everything worked out very nicely.

    My prostate, by the way, was about 3x normal size -- a 98 gram prostate with a 2 gram tumor.

    Could be that your prostate size is the sole cause of your PSA, although the number is quite high -- especially how it spiked a couple points. Could also be an infection making the number so high. One other thing: sex, riding a bike, having the digital prostate exam, etc., are all things that make the PSA go up because they excite and/or agitate the prostate.

    So it is good that you had a biopsy to make sure.

    Chances are good that the sore back, etc., is NOT related to any possible PC that might be detected. That usually happens only in later stages of PC. If you should get a positive PC diagnosis, the doctor will probably send you in for a couple standard tests, including a bone scan and CT of the abdomen. These are just common tests after a PC diagnosis simply to establish baseline readings.

    Do you know what your PSA reading was from that one several years ago? Do you have a family history of PC? These are things that can give you some advance speculation. At the same time, a PSA of 126-128 is very much on the high side. But it also served as advance warning that things needed to be checked out. So just hang in there & see what the doctor says about the biopsy. If PC should be confirmed, I'd bet that it is still in the curable stage and that you will be just fine.

    Others in this forum will undoubtedly have additional info & more knowledge to offer you. And we all have our experiences to share so you will not be in the dark as things move forward.

    Please keep us informed on how things are going.
    Best of luck to you!
    Chuck
    Last edited by HighlanderCFH; 09-29-2012 at 02:03 AM.
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Post-op exams 2/13/12, 9/10/12, 9/9/13, 9/29/14 PSA <0.1
    Semi-firm erections from time to time.

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    Chuck,

    Thank You very for all your help and taking the time to reply to my post. I don't know the PSA level from years back. Don't know of any family history of PC.

    Dave

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    Sorry you have to be here but welcome.

    Even for a prostate that is 4x normal, A PSA of 126 is very high and very serious, especially you have symptoms. If you had a PSA test a few years ago, it is very helpful to your doctor if you can find out what that number was because it could give some insight on how rapidly your PSA is rising.

    Hopefully, you have BPH + inflammation which could also cause the symptoms you mentioned.

    Best of luck.
    PCa Dx at 65. PSA 2.5 in 2000, 8.4 in 6/09. Three negative biopsies in between. 6/10 PSA 10.7, biopsy 1 of 12 cores 5% cancer, Gleason 3+3
    CT, bone scans & MRI all negative
    Da Vinci 8/10; nerve sparing, catheter out in 7 days; no incontinence, no ED
    Post Op Pathology pT2N0Mx: organ confined; negative margins; lymph nodes & seminal vesicle not involved but PNI present; cancer extensive within prostate, multifocal G 3+3 and tertiary G 4+
    9/10, 12/10, 12/11, 12/12, 12/13, 12/14 PSA <.1

  5. #5
    Moderator Top User HighlanderCFH's Avatar
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    Quote Originally Posted by grandpaof4 View Post
    Chuck,

    Thank You very for all your help and taking the time to reply to my post. I don't know the PSA level from years back. Don't know of any family history of PC.

    Dave
    No problem Dave,

    Exactly one year ago I was precisely where you are -- wondering what the future holds. newporter has a good point about your previous PSA. Is there any way you can check with the medical facility that did that PSA test a few years ago? If so, that will give you a comparison with then and now.

    Glad to hear you have no family history of PC. That is helpful to know.

    Chuck

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    Thank You Newporter,

    Monday, I'll make a call to my current Dr. and see if she has all my old records.

    By the way, was born in Modesto, raised in Santa Rosa, have family all over CA. Been in the Memphis, TN area since the early 70's.

    Dave
    Last edited by grandpaof4; 09-30-2012 at 12:24 AM.

  7. #7
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    Pick up a copy of Dr. Walsh's book and read it..It will give you the background you need to sort through this and ask intelligent questions..
    Best of luck to you....
    PSA at age 55: 3.5, DRE negative.
    65: 8.5, DRE " normal", biopsy, 12 core, negative...
    66 9.0 DRE "normal", BPH, (Proscar)
    67 4.5 DRE "normal" second biopsy, negative.
    67.5 5.6, DRE "normal" U-doc worried..
    age 68, 7.0, third biopsy (June 2010) positive for cancer in 4 cores, 2 cores Gleason 6, one core Gleason 7. one core Gleason 9. RALP on Sept. 3, 2010, Positive margin, post-op PSA. 0.9, SRT , HT. Feb.2011 PSA <0.1 Oct 2011 <0.1 Feb 2012 <0.01 Sept 2012 0.8 June 2013 1.1, Casodex added, PSA 0.04 10/2013. PSA 0.32 1/14. On 6/14 PSA 0.4, "T"-5. 10/14 PSA 0.6, T-11

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    Quote Originally Posted by grandpaof4 View Post
    By the way, was born in Modesto, raised in Santa Rosa, have family all over CA. Been in the Memphis, TN area since the early 70's.

    Dave
    I am in "Southern" Cal. TN, yeh! One of my friends who recently retired moved to TN and said his $ bought a lot more there! Must be the bad Cali weather, most of my rich retired friends are moving out, many moved to Nevada some to Washington State, some Az.

  9. #9
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    Fairwind,

    Thank You, I'll do that.

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    WOW!!!!!! Didn't expect this at all!!

    Monday morning at 9am, my dr called me at home with the lab reports. Called me in for: BICALUTAMIDE 50 MG, ONE A DAY).. Cancer has spread into my Fat tissue around my prostate (BAD). "FREE PSA" isn't a factory now...

    all 12 cores high volume and cancer is very aggressive. 5 gleason are 4+5=9; 2 4+4=8, 2 3+5=8; 2 4+3=7 (one not showing any scores just: atypical small acini).

    Yesterday, I Had bone scan and CT. Getting results and treatment plan this afternoon. Yesterday, Dr told me I had a T3 score.

    Will try to update this evening.

  11. #11
    Moderator Top User HighlanderCFH's Avatar
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    Hi,

    I'm praying for your news to get better. Hopefully the bone scan & CT will be okay. Sorry to see it has spread to the fatty tissue around the prostate. But that doesn't mean that it has necessarily gone anywhere else at this point. Maybe this was found in time to stop any further progression and hopefully you will be fine.

    Please keep us updated as we wish you the best!
    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Post-op exams 2/13/12, 9/10/12, 9/9/13, 9/29/14 PSA <0.1
    Semi-firm erections from time to time.

  12. #12
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    Hello,

    Got Very bad news this afternoon, will inform tomorrow as I'm trying to process it tonight.

    Dave

  13. #13
    Moderator Top User HighlanderCFH's Avatar
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    Hi,

    I (and I'm sure many others) will sure be keeping you in my prayers.

    "Talk" to you tomorrow.
    Chuck

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    Quote Originally Posted by grandpaof4 View Post
    Hello,

    Got Very bad news this afternoon, will inform tomorrow as I'm trying to process it tonight.

    Dave
    Sorry to hear that. However, even if the cancer is out of the prostate, there are a lot of medications and procedures to control and keep you around for a long time. Some oncologists can manipulate the treatment and drugs to keep the cancer at bay for a long time. This is a complicated disease and you need to be knowledgeable and be your own advocate even after you find the best oncologist to help you. If possible, consult with Dr. Scholz or Dr. Lam in Southern Cal. They are well known prostate cancer oncologists.

    Good luck.

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    Hi all,

    Well....Bone scan shows cancer has spread from the top of my head to my toes. As of today, not gotten the CT report yet. Wed. (Oct 3rd.) Urologists gave me two injections of FIRMAGON (degarelix for injection), two injections each of 120cc in my abdomin and every 28 days one shot of 80cc. Waiting on approval from my insurance to get a injection (Xgeva) for my bones. My dr. said I was a grade "T3". Also started taking: Vitamin D800-100 IU a day and Calcium 1200mg a day.

    He told me I had 4-5 years to live!! Surgery is out as well as a treatment plan to reverse the cancer. I"m changing my diet and walking more.

    I Really like my Dr. and not sure if I want to change to a oncologist or it that is the wise thing to do!! Please advise as this is all new to my wife and I.

    Forgot to mention, my dr. told me last Wed. (Oct.3rd) that the cancer has been in my system for 2-3 years. EVERYONE...GET A PSA TEST!!

    Thanks,
    Dave
    Last edited by grandpaof4; 10-06-2012 at 12:19 PM.

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    Grandpaof4,

    I am very sorry to hear that your cancer has metastasized to your bones. With such a diagnosis, you need an expert oncologist to handle your case. If you like your urologist, you can keep him but you should add an oncologist who specializes in prostate cancer to your medical team. Urologists are trained to do surgeries and most of them are not expert oncologists. Your urologist should not object as your case is serious.

    If you do not want to travel far, consult with an expert oncologist at a major cancer center near you, e.g., Duke (Durham, NC), Vanderbilt (Nashville, TN), Wash U (Saint Louis, MO), etc.

    Best of luck and hope you are one of those that will keep your cancer under control for a long time.
    Last edited by newporter; 10-06-2012 at 04:45 AM. Reason: add Wash U to list

  17. #17
    A medical oncologist is most appropriate to manage metastatic prostate cancer, since they're more well-versed in therapies beyond the first line, and urologists would agree. The treatment plan sounds appropriate for somebody with newly diagnosed metastatic prostate cancer. Some variations to the therapy you're getting (no right or wrong answer) would be leuprolide (Lupron) instead of degarelix, and zoledronic acid (Zometa) instead of denosumab (Xgeva), but it seems like more people prefer denosumab nowadays.

  18. #18
    Moderator Top User HighlanderCFH's Avatar
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    Hi Dave,

    I am so very sorry to hear that it has spread and of your prognosis. If the doctor says 4-5 years, hopefully with your change in diet, continued treatments -- and continued medical advances -- maybe you can shoot for a decade or longer.

    There are MANY cases of cancer where a patient lived far, far longer than the original prognosis predicted. And I hope & pray that you will be one of them.

    As always, keeping you in my prayers,
    Chuck

  19. #19
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    Quote Originally Posted by HighlanderCFH View Post
    Hi Dave,

    I am so very sorry to hear that it has spread and of your prognosis. If the doctor says 4-5 years, hopefully with your change in diet, continued treatments -- and continued medical advances -- maybe you can shoot for a decade or longer.

    There are MANY cases of cancer where a patient lived far, far longer than the original prognosis predicted. And I hope & pray that you will be one of them.

    As always, keeping you in my prayers,
    Chuck
    Dave,
    I echo Chuck's response but I would add one thing. When your Doc gave you 4 to 5 years, he was quoting statistics.
    Whatever you choose to do, DO NOT think to yourself, "okay, five years is my limit because the stats say so". That is BULL!
    We all share this together, whatever the outcome and you need to know that you probably still have more options than you are aware of.
    Possibly a 2nd opinion?
    Please share as much as you are comfortable with. We care!
    Last edited by FeatherBoy; 10-06-2012 at 03:28 PM.
    Age At Diagnosis: 59
    Pre-Op PSA: 4.5
    Diagnosis: Prostatic Adenocarcinoma
    Surgery: Retropubic Radical Prostatectomy (RRP) 07/16/2012
    Stage: pT2c,pNO,PMX
    Gleason Grade: 4+3=7 (Not-So-Good Cancer)
    Extraprostatic Extension: Neg.
    Lymph Nodes: Neg.
    Seminal Vesicles: Neg.
    Positive Margins
    Tumor Quantitation: <5% Of Prostate
    Tumor size: 1.1cm.
    High-Grade PIN
    Perineural Invasion: Present
    Post-Op PSA: 0.4
    Completed 35 sessions adjuvant IMRT on 12/13/2012
    PSA as of 01/10/2013: 0.2
    PSA as of 04/12/2013: 0.1
    PSA as of 07/10/2013: <0.1
    PSA as of 10/08/2013: 0.1
    PSA as of 01/15/2014: 0.2
    PSA as of 05/23/2014: 0.2


    願你的生活充滿了幸福和吉祥。

  20. #20
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    Newporter,

    Thank you and I'll call my dr Monday. Yesterday, I did call the West Clinic here in Memphis, TN. They would need for my dr to send my records so someone could look at them.

    Thanks so much,

    Dave

 
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