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Thread: New labs and PSA back

  1. #11
    Quote Originally Posted by Another View Post
    Prostatitis typically bounces the PSA around. Yours is a steady rise. Now velocity starts to matter.
    Yeah, I agree. I’ve been fairly consistently rising and this test was —for me—supposed to be one of those “let’s validate you are stable and still rising consistently” tests. But for that matter the 4K and mrI were supposed to be “let’s rule it out” tests. 😀

    I have a follow up with my current urologist to discuss these labs and biopsy results on May 3. I’ll ask if it’s wise to try a course of antibiotics and then retest PSA to rule out prostatitis. It might not be, just grasping for some hope. If he thinks it’s wise, I should be done with the antibiotics before my new urologist appt, so that might work great.

    I hope the new doctor will retest PSA on the appt date.
    Last edited by IceStationZebra; 04-20-2019 at 05:24 PM.

  2. #12
    Quote Originally Posted by Michael F View Post
    Hi ISZ! Are you currently looking for better urologic care or specifically a urologic surgeon who specializes in PCa?

    I don't have any personal experience with Dr Miller / Northside Hospital but have heard only good things.

    My understanding is he does not accept insurance so you will have to pay 100% out of pocket and then submit charges to your insurer. Certainly get all of the facts from Dr Miller's office and check with your insurer to determine exactly for what & how much they will pay.

    My suggestions to anyone looking to consult with top RP URO Surgeons in Atlanta would be Dr Miller/ Northside H & Dr Sanda / Emory- St Joseph's. Coincidentally, both hospital centers are next door to each other!

    Good luck determining:

    - if it is now time to treat
    - the best treatment option
    - the best URO MD specialist

    MF
    Hi MichaelF

    Actually I think Dr. Miller just switched to Wellstar and is associated with Wellstar north Fulton now. Fortunately, he takes my insurance so I should be good there.

    It’s a bit of a story how I found him. I was googling best prostate cancer doctors in a atlanta and the paid ad for my current docs landed first (yeah right). But as I dug I saw Dr. Miller’s articles —those he wrote and those written about him and was impressed. He’s been on local and national media and his approach seemed to speak to me. But I’ll reassess after the consultation.

    He specializes in both prostate cancer (which was what drew me to him) but also on RP with a specialized approach he does).

    I’m almost 49 so I’ve kind of personally ruled out Any radiation treatment because of the risk of bladder or colon cancer before I check out. If I was 75 or older, seed me up and let’s call it a day. I just don’t see that radiation is viable for long term survivability. Add the fact that I would eventually have to do something about my giant prostate that seems to be growing and it further leans RP.

  3. #13
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    The use of antibiotics as a diagnostic test for prostate cancer is not definitive and should be used cautiously, if at all. Generally, I do not recommend it because I consider it an overuse in the face of the impending medical crisis of antibiotics becoming ineffective worldwide, and bad medicine inappropriate for this purpose. Yet, your case may warrant it. I personally don't see it.

    Studies have shown it to be ineffective for this purpose and the resulting lowering of the PSA is stastically no different than in the control group leading to early misdiagnosis impacting those cases similar to yours with a delay in smaller more aggressive cancers being found. Prostate cancer often is accompanied by some form of inflammation which may respond in some small way to antibiotics. I hate to be the doom and gloomer here, but your profile is beginning to take shape as more and more facts begin to unfold.

    I'd advise the new doctor be the one to answer this question and implement it if called for as a good idea. It will also give insight into his professionalism. While professionals are trained to be objective they can fall into the trap of the patient's denial or minimally work to appease it at the risk of lost time and perpetuating the bias towards denial and inaction.

    As a footnote, the overuse of antibiotics for this purpose repeatedly with specific patients increases the risk of antibiotic resistance and complications with individual patients and life threatening infections should intervention be required.
    Last edited by Another; 04-20-2019 at 06:16 PM.
    Born 1953
    family w/PCa; grandfather, 3 brothers
    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
    5-21-19 PSA <0.02, Zero Club 3.5 years

  4. #14
    Quote Originally Posted by Another View Post
    The use of antibiotics as a diagnostic test for prostate cancer is not definitive and should be used cautiously, if at all. Generally, I do not recommend it because I consider it an overuse in the face of the impending medical crisis of antibiotics becoming ineffective worldwide, and bad medicine inappropriate for this purpose. Yet, your case may warrant it. I personally don't see it.

    Studies have shown it to be ineffective for this purpose and the resulting lowering of the PSA is stastically no different than in the control group leading to early misdiagnosis impacting those cases similar to yours with a delay in smaller more aggressive cancers being found. Prostate cancer often is accompanied by some form of inflammation which may respond in some small way to antibiotics. I hate to be the doom and gloomer here, but your profile is beginning to take shape as more and more facts begin to unfold.

    I'd advise the new doctor be the one to answer this question and implement it if called for as a good idea. It will also give insight into his professionalism. While professionals are trained to be objective they can fall into the trap of the patient's denial or minimally work to appease it at the risk of lost time and perpetuating the bias towards denial and inaction.

    As a footnote, the overuse of antibiotics for this purpose repeatedly with specific patients increases the risk of antibiotic resistance and complications with individual patients and life threatening infections should intervention be required.
    Good to know thank you.
    2006: 1.6 PSA age 36
    2007: 1.3 PSA age 37
    2012: 2.2 PSA age 42
    2013: 2.6 PSA age 43
    2014: 2.8 PSA age 44
    2015: 3.1 PSA age 45
    2016: 3.5 PSA age 46
    2017: ? N/A
    3/18– 4.1 PSA at 48 YO. u/s measured 46 ml prostate
    3/18–free PSA 10%
    3/18–12 core all negative
    9/18– 4.5 PSA
    9/18– negative pca3
    12/18- 4K at 17%
    12/18- 3t MRI, 5mm pirads 3-4 and a pirads 1-2
    2/19- Fusion biopsy. G6 (3+3) 20% of a single core
    AS for now
    4/19-PSA at 7.21 (up from 4.5 in September 2018! Gulp

  5. #15
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3 -
    2013 TURP (90→30 g) path neg. then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 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 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (30-day check)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015

  6. #16
    Thank. Maybe I’m confused but my statement about antibiotics was meant about a 1 week treatment in hopes that the sharp jump was due to prostatitis.

    My PSA rise as been consistently .2-.4 a year and had a large jump over six months. So I was hoping that my sharp rise was just a temporary fix.

    I’ve seen people who have sharp PSA increases on this board where the doctor gave them antibiotics to make sure the increase wasn’t just due to prostatitis.
    2006: 1.6 PSA age 36
    2007: 1.3 PSA age 37
    2012: 2.2 PSA age 42
    2013: 2.6 PSA age 43
    2014: 2.8 PSA age 44
    2015: 3.1 PSA age 45
    2016: 3.5 PSA age 46
    2017: ? N/A
    3/18– 4.1 PSA at 48 YO. u/s measured 46 ml prostate
    3/18–free PSA 10%
    3/18–12 core all negative
    9/18– 4.5 PSA
    9/18– negative pca3
    12/18- 4K at 17%
    12/18- 3t MRI, 5mm pirads 3-4 and a pirads 1-2
    2/19- Fusion biopsy. G6 (3+3) 20% of a single core
    AS for now
    4/19-PSA at 7.21 (up from 4.5 in September 2018! Gulp

  7. #17
    Top User
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    Aug 2016
    Posts
    1,645
    True, but it doesn't make it good medicine. The next PSA will tell a lot. Antibiotics only corrupts that data. Patience.

    It is not unreasonable to consider the clomid has boost your testosterone and your cancer.
    Last edited by Another; 04-21-2019 at 12:24 PM.

  8. #18
    Quote Originally Posted by Another View Post
    True, but it doesn't make it good medicine. The next PSA will tell a lot. Antibiotics only corrupts that data. Patience.
    Okay thanks. I’ll not mention it then, I thought I understood it to be standard procedure.

    My PIRADS 3/4 was indicative of inflammation or prostatitis so maybe I’m just prone to it. Maybe this is a temporary jump.

    After years of nearly ho hum fairly consistent increases this one freaked me out a little. It didn’t help that this article was the first when I googled “large increase in PSA over a year”

    https://abcnews.go.com/Health/Health...4507339&page=1

    “But a PSA velocity jump of 2.0 points or more in the year before treatment was the best single predictor of a poor outcome overall, the researchers said. This observation held true regardless of whether a patient had surgery or radiation.”

    That article didn’t make my day.

  9. #19
    ISZ,

    Agree radiation isn't a first choice of treatment under the age of 55.

    My surgeon was of the opinion my quickly worsening urinary symptoms might mean I am suffering from fleas on top of lice. And indeed post-surgery pathology revealed partly purulent chronic inflammation in my prostate on top of the 15mm grade 4 tumor. The jump in your PSA is more likely an effect of inflammation than quickly growing cancer, which doesn't say your cancer is harmless and will continue to be so over the next couple of years.

    In my opinion prostate cancer is a choice of HIV (the cancer killing you slowly), black plague (the radiation therapy that might kill you all the same), cholera (difficulty to hold on to bodily fluids after the thing was removed), and an anxiety disorder for mentally juggling the first three options.

    I tend to think the cholera, if chosen early enough, is still best especially if one is subsequently spared the plague with HIV gone.

    Anyways, best of luck!

  10. #20
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    Quote Originally Posted by IceStationZebra View Post
    Okay thanks. I’ll not mention it then, I thought I understood it to be standard procedure.

    My PIRADS 3/4 was indicative of inflammation or prostatitis so maybe I’m just prone to it. Maybe this is a temporary jump.

    After years of nearly ho hum fairly consistent increases this one freaked me out a little. It didn’t help that this article was the first when I googled “large increase in PSA over a year”

    https://abcnews.go.com/Health/Health...4507339&page=1

    “But a PSA velocity jump of 2.0 points or more in the year before treatment was the best single predictor of a poor outcome overall, the researchers said. This observation held true regardless of whether a patient had surgery or radiation.”

    That article didn’t make my day.
    You are free to mention it. My view is different than most and I may jump in to counter it. This freedom to counterpoint is one of the strengths of this forum. The antibiotic ruling out strategy is standard procedure for many yet it leaves a small subset of young men like you at higher risk. It is also standard procedure to not screen over 80 percent of older men for PSA.

    There is no way to claim or test that any unwanted jump in PSA is due to prostatitis, yet it is the first response to an unwanted rise in PSA. Only a subsequent fall back to previous levels can suggest it. There is no indication of it in your history implying your steady rise is the result of BPH or cancer or both.

    My view is when there are two possibilities in the diagnostic phase act on the one that has the highest risk to your life. It is a better safe than sorry strategy based on conducting an aggressive diagnostic campaign.

    Your yellow flag on the beach is your continued efforts to manipulate your testosterone. It will be interesting to hear your new doctor' s recommendation for this treatment strategy. From what I read, it is not recommended pre-RP.

    Back to your prostate size. Enlarged prostates are generally the result of a switch in the cell DNA. Prostate cells life cycle are directed by their DNA and healthy cells die and generate at similar rates regulating a steady size of the gland. As men age their prostate cells lose this DNA feature and begin to live longer. The result is an expanding gland or BPH. This is occurring early for you. The question is why?

    A plausible explaination is your DNA switch is triggering earliar. Couple this with the knowledge almost all men will have BHP and 80% of all men will have cancer by the time they are 80 suggests this entire transformation has begun early for you. The therefore in this scenario is younger men presenting early with these symptoms are at higher risk of having cancer than another explaination.

    The complication is your obesity. It adds another higher risk factor for cancer presenting early. This is thought to be due to the presence of viseral fat and what is stored there from diet. The third complication is the testosterone therapy which we understand the least.

    A common obesity symptom is loss of or lowered testosterone production. This may suppress your cancer which has been triggered by other factors. Add in the supplementation and it may flare it. This may even vary with the possiblility that G3 responds differently than G4 and 5 to increases in testosterone. There is belief it may hold G3 at bay while boosting more aggressive grades.

    Yours is a perfect storm. Hopeful thinking about prostatitis or MRI detection of it or inflammation is the least useful thought at this point, imo. Hence, keep your antibiotic powder dry for when you need it and stay on the hunt.
    Last edited by Another; 04-21-2019 at 01:34 PM.

 

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