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Thread: prostate cancer?

  1. #1
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    prostate cancer?

    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!

  2. #2
    Sorry you are here. Based on my journey, I would opt for the 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 with Intraductal Carcinoma
    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)
    9/10/2019. <.02. (198 days)

    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)

  3. #3
    Biopsy.

    I have a similar psa and never had anything felt on the dre. I have cancer, mild thankfully for now.

    The antibiotic doctor isn't one I would keep. There are times where the antibiotic makes sense but this isn't one of them....in my opinion.

    Good luck.

  4. #4
    Hi Sushi and Welcome to the Forum! I'll make a guess that you are in Europe from your use of a decimal comma rather than a decimal point

    I would second the advantages of a biopsy. The only question I have is whether your uro thinks it pays to first do an MRI and then a "fusion biopsy" which, in addition to the usual cores taken in around the prostate, would add extra cores in areas judged to be suspicious on the MRI.

    While high-grade, aggressive prostate cancer is, fortunately, less common than low-grade and less aggressive PCa, it nonetheless does occur and the very best weapon against it is early diagnosis. A negative biopsy will give you peace of mind and provide a baseline if there is continued PSA rise. In the event PCa is detected, you will know you found it at an early stage and can take the appropriate action, whether to monitor it (active surveillance) or treat. A biopsy can miss existing cancer; the remedy for this, when PCa is strongly suspected, is repeat biopsies (and imaging) over time.

    Keep us posted,

    Djin
    Last edited by DjinTonic; 09-16-2019 at 12:23 PM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (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
    08-28-19 (2 yr. ) 0.016
    Avg. = 0.013

  5. #5
    Top User
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    1,791
    A biopsy is called for when the PSA is consistently 3.0 to 4.0. The PSA can be affected slightly by some activities you should avoid several days prior to the test; no sexual activity, no bicycling, no heavy lifting, no DRE. Stimulation of the prostate can bump the number slightly.

    I agree the recommendation of antibiotics disqualifies the doctor making the suggestion. There are more detailed reasons for this. Suffice it to say such a suggestion indicates a misunderstanding of PCa and the abuse of antibiotics.

    Consider waiting a month, avoid the activities mentioned for several days before and retest. If it confirms the PSA is rising, even if it drops slightly, but not to the baseline, get a biopsy.

    Early detection and early treatment is the mantra for treating, curing, or managing PCa. Denial and delay are the two demons of cancer. PCa is most often treatable and even curable if detected and treated before it becomes life threatening.

    You said the DRE is normal. Does this mean it is not enlarged? It is common to have prostate enlargment with age. Prostate cells die and regenerate regularly and in a balanced way. As we age, the cells can begin to die at a slower rate while regeneration continues at the normal rate. Enlargement or BPH can raise PSA numbers. Even so a consistent 3.0 to 4.0 calls for a biopsy even with enlargement. The reason I ask, enlargement affecting the PSA can complicate using PSA since a portion of the increase can be attributed to BPH. Here's the kicker, if you are not experiencing BPH or enlargement and your prostate is still a normal size then the PSA increases are almost all attributed to evidence of cancer.

    Avoid supplements and other activities that may affect your PSA. Some men will attempt to manipulate their PSA thinking it is suppressing the cancer. It is not. A reliable PSA marker is your best friend going forward if you do have cancer.
    Last edited by Another; 09-16-2019 at 05:13 PM.

  6. #6
    Senior User
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    Nov 2018
    Posts
    251
    I would do the biopsy. Your PCP let you know early your psa was elevated which is good and referred you to a Urologist. My PCP waited a year to tell me.
    DOB 1955
    63 at dx
    3/2018 PSA 4.05 DRE normal refer to URO small town
    10/2018 PSA 6.28 DRE normal
    Bx 11/2018 12 cores 3 pos 1 - 5% left mid 2 - 50% left base
    GS 3+4=7 T1c
    Appt Mayo Clinic Phoenix Az 1/4/2019
    Dr. Paul Andrews recommend
    MRI 2/27/2019 Mayo AZ
    RALP 2/28/2019 Mayo AZ Dr. Paul Andrews
    Path: GS 3+4=7, Tertiary Gleason Pattern none, Grade Group 2
    Tumor presents moderate to extensive volume mainly posterior
    portion of prostate. Largest tumor nodule measures 8 mm
    Prostate: 21g 3.5 x 3 x 3 cm
    EPE: Neg
    Bladder Neck Invasion: Neg
    Seminal Vesicle Invasion: Pos (left seminal vesicle)
    Margins: Pos left lateral base & central base 2mm focus each
    Lymph Nodes involved: 0
    Lymph Nodes Ex: 16
    Nerves spared right side only
    Path Staging (AJCC 8th Edition)
    Primary Tumor pT3b
    Regional lymph nodes: pNO
    Distant Metastasis: Mx
    Continence 99% 9 wks
    ED Present
    PSA 4/17/2019 <.10
    PSA 5/2/2019 <.007
    PSA 6/10/2019 <.10
    PSA 8/1/2019 <.007
    PSA 9/16/2019 <.10

  7. #7
    Top User garyi's Avatar
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    1,382
    3T MRI, then a "fusion biopsy" to get the real picture. Antibiotics will just mask whatever the issue is, and is a very bad suggestion.
    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, .081 9/19
    We'll see....what is not known dwarfs what is thought to be fact

  8. #8
    Quote Originally Posted by garyi View Post
    3T MRI, then a "fusion biopsy" to get the real picture. Antibiotics will just mask whatever the issue is, and is a very bad suggestion.
    If this is allowed by your insurance, this is a good suggestion. Some insurance won't do the MRI without a previous random.

    If you go this route, let them fusion biopsy anything that lights up on the MRI but then have them also do a mapped/random biopsy in addition. I had two areas show up on the MRI that weren't cancer and my cancer was found in the subsequent random/mapped additional cores they took.

  9. #9
    Top User
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    Posts
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    Or, it missed the cancer in the MRI lighted areas.

    PCa biopsies have a high false negative rate which increase with the size of the prostate.

  10. #10
    Quote Originally Posted by Another View Post
    Or, it missed the cancer in the MRI lighted areas.

    PCa biopsies have a high false negative rate which increase with the size of the prostate.
    Also a concern. I don't have much faith in the doctor who did it. The entire experience was an absolute nightmare. I'm going to ask the new doc to really hit those areas hard. We may need more than 12 cores.

    I'll be knocked out on Thursday so when in Rome....
    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–TRUS all 12 cores 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 TRUS biopsy. G6 (3+3) 20% of a single core. Two cores pre-cancerous. AS for now
    4/19-PSA at 7.21 (biopsy effect)
    6/19-PSA back down to 4.8
    9/19-TRUS-- Right mid - prostatic adenocarcinoma G6 (3+3) grade group 1 involving 25% (4mm) of one core
    Right lateral - prostatic adenocarcinoma G6 (3+3) grade group 1 involving 90% (6mm) of one core
    Right lateral apex - prostatic adenocarcinoma G6 (3+3) grade group 1 involving 40% (8mm) of one core. Right base - Atypical small acinar proliferation.
    12/19- Planned Davinci RP

 

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