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Thread: Elevated and rising PSA, what should I do?

  1. #51
    Regular User
    Join Date
    Feb 2017
    Thanks, Chuck. All fair points.

    Yes, what I have in mind is ACTIVE in nature. PSA's, MRI's, biopsies, whatever. Intervention upon detection of clinically significant change or growth.

    And believe me, I understand that after the disease spreads beyond the prostate, the concept of "cure" no longer applies.

  2. #52
    Gerard, Best of luck to you with your self-monitoring efforts.

    What really concerns me is that the largest AS program, run by Dr. Laurence Klotz, concluded last year that the results for men with G(3+4) were not acceptable. You have G(4+3). You don't need a lecture from me, but I do hope that you spend a lot of time determining what type of treatment you will choose if/when that becomes necessary.
    DOB: May 1944
    In Active Surveillance program at Johns Hopkins
    Five biopsies from 2009 to 2014. The third and fourth biopsies were positive with one core and three cores <5% and G 3+3. Fifth biopsy was negative.
    OncotypeDX: 86 percent chance of PCa remaining indolent
    August 2015: tests are stable; no MRI or biopsy this year for my AS program
    August 2016: MRI unchanged from 2/2014; PSA=3.9; FPSA=26; PHI=28. No biopsy necessary.

    A NOTE ON PSA: My readings have been erratic for over 10 years; typically being 3.5-4.2, but spiking to over 10 at times.
    These spikes are asymtomatic to me, and resolve themselves. A prostate biopsy can triple the PSA, which lasts for months.
    Last Free PSA was 26. I don't worry about PSA spikes anymore.

  3. #53
    Senior User
    Join Date
    Apr 2017
    Gerard....I wish you luck and peace on your journey. I fear you will need both. Please don't watchfully wait too long.
    70 @ Dx
    PSA's over past 17 years - gradual increase from 1.0 to 3.0
    Current PSA 2.3
    TURP 2/16, 24 g removed, 35 g remaining
    G3+4 discovered
    3T MRI 5/16
    PI-RADS 5 Lesion in Right Apical Posterior
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4, Grade T1b
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule and new
    effacement of adjacent neurovascular fat planes
    Worrisome for extracapsular extention PI-RADS-5
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2c pNO pMn/a Grade 2
    Dry so far

  4. #54
    Senior User
    Join Date
    Aug 2016
    St. Louis, MO
    Your next step is to determine measures that will begin your intervention. Significant cancer growth is not measureable. Prostate size is, for example. Larger masses of cancer cells are measurable with MRI and other scans all designed more for treatment than diagnosis.

    G5 is a rare bird that flies out, once you see it, it's gone and too late. G4 is a rabbit, small, quick and stealthy. G5 and 4 reproduce rapidly. G3 is a turtle or sloth in all ways. Your plan is to herd rabbits.

    Within months, if not already, G5 and 4 can be out. It is all they do.

    G3 is what gives prostate cancer it's public face. Slow, indolent, an inconvenience that can be out lived. We all get it eventually and we don't die from it. It is surviveable, and the most common.

    G5 and 4 are not that. If not treated successfully and early they are survived only with toxic and unpleasant radiation, drug and chemical therapies, and for a limited amount of time.

    I, for one, think the intermediate risk classification is too broad if useful at all. In my world, 3+3 and 3+4 are low risk. Everything else is high risk. The current classification categories that include intermediate are better for treatment classification, and not cancer risk classifications.

    With primary G4 you get only one shot at possible early detection, if your lucky.
    Last edited by Another; 08-12-2017 at 02:03 PM.

  5. #55
    Top User
    Join Date
    Jan 2014
    Greater Atlanta
    Hi Gerard! As you are "painfully" aware: your Forum Brothers & Sisters simply want the best outcome for you.

    Simultaneously, it is time for all of us to "cease fire" and let you complete the process of decision making. You have most wisely scheduled upcoming consultations with both an RO and a URO Surgeon. This is the most essential component of "The Process!" Ultimately, it will be best to heed the advice of these expert MDs.

    None here ever wants to hear another to say "I should have treated this sooner while it was curable.." Those making the decision to not treat must unselfishly consider the catastrophic impact this will have on family and caregivers who will be forced to provide support during long protracted process of death.

    I have no doubt that you and your MDs will arrive at the best decision and timing to "Avoid The Avoidable."


  6. #56
    Senior User
    Join Date
    Aug 2016
    St. Louis, MO
    I'm good with that. As long as it is clear to anyone following this thread that non treatment of primary G4 is not Active Surveillance.
    Born 1953 family w/PC-grandfather, brother
    BMI: 23.4
    07-12-04 PSA 1.90
    07-10-06 PSA 2.02
    08-30-07 PSA 3.20
    12-01-11 PSA 5.69
    05-16-12 PSA 4.76
    12-11-12 PSA 5.20
    03-07-16 PSA 7.20, DRE-smooth, enlarged
    03-14-16 TRUS biopsy adenocarcinoma 1%-60% across 8 of 12 samples,G 3+3=6
    03-31-16 MRI pelvis
    05-04-16 DaVinci prostatectomy, nerve sparing, Surgeon Dr. Kent Adkins, recommend
    Final Path: weight 65g, Tumor volume 35%, +pT2c, lymph nodes, seminal vesicles, capsule, margin all negative, G 3+4=7
    Catheter out 12 days, bladder spasms for 3 days were harsh
    Incontinence at 6 mos is minimal no pad
    08-10-16 PSA 3 mos <0.02, Cialis 3x/wk & Viagra on occasion
    11-21-16 PSA 6 mos <0.02, Erections <50%, orgasms 100% & intense, Stopped Cialis & Viagra due to back/pelvis pain, start self-injection therapy for erections, 7ul Trimix
    12/31/16 Stopped Trimix injections with onset of Peyronie's
    06-01-17 PSA 1 yr <0.02

  7. #57
    Regular User
    Join Date
    Feb 2017
    Well said, Michael, and thanks to you and everyone else who expressed respectful opinions or offered respectful advice.

    I've been sort of thinking out loud here the last few days. I haven't made any decisions at this point nor ruled anything out, but I do have three appointments with doctors over the next two weeks. Whatever course I end up taking, whether it's some variant of AS or conventional treatment, it will be with eyes wide open.

    As I said to Another, we're all on our own trains. And the first stop for everyone is at the same station. (The second and more important stop comes afterward, but that's a discussion for a different board.)

    God bless all of you guys.

  8. #58
    Experienced User
    Join Date
    Jan 2013
    I've known four guys who had PC. Three of them died from it. So it is a killer. As for myself, I guess I'm on AS, although the doctor has not called it that. My PSA jumps around a lot, first biopsy found a few atypical cells, second all plugs were normal. Since the doctor knows more about this disease then I, what ever he recommends I do. If he said another biopsy I do it, or another PSA in 3 or 6 or 12 months I do it. And since he is a surgeon he will probably recommend surgery and if I'm healthy enough for it, that's what I will do. And because of the blood you found in your bed (assuming there was not a horse head under your sheets) I would go with surgery, if for no other reason but the doc can look around in there and spot anything abnormal. Good luck to both of us.


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