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Thread: Nodule found on my DRE psa level .8 What now

  1. #1
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    Nodule found on my DRE psa level .8 What now

    I ve gotten screened over the last few years and everything was fine.I ve developed urinary symptoms over the past year and last year had blood in my semen that went away so i didnt think much about it since my DRE/psa test were normal the previous 3 years.Now every since my exam ive had pain in that area between my anus n scrutum with an increase in symptoms, im hoping its psychosomatic. Im scheduled to see a urologist may 8.Dr google claims that its a 50% chance that its cancer.Has anyone had the new biomarker test using urine before getting a biopsy.or mri any suggestions on my approach or just follow dr. s protocol. im worried stiff that i ve had for 2 or 3 years and it just wasnt showing up on screening.

  2. #2
    Moderator Top User HighlanderCFH's Avatar
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    Welcome to the forum, Dpix. My guess is that it is probably something other than prostate cancer.

    Can you give us your age and your history of PSA readings? That will give us a lot more info to go by in offering you our opinions.

    Good luck!
    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.
    Seven annual post-op exams 2012 through 2018: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  3. #3
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    Quote Originally Posted by daddypix View Post
    I ve gotten screened over the last few years and everything was fine.I ve developed urinary symptoms over the past year and last year had blood in my semen that went away so i didnt think much about it since my DRE/psa test were normal the previous 3 years.Now every since my exam ive had pain in that area between my anus n scrutum with an increase in symptoms, im hoping its psychosomatic. Im scheduled to see a urologist may 8.Dr google claims that its a 50% chance that its cancer.Has anyone had the new biomarker test using urine before getting a biopsy.or mri any suggestions on my approach or just follow dr. s protocol. im worried stiff that i ve had for 2 or 3 years and it just wasnt showing up on screening.
    I am not an MD, but my advice is to get a 3T MRI and a biopsy. If the URO you see has a let’s watch this attitude, get a new URO.
    DOB 5/1957

    PSA - 11/2010=1.9, 6/12=2.3, 12/13=2.19, 12/14=2.64, 3/17=5.29, 3/17=3.91, 6/17=3.47, 12/17=4.50, 12/17=3.80, free PSA low risk (local (Uro, “My opinion you don’t have cancer), 8/18=5.13, 10/18=5.1, 10/19 ISO PSA 56% risk cancer. All DREs negative.

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative, (Uro opinion “This has been going on for a year”.... ah, more like 2 years ). Bone scan/CT negative

    2/25/19 R-LESS (Robotic Laparoendoscopic Single Site Surgery) outpatient Cleveland Clinic,

    3/6/19. Pathology - Grade Group 4 with Intraductal Carinoma
    T3aNO, GS8, 21 mm unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., +LVI, + EPE non focal apex/mid lateral 1mm max extension, Cribriform pattern present. Decipher .86 High Risk.

    PSA 3/27/19 .03. (29 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)

    ADT - 6/3/19
    ART - 8/5/19

  4. #4
    Welcome to the Fourm, Dp! With your urinary symptoms now increasing, new nodule, pain in the area, and history of blood in your semen, I think it's safe to say your uro will be investigating. He or she will be able to judge from your history and physical which tests tests and their order.

    There is a Sticky post near the top of the main page with instructions on how to create a signature that will be automatically appended to all your posts. That will save you time and help folks in their replies. Have a look at other signature for examples of summarizing your history. Start with your age.

    Keep us posted, please.

    Djin
    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

  5. #5
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    Hey chuck thx for the reply........im 54 yrs old,,,,,2016 was .7 2018 2.0 2019 .8....used a different lab in 2017 so i dont have that year for my psa reading....My gp felt the nodule but said my prostate didnt feel enlarged........I was hoping that some kind of infection might have been the cause...but my urine was clear......im concerned that i ignored my urine issues increase in frequency,slight burn on occasion,blood in semen that went away slight dribbling,and now ever since my DRE i ve had pain in my area between my anus and scrotum.......feels like i need to pee all the time.....and now ive got an aggressive form of it that was missed up until this year........surely i couldnt be that unlucky...If by chance i ve had it for 3 years could it be in my pelvic bones and hip...my hip joints have been sore but i figured it was just getting older........

  6. #6
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    Thx for the reply i meet with the urologist may 8th.......hope he s not a quack............

  7. #7
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    thx for the advice duck2

  8. #8
    Quote Originally Posted by daddypix View Post
    Thx for the reply i meet with the urologist may 8th.......hope he s not a quack............
    I hope not either. Unless you got the referral for the urologist from a book of matches or the back of a comic book, he probably isn't a quack, at least in America.

    Your PSA test scores aren't disturbing at all, less than 1 and dipped between 2018 and 2019.

    The fact that you have symptoms seems to be a good sign, at least in regards to Prostate Cancer. A cancer large enough to cause the symptoms that you describe would likely create a lot more PSA than you have.

    I would be positive about this. Sure its possible that it could be PC, it just doesn't seem very likely at all.


    A lot of guys get prostatitis, and the symptoms are across the board on it. It can be pretty frustrating for the patient and doctor as well. A former colleague of mine in 70, and has been going to the urologist for this since he was in his 40's.
    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, PSA test 7/2019 2.0


    DOB 1956, in Pittsburgh, USA

  9. #9
    Welcome daddypix! Early stage prostate cancer (PCa) typically does not have associated symptoms. In addition, your PSA levels (latest = 0.8 ) are not typical of adenocarcinoma of the prostate. There are a few types of PCa that do not cause an increase in PSA BUT fortunately these are very rare.

    You have taken the most important and essential step => an appointment with a URO MD. He/she will investigate the nodule and seek an explanation for your symptoms and hopefully arrive at a quick solution/cure!

    Doubtful that you are harboring PCa & very hopeful that you will NOT qualify for membership in "The PCa Club!"

    Continue asking questions and seeking correct answers = exactly as you are doing. Good job!

    Meanwhile, keep your concern about having PCa to a minimum & let your URO MD determine the cause(s) of your symptoms.

    Keep us updated.

    MF
    Last edited by Michael F; 04-24-2019 at 02:08 PM.
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = G7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left: PM + EPE. 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 c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: 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 84 Months Post Op: Mean = 0.021 (20x uPSAs: Range 0.017 - 0.026) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  10. #10
    Top User garyi's Avatar
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    Daddypix...welcome. many, or most of us have been where you are. I suspect you, with the assistance of Dr. Google, are getting WAY ahead of what you issue is. If you are really concerned about the quality of your URO, use Google to check that out.

    I suggest you RELAX, wait for your appointment, and get some real physician input. In my experience, a GP usually knows next to nothing about what a supposed prostate nodule is indicating. Controlling very probable baseless worry will really help you. Please try, and let us know what you learn.
    72...LUTS for the past 7 years
    TURP 2/16,
    G3+4 discovered
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor still in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    Radiation Procitis, and Ulcerative Colitis flaired after 20 years
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19
    We'll see....what is not known dwarfs what is thought to be fact

 

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