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Thread: Psa 25.54

  1. #1
    Newbie New User
    Join Date
    Apr 2017

    Psa 25.54

    I was diagnosed 2 weeks ago, I am 73 years old, any ideas what treatment to do? My Dr said radiation.
    My readings were 3+4

  2. #2
    Moderator Top User HighlanderCFH's Avatar
    Join Date
    Nov 2011
    Welcome to the forum, Ray.

    The two main treatment types are radiation and surgery, depending on the circumstances. The cure rates between both types are about the same, so sometimes it can also be a matter of preference by the patient.

    At the age of 73, you are close to the time when surgery might be a bit rough to undergo, which is probably one reason the doctor recommended radiation.

    Basically, the least aggressive form of prostate cancer is 3+3, which is virtually NEVER fatal. I bring this up because a 3+4 behaves almost the same as 3+3 (as opposed to 4+3). So you should be in pretty good shape after whatever treatment you choose.

    You'll be getting a lot of advice & comments from the others here, so let's watch & see what they say. Weekends slow down here, but will pick up on Monday. But you'll still get some good comments over the next few days.

    You might also purchase the book by Dr Pat Walsh entitled the Guide to Surviving Prostate Cancer, 3rd edition.

    Best of luck to you!
    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.
    Six annual post-op exams 2012 through 2017: PSA <0.1
    Semi-firm erections 5 years post-op whenever the moon turns into blue cheese.
    NOTE: ED caused by BPH, not the surgery.

  3. #3
    Hi Ray, Sorry that you have to be here. We are the same age, and while I consider myself healthy, active, and agile, I would not consider choosing major surgery at our age, when there is an equally effective alternative. That is because I am always hearing about classmates having surgery for one thing or another, and it seems like they have far more complications and slower recoveries now than when younger.

    That is a pretty high psa. What does the biopsy pathology report say about the extent of the cancer? How many cores, how much of the prostate affected, and is there PNI or extracapsular extension (EPE)? Radiation can target a wide margin around the prostate if there is a concern of the cancer escaping.

    This is early in your learning process. There are hundreds of men here who have been through the decisions and the aftermaths, and they will certainly chime in with their great advice. Good luck.
    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
    April 2018: PSA 4.4, Free PSA 26. No change from six years ago.

  4. #4
    Newbie New User
    Join Date
    Apr 2017
    Thanks for the comments, I have also had 4 heart attacks with 7 stints, my insurance man has had this for 8 years, he suggests doing nothing just wait and
    see, he said I will die from something else before the cancer. I am going to get a 2nd opinion May 16

  5. #5
    Welcome Ray! As we always greet our new arrivals: Hate that you have been diagnosed with prostate cancer(PC) but very glad that you have found The Forum where you will find a lot of support.

    Where are you located? There may be other Forum Brothers who have been treated nearby and can provide suggestions.

    What is your PSA history and what issues led to your diagnosis of PC?

    Both Chuck & ASA have provided sound suggestions.

    So what to do?

    Most MDs will not initiate treatment for approx 7 weeks following biopsy. So you have time to continue to ask questions and obtain the correct answers for your situation.

    What scans (Bone scan, CT Scan, MRI) is your current MD scheduling you to have and when?

    - Purchase the latest edition of the Patrick Walsh, MD, book Guide to Surviving Prostate Cancer and read it.
    - Discuss with your MDs the implications of an elevated PSA (25). Ask if the scans can determine if your PC is confined or if it has spread outside of the prostate gland. If spread ask "How far?"
    - Get at least 1 expert 2nd opinion. If not sure where to go, try the nearest academic teaching hospital and make an appointment in the Dept of Urology for a 2nd Opinion Consultation.
    - Ask if you are a candidate for early Hormone Therapy (HT). This can place your PC into "hibernation" during treatment.
    - For treatment, select an MD who specializes in treating PC and treats multiple PC cases each week.

    Keep in mind there is only 1 opportunity to get this done correctly from the start!

    Keep asking questions - exactly as you are doing - and be sure that you understand the answers.

    Remain optimistic and keep us updated as you make progress towards arriving at a treatment decision.

    We will be here every step of the way!

    Last edited by Michael F; 04-21-2017 at 06:30 PM.
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = Gleason 7 (3+4) and 5 = Gleason 6
    March '12: Robotic RP: Left Positive Margins + EPEs. MD waited in surgery for preliminary Path Report then excised substantial left adjacent tissue(s) down to negative margins and placed 2 Ti clips for SR guidance, if needed in future.
    Pathology: Gleason (3+4) pT3A pNO pMX pRO / Prostate Size = 32 grams; Tumor = Bilateral; 20% / Perineural invasion: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml uPSA remains "stable" at 72 Months Post Op: Mean = 0.021 (17 uPSAs: Range 0.017 - 0.026) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  6. #6
    Welcome Ray:

    Your history of multiple heart attacks makes prostate surgery at age 73 a remote, unnecessarily risky and unwise decision. Your doctor's recommendation of radiation appears to be on target.

    Prostate cancer is the second leading cause of cancer deaths among men. Your insurance man may be correct that you should do nothing because something else will probably kill you first. But before you do that, you may want to ask him about the 30,000 men who died last year (and every year) from prostate cancer. If he had given those men the same advice that he is giving you, then he would have been wrong THIRTY THOUSAND TIMES.

    A second opinion -- already scheduled -- sounds like a much more practical path to take.

    Best of luck,
    Age: 71 -- 12/2013 - Cat Scan sees new irregular 1.8 cm nodule in right middle lobe.
    3/13/14 - PET Cat Scan confirms presence of same nodule -- same size. Nodule lights up indicating likelihood of lung cancer -- Location not conducive to biopsy.
    3/17/14 - Three top doctors say it MUST come out via a wedge re-section. If cancerous, the entire right middle lobe must be surgically removed.
    6/13/14 - Nodule shrank by 1/3. Not cancer. Surgery cancelled. Next scan 9/14. Nodule "resolved" - gone.

    Age: 67 -- 2/2010 - PSA: 4.05
    8/2010 - PSA: 4.95
    9/2010 - Biopsy - 2 out of 12 cores positive - Gleason: 3+4=7
    11/8/2010 - DaVinci RALP - small positive margin - was told it was meaningless.
    2/11 - PSA: 0.02; 8/11 - PSA: 0.04; 2/12 - PSA: 0.06; 8/12 - PSA: 0.08; 2/13 - PSA: 0.11; 5/13 - PSA: 0.16 - referred to oncology radiologist.
    9/2013: 40 sessions of IMRT salvage radiation completed.
    1/14, 4/14, 7/14, 10/14, 1/15, 8/15, 3/16, 8/16, 3/17 - All PSA: 0.00

  7. #7
    Newbie New User
    Join Date
    Apr 2017
    I am from Grants Pass, Oregon, I have had the Bone scan, ct scan, they were both negative, my PSA: 2013 7.25, 2014 14, 2016 25.54.
    The cancer is on the right side only
    Looks like great people on this forum!

  8. #8
    A second opinion is almost always in order, but not if it is an excuse to postpone action.

    Your insurance man's remark is outdated and dangerously misleading. If he is in an actively monitored surveillance program provided by his health care system and adhering to their protocol I would expect an explanation with his comment describing all he is doing in serious pursuit of his own health and in a concern not to mislead you into resignation. If he has been diagnosed and knows his Gleason scores and volume of cancer there is no wait and see. We have very good prediction tools as to what he may expect. If he knows via biopsy, within reasonable odds, that his cancer is low risk he may be advised to enroll in an active surveillance program and be prepared with a plan for action if it changes. With no more information than what you offer about him I say he is whistling past the graveyard.

    Many of us have practiced some form of denial and delayed action in the beginning. I know I did. It is what motivates me to participate in this forum. I am here with a story of survival that has to do more with good fortune than my own diligence in the beginning.

    It is true you may die tomorrow of another blocked artery you are unaware of. So, let it be that. I suggest you continue to deal with what you know and pursue a continued diagnosis and treatment for your cancer under the guidance of your doctors. That spirit has served you well so far.

    I will add that if your urologist allowed your PSA to go so high without determining the source, regardless of what you may have said, I suggest you find another urologist.
    Last edited by Another; 04-21-2017 at 09:29 PM.
    Born 1953
    family w/PCa; grandfather, older brother
    07-12-04 PSA 1.90
    07-10-06 PSA 2.02
    08-30-07 PSA 3.20
    12-01-11 PSA 5.69 Internist recommends urologist, I say no
    05-16-12 PSA 4.76 manipulate w/diet & supplements
    12-11-12 PSA 5.20, Health system changes to 3 years on testing
    03-07-16 PSA 7.20 Internist adamant on urologist
    DRE smooth, enlarged
    03-14-16 TRUS biopsy-prostatic adenocarcinoma 1%-60% across 8 of 12 samples, Gleason 3+3=6
    03-31-16 MRI pelvis w/o dye
    05-04-16 DaVinci prostatectomy, nerve sparing, Dr. Kent Adkins - recommend
    Final Path; weight 65g, lymph nodes, seminal vesicles, capsule, margin all negative, Gleason 3+4=7, Tumor volume 35%, +pT2c
    Catheter out - 16 days
    Incontinence at 6mos is minimal – no pad
    Cialis 3x/wk & Viagra on occasion
    Begin self-injection needle therapy for erections, stop after 6 due to onset of Peyronie’s
    Erections 100% - 14 months
    6-1-18 PSA <0.02, Zero Club 2 years

  9. #9
    Quote Originally Posted by ray1944 View Post
    ... my PSA: 2013 7.25, 2014 14, 2016 25.54.
    The cancer is on the right side only

    Looks like great people on this forum!
    Yeah, we're great because your PSA and tumor location seems to be exactly like mine!

    I'll tell you, those two years when mine went from PSA=9 to 25 were years I would NOT want to re-live!

    Others are right... at your age (you are my late older brother's age) surgery is probably not recommended, however some radiation therapy could add years to your life. Given that your G7 breaks down as 3+4 indicates that there is grade 4 PCa growing in there (grade 3 already established). Yes, you have some time on your side, for now. I'd say go ahead and get this treated, and live long enough to die from something else. You do NOT want metastatic bone disease in your old age!
    2012: PSA 4, all DRE's negative
    2014: PSA 9, TRUS biopsy negative
    2015: PSA's 12, 20, Mar'16: PSA 25, changed Uro
    Jun'16: MRI fusion biopsy, tumor right base, 4/16 cores: 2-100%+2-40% G8(4+4)
    Aug'16: DaVinci RP, -SM, 11 LN-, 53g, 25% involved, PNI, 6mm EPE, BL SVI, pT3B

    Jan 2017: started 18 months Lupron ADT, uPSA's ~.03
    May 2017: AMS800 implanted, revised 6/17
    Aug 2017: 39 tx (70 Gy) RapidArc IGIMRT
    Jan, Apr 2018: PSA's 0.00, Dx Radiation Colitis

    "Everyone you meet is fighting a battle you cannot see"
    Mrs: Dec 2016
    Dx stage 4 NHL/DLBCL, Primary Bone Lymphoma
    spinal RT boost+6X R-CHOP21+IT MTX via LP. Now in remission
    Read our story at CancerCoupleBlog.com

  10. #10
    Welcome ray. Anything I could add would be redundant but feel it necessary to say" IGNORE your insurance man's recommendations. Obviously he graduated from the National Enquirer school of stupid.
    Although your PSA is a high number, a G score of 3+4 is better then I would have expected. Hopefully the pathology report supports it.
    Good luck


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