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Thread: New member, no dx yet, psa 29

  1. #1

    New member, no dx yet, psa 29

    Hi everyone,

    I'm a 59 year old guy who just had my first PSA test and scored a 29. The DRE my doctor gave me noted that my prostate was definitely enlarged but didn't feel hard or lumpy. The doctor described it as "spongy." I have my first ever appointment with a urologist a week from tomorrow and I am scared to death about pretty much every aspect of this. My wife is also concerned.

    I had a physical last week and told my primary care physician I had been experiencing some issues I figured were related to my prostate. Intermittent symptoms of weak urine steam, incomplete emptying of my bladder, sometimes difficulty starting urination, dribbling afterwards, etc. I noted to my doctor that I have been a professional courier driver for 35 years (smaller vans and passenger cars) and a long distance courier for about the past 5. Professional drivers often develop very flat backsides and there is a pretty clear sensation of sitting on my perineum or scrotum which gets pretty uncomfortable at times. We also sometimes have to hold our pee for hours - which is something I've done my whole life anyways I told the doc about 3 months ago I suddenly started having nothing come out when I ejaculate and I said the symptoms with urination probably started 6 months ago or maybe a little more. This is what prompted the DRE and PSA test.

    The results came back with a 29 which immediately got me a referral to a urologist. The urologist nurse who called to make an appointment also seemed to have a little urgency in getting me an appointment. Of course I am assuming the worst and have been reading everything I can possibly find, including a lot of posts on this forum, trying to figure out if there's a possibility that a greatly enlarged prostate, which is also constantly irritated by my job and which possibly harbors some sort of infection from the endless pee-holding, might shoot PSA up that high. It might be paranoia but all the statistical things I find seem to point to a fair certainty of PCa when a number is that high.

    Does anyone have any idea what may happen at this first urologist appointment? I don't have any family history of cancer that I know of but I also have a very small sample size for family. In case it matters, I am classified as obese, I have arthritis in several places, I am a severe asthmatic and a fairly heavy drinker of alcohol.

    Thank you to everyone here. You have already been a valuable resource before I registered today and of course if I get the diagnosis I don't want, this forum and its members will become even more invaluable.

  2. #2
    Hi and Welcome, Strings! Being scared is pretty run-of-the-mill for everyone joining. I'm sure things will settle down after your uro visit.

    I think you can expect your doc will review you records before your visit and then take a complete uro-genital and general history, including a family history, give you a physical exam with a DRE, collect urine and blood samples, discuss with you what he/she is thinking, what further testing/imaging should be done, and perhaps prescribe medication to try for your symptoms (and maybe do an ultrasound--I can't remember that far back to my first visit). As you have questions answered, you will think up new ones. Keep a written list of them to bring to your visits. If you trust your memory it will probably fail you: as you get into discussions with your doc you loose your place in any mental notes. Taking your wife along is a good idea for an extra set of ears and to ask additional questions.

    As you know, PSA can rise for many reasons, and having one condition does not rule out another. But you do want to know the cancer situation: either to rule it very unlikely or to have as early a diagnosis as possible, which is a Great Big Weapon to have

    If you'd like to get started on a path to good health, you can cut down on the alcohol and address the weight issue, they can only cause or exacerbate problems (surprise!).

    Please keep us posted---you will soon be batting 1000 !

    Djin
    Last edited by DjinTonic; 03-21-2019 at 01:03 PM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. biopsies, PCA3 -
    2013 TURP (90→30 g) path. neg. for cancer; then 6-mo. checkups
    6-06-17 DRE: nodule R and PSA rise, on finasteride: 3.6→4.3
    6-28-17 Biopsy #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 5% RLM
    Bone scan, CTs, X-rays: negative
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 bilat. acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5 x 5 x 4 cm, 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%; 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 weeks) PSA <0.1;
    LabCorp uPSA (Roche ECLIA):
    11-28-17 (3 mo. ) 0.010
    02-26-18 (6 mo. ) 0.009
    05-30-18 (9 mo. ) 0.007
    08-27-18 (1 year) 0.018
    09-26-18 (13 mo) 0.013 (checking rise)
    11-26-18 (15 mo) 0.012
    02-25-19 (18 mo) 0.015
    05-22-19 (21 mo) 0.015

  3. #3
    Senior User
    Join Date
    Jan 2019
    Posts
    311
    Based on your symptoms and PSA, it is likely you have cancer. Relax a little. It is treatable and you are not likely to die from it.

  4. #4
    Hey 1000: Welcome to the forum, sorry that your situation brings u here. For now, just take it one thing at a time. It is quite normal to be scared, and the entire beginning of this PCa mess can be very unnerving. Since at this point u don't know anything, step one is to get to the URO and start the process. U are correct, a PSA of 29 might mean some cancer, but please keep in mind that most of the PCa Dx are very curable. Since u have other issues going on, your psa spike could be related to something else, no way of telling until you see the Uro. I would start with working on a few of your other health issues, and get moving on this ASAP. Your first appt.?.......probably a DRE, and then I would guess either some antibiotics and/or scheduling a biopsy. Hang in there, as the days move on, things will become clearer...Please keep us posted. MM
    DOB:Feb 1958
    PSA: 9/15: 5.9 PC/Father
    DRE: Negative
    Biopsy: 10/1/15. Second Opinion University of Chicago. 9 of 12 cores positive. G6: 5 cores, G7 ( 4+3) 4 cores
    10/12/15: Ct scan/bone scan- Negative
    Clinical Staging: 10/28/15 T2c
    ( RALP) University of Chicago 12/29/15

    Final Pathology Report; Jan. 6 2016

    15 lymph nodes; no tumor present
    gleason upgraded to 9 ( 4+5)
    +EPE
    +LVI
    Right SV Positive
    Left SV and vasa deferentia, no tumor present
    PI present
    PM
    pT3bNO
    uPSA 2/9/16 0.05
    uPSA 3/23/16 0.11
    Casodex 4/1/16-8/5/16
    Lupron 4/15/16-5/15/18
    SRT 6/14/16...8/5/16 38Tx
    uPSA 8/10/16---2/14/19 <0.05
    Feb. 2017 Loyola Chicago
    11/15/2018 AUS 800 Implanted
    12/18/18...T Levels...Free T 42.8...Total T...262

  5. #5
    Top User
    Join Date
    Aug 2016
    Posts
    1,436
    First, retest to confirm first test.

    Recommend first biopsy be a 3T MRI fusion biopsy both targeted and random.

    Protocol is a standard TRUS biopsy first. A PSA of 29, if confirmed, is not standard. Move yourself ahead in line when you can and skip standard steps in the diagnostic protocol when you can with the guidance of your doctor. Your urologist will support you with this.

    Keep it moving forward. You will have time to consider as you go. Don't let the system put you off. Be persistent. They will accommodate.

    Set up your signature. We will be here. Lots of knowledge and first hand experience on this forum. Best I've found.
    Last edited by Another; 03-21-2019 at 08:40 PM.

  6. #6
    Thanks, Djin!

    It's very helpful to have some idea what to expect on that first visit. My wife and I have been together for five years and got married almost exactly a year ago, her previous spouse was an older gentleman who was a lifelong diabetic and had a lot of other medical issues, so she is insisting on coming to the appointments and already mentioned writing everything down.I am definitely the kind of person who tends to trust my memory but maybe I should trust some other smart people once in awhile too.

    I realize it's sort of pointless conjecture, but I have not yet been able to figure out if some of the non cancer conditions that I know can cause an elevated PSA can push numbers up that high. When I see numbers like 5 or 6 being called high, having a 29 leaves me thinking it can't be anything but cancer. Can a BPH prostate that's also got prostatitis end up in that range? I guess I'm just trying to figure out if that's even a possibility, just to calm myself down until my appointment 8 days from now.

  7. #7
    You might have cancer, but your urinary systems actually make a case that you might have other reasons for your disturbingly elevated PSA score.

    Most prostate cancers are asymptomatic at an early stage.

    Being fat, riding around all day in a car, can't be good for your urinary system, but neither are a cause for cancer.

    Prostate infections can cause PSA scores to rise, ditto for VD like gonorrhea or chlamydia can cause both your urinary symptoms as well as the PSA score. Good luck on your doctor visit, keep a positive attitude.

    There is a decent chance that you don't have cancer at all, and if you do, there is a good chance that the cancer is very curable.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3

  8. #8
    Top User
    Join Date
    Aug 2016
    Posts
    1,436
    Usually numbers this high indicate cancer. You are correct to take this seriously. That said, PC is both treatable, "curable", and manageable. It has many forms from nonaggressive to very aggressive.

    As you put your team in place you may what to consider a cancer center that has a strong PC practice. They offer multiple disciplines and a coordinated team approach if you should need it.

  9. #9
    Hang in there bud it looks like youíre cruising towards a possible diagnosis but it could also be something as simple as prostatitis.

    For the appt I would expect to get felt up but it looks like youíve already been felt up. You will likely get bloodwork and maybe even an ultrasound. They might give you a course of antibiotics and retest in a few weeks but with your symptoms they might go straight to a biopsy.

    This will make others laugh (Iím the resident board worrier) but just relax nothing you can do about the outcome. Pca likely will not kill you but is just something you need to manage and deal with...a life inconvenience.

    For what itís worth all my DRE were normal with no lumps or abnormalities found. My tests (all kinds) were a mixed bag with some pointing to cancer and others pointing away. The MRI was essentially useless since it pointed out a pirads 3/4 that wasnít cancer and missed a spot of cancer that they found via a random 12 core. So expect a lot of tests that honestly mean little to nothing óunless they lead to a biopsy that finds cancer. Beyond that there is precious little certainty. Itís definitely a marathon and not a dash, so this isnít something you can hit with a course of antibiotics and go in with life (unless itís prostatitis). Either way..cancer or not...itíll be something youíre dealing with for a while.

    Best of luck! Prayers for a good outcome.

  10. #10
    Thank you to the other folks who responded. I have an appointment with the urologist a week from tomorrow, so whatever is going to happen is going to start happening that day.

    As far as the weight issue goes, I'm down 68 lb from my highest weight but that was many years ago. I actually have a pretty good diet and I've been steadily shedding pounds for the last five or so years. It doesn't help that my job is very sedentary

    The alcohol is a problem but I have also stopped drinking for several years a couple times in the past. If I end up having to battle Cancer and a bunch of related things, it only makes sense to stop again.

    It's no fun to hear that I likely have cancer. If that's the case, I guess the focus kind of shifts to hoping it's contained within the prostate and hasn't spread.

    I have decent health insurance through work, so what I can do for testing and how I have to go about it is probably largely dictated by what they will pay for. I have little or no resources of my own to pay for anything else.

    Thanks again!

 

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