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Thread: prostate cancer?

  1. #11
    Moderator Top User HighlanderCFH's Avatar
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    I welcome you to the forum. You've come to a great place for help & support.

    I also have to join with the others & suggest the biopsy. Good luck!!
    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.
    Eight annual post-op exams 2012 through 2019: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  2. #12
    Regular User
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    Hello again! Many thanks for your replies & correct, I am from Europe!
    So, the second uro recommended antibiotics, based on the high free psa, 30%. If the total psa level drops significantly after the treatment, then we assume that something else rather than cancer made the psa to elevate?
    My partner begun the antibiotics therapy, but he is not relieved. I think that he will proceed with the biopsy. I hope that 20days is not a big delay.

  3. #13
    20 days is not a big delay, but free PSA is no guarantee he does not have cancer nor is a negative biopsy.
    YOB 1957

    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.

    3/6/19. Pathology - Grade Group 4 Intraductal Carcinoma
    T3aNO, 1 mm EPE, GS8, 21 mm uni-focal tumor involved 10% of prostate.

    7 Nodes, SV, SM, PNI, and BNI were negative.

    LVI and Cribriform pattern present.

    Decipher .86 High Risk.

    Post Surgery PSA
    3/25/19 .03. (<1 month)
    4/25/19 <.03. (2 months)
    5/25/19 <.02. (3 months)
    9/10/2019. <.02. (6 months)
    11/27/2019. <.02. T<3. (9 months)

    3 Part Modality Treatment

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic,

    ADT - started 6/19, end date 6/21.

    ART - Completed 9/26/19. (78 Gy, yes, I glow in the dark)

  4. #14
    Quote Originally Posted by Sushi2911 View Post
    Hello!

    My partner is 59 & last month, during his annual check up, his PSA was elevated at 4,6 ( from 2,7 last year ) with ratio 0,30
    We visited 2 urologists.
    Both said that DRE is normal.
    The first one recommended a biopsy & the second one antibiotics for 20 days and repeat PSA.

    We are so anxious!

    It isn't time to panic yet on this, by any stretch. His PSA is only moderately elevated, and there is even a bit of a dispute among doctors as to whether a biopsy is warranted yet. Without knowing anything about the two doctors, I would put more value on the "delay biopsy" opinion, at least here in the United States. Biopsies are the urologists' bread and butter so there would be a natural inclination to lean that way, but it might not be where you are at.
    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

  5. #15
    Top User
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    Taking antibiotics "for some other unknown reason" makes my point. You take antibiotics for bacteria infections. You do not take antibiotics to screen for prostate cancer.

    If the doctor wants to run a culture for an infection before prescribing antibiotics that works. If your partner has a history of urinary infections that works. But be warned, using antibiotics indiscriminately can create resistance which can put you at risk later when you really need them. Men treated with antibiotics as a screening tool for PCa have a higher risk of related complications from infections during biopsy.

    Studies have shown there may be a drop in PSA after a course of antibiotics. The number of participants experiencing a drop in PSA was no different than the control group in the study that was not given antibiotic and had PCa. However, there is a risk this random drop in PSA will be associated with the effects of antibiotics leading patients to think they had an infection and not PCa leading to a delay in biopsy and treatment if warranted.

    Only a biopsy can diagnose PCa. A course of antibiotics can not diagnose PCa. It is bad doctoring. Men seem to be especially suceptible to denial in the presence of PCa. This plays to their worse fears and bias including the doctor's if he is a man.
    Last edited by Another; 09-18-2019 at 01:46 AM.

  6. #16
    Do not worry about a delay; however, I think you are headed for a biopsy. Whenever my PSA went up a little more than what was expected from my BPH, a biopsy was suggested, which I always did. In more than 20+ years of my rising PSA, antibiotics were never once mentioned by any one of my uros, let alone prescribed. Biopsies may be urologists' bread and butter, but I assume you are going to them for their expertise about your partner's situation. A PSA >4 and a rapid rate of increase should be your focus, not your doc's vacation fund.

    As you know, a rise in PSA can be caused by conditions other than PCa. But having BPH, prostatitis or some other condition does mean there isn't PCa present as well.

  7. #17
    Experienced User
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    1. Forum member 'Another' makes a good point about antibiotics. Since biopsy may be ahead, ask the MD if you can have it prior to the end of the 20 day course of antibiotics. Otherwise you will be put on another course of antibiotics for the biopsy.

    2. For 48 hours prior to PSA blood draw there must be no activities that place mechanical pressure on the prostate gland or cause it to have muscular or pulsatile/rhythmic contractions that can result in an increase in circulating PSA. DREs, bicycle riding, sexual activities can result in false/temporary increases in serum PSA levels.
    Last edited by Semiramide; 11-06-2019 at 03:41 PM.

  8. #18
    Quote Originally Posted by Semiramide View Post
    1. Forum member 'Another' makes a good point about antibiotics. Since biopsy may be ahead, ask the MD if you can have it at the end of the 20 day course of antibiotics. Otherwise you will be put on another course of antibiotics for the biopsy.

    2. Prior to biopsy there must be no activities that place mechanical pressure on the prostate gland or cause it to have muscular or pulsatile/rhythmic contractions that can result in an increase in circulating PSA. DREs, bicycle riding, sexual activities can result in false/temporary increases in serum PSA levels.
    Semiramide, in n.2, don't you mean "Prior to a blood draw for PSA testing"?

    Djin

  9. #19
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    Edited. Thank you DjinTonic!

  10. #20
    Regular User
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    Good morning.
    Some update.....
    My partner has not yet decided to have a biopsy.
    So, his PSA on 08/2019 was 4.6 and % PSA Free 30 and now 10/2019 his PSA is 4.4 and % PSA Free 30 again.
    Two uros say that since the DRE is normal and free percentage is that good, he should recheck in 2-3 months.
    One uro says DRE OK, free precentage OK, but do a biopsy, never hurt anyone.
    He told me that he wants to recheck it in 2 months and then decide what to do.
    His PSA last year was 2.6 (07/201 and his prostate volume is normal, around 30cc (not from rectal ultrasound)
    He just turned 60

    I am so confused and worried from everything I have read here.
    Is it so likely for him to have cancer?

 

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