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Update after meeting urologist and a question

worriedabouthubby
Posts: 37
Joined: Aug 2012

Husband's biopsy now scheduled for this Thursday. Doctor said possibility of cancer is high (better than 70%). Prostate felt 'hard' or 'firm'. Not enlarged as far as he could tell. Doing some urine tests. Will order bone scan and CT scan after getting biosyp results (insurance requires the wait).

I found a site than calculates the doubling time and velocity for PSA scores. I put in his score from the bloodwork on Aug. 10 (73.76) and Aug. 20 (81). Doubling time is 2.34 months or 0.2 years. Velocity is 22.04 ng/ml/month or 264.44 ng/ml/year.

These see even higher than just looking at the PSA. And see to indicate more aggressive.

Anyone know anything more about this type of info? Doctor didn't say alot- wants to wait on biopsy and Gleason scores and scan results.

Thanks to all for the previous responses and comfort!

hopeful and opt...
Posts: 1282
Joined: Apr 2009

make sure that the doctor does at least 12 cores.

In my opinion calculating doubling time is not appropriate for psa's 10 days apart.

By the way which site did you use?

Also where are you located, I looked up your doctors name, and there were several urologists in different parts of the united states.

A bone scan and a ct scan may or may not be appropriate. It all depends on the results of the biopsy. additionally an mri is a preferred test to a ct scan.

best

laserlight's picture
laserlight
Posts: 165
Joined: May 2012

I agree, have the doctor take at least 12, my doctor took 18 samples. At this point in time the PSA doubling is looked at. But the biopsy is the next step, this will give you a accurate indication of cancer activity. As was indicated before psa results can be misleading. The biopsy is the true indicator of cancer. It might be good idea to start to collect the medical records, this will help you keep the information correct. Sorry to hear about this.

worriedabouthubby
Posts: 37
Joined: Aug 2012

The urologist is Dr. Daniel Watson of Urology Specialits of the Carolinas. He said he would do "12 or more cores". I found the doubling rate stuff on line and don't remember the site right now- will try to find it again. Didn't find it until after the appointment today, so didn't mention it to the doctor.

He won't admit it, but he has been having some back pain (he's had back problems in the past and won't admit the connection) and has been having to urinate more than in the past (I don't think he realizes this- but I have noticed on our trips. Used to I'd have to ask him to make a pit stop, now he's stopping for himself more than I need it- and that's alot). He's also developed indigestion and doesn't see that as related either. I'm not pushing any of that right now- he's got enough to deal with. I'm just trying to be vigilant and make note of what might be important to share down the road. I forgot to ask about a PCA3 test today. Is that done on urine? They did ask for a urine sample, but did not draw blood today.

laserlight's picture
laserlight
Posts: 165
Joined: May 2012

Several items to keep in mind here. I to had lower back pain that I could not explain, it was intense at times. After surgery the pain is gone, I have no answer for that. It is good that the doctor is willing to take 12 or more samples. The other item is that doctors for the most part will not do biopsy if they donot suspect cancer. The fact that the doctor wants to do a biopsy is an indication that he to is concerned. Urine samples are always taken on me when I visit the doctor, one of the items checked is blood in the urine, as this might indicate more problems. The indigetion can come from many sources. The main focus right now is the biopsy, follow the instructions completely. This will cut down on the risk of infection. My psa level was only at 2.25 but I was already in stage T2C Pc. I had a doctor visit the other day and we spoke about this. right now there is huge debate going on in the medical communite about psa levels. She indicated that the psa test is misleading. There is a goos site to go to it is called PUB MED google should take you there. This site has lots of good medical information. I hope this helps sorry for going on.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Laser,

Good advice here but I guess I am more jaded than you in your belief that doctors won't do a biopsy unless the suspect prostate cancer. A biopsy is a major money maker for urologists. In my own case with a PSA level that just barely broke the then standard of 4.0, he wanted to do a biopsy to "rule out cancer." There were no symptoms, no history, and a normal DRE. Other than being in the age bracket at 58 with a slightly enlarged prostate there was nothing at all to suspect prostate cancer. Statistics show that about 25% of men over 50 will be positive for prostate cancer and many, many of these men with follow the urologist recommendation for surgery to remove the prostate.

I wish it weren't so but I think most urologists go forward with biopsies because they see no harm in it and they truly believe that early detection will benefit the patient. In my own case I wish the doctor had told me to refrain from sex for 48 hours and administered another PSA test. If that was high then he should also have considered PSA increases due to BPH or possible UTI before proceeding with a biopsy. Of course, I did end up with a low risk diagnosis and he strongly recommended surgery. I went another route but I often wonder if I allowed myself to be over treated. I can't rewind that and am grateful that the course of action I took has left me with no side effects and it did zap the small amount of cancer I was found with so all is good. Sort of.

Of course, in worriedabouthubby's case it is a different situation and I think a biopsy here is definitely warranted. While there may be other explanations for such a high PSA the most likely cause is prostate cancer and the sooner they know the situation the sooner they can begin making informed decisions about the course of action.

The urine test is, I believe, a new test that has been shown to be an indicator for prostate cancer. I recall when I visited my urologist they asked me to participate in an ongoing study to see if they could correlate bio markers in urine to prostate cancer that could be used in conjunction with the PSA test to provide better predictive tool. My urine test did not contain prostate cancer markers. There have also been studies where dogs can be trained to alert on urine of men with prostate cancer.

Although doctors believe there is little to zero risk associated with a prostate biopsy, there are many men each year who contract sepsis as a result of the biopsy. I have a close friend who almost died. More and more we are seeing the antibiotics that we are given to fight off the potential infection risk by going through the wall of the rectum into the prostate being ineffective because of the super bugs that are out there. I believe these super bugs are the result of a diet where we eat the meat and drink the milk of bovines that are shot through and through with antibiotics.

K

laserlight's picture
laserlight
Posts: 165
Joined: May 2012

Kongo;

I agree I tend to get real involved at times. I have good doctors that I trust. Granted that there are doctors that are trying to generate income and that needs to be watched. In my case I am able to focus on PC and not worry about helping doctors income.

hopeful and opt...
Posts: 1282
Joined: Apr 2009

"I went another route but I often wonder if I allowed myself to be over treated. I can't rewind that and am grateful that the course of action I took has left me with no side effects and it did zap the small amount of cancer I was found with so all is good. Sort of"

KONGO, IN MY OPINION, ON AN INDIVIDUAL BASIS, THERE IS NO ANSWER TO TREATMENT CHOICES OF THIS NATURE. IN MY CASE WHERE I AM DOING ACTIVE SURVEILLANCE, I'VE WONDERED AT TIMES IF I WAS UNDERTREATED.

THE DECISION OF TREATMENT IS VERY DIFFICULT, SINCE WE ARE HIGHLY THREATENED AT THE TIME OF THE DECISION, AND EVEN AFTERWARD....THERE REALLY AREN'T ANY DIRECT COMPARISONS OF DIFFERENT TREATMENT CHOICES.

DID YOU OVERTREAT? MAYBE, OR MAYBE NOT...YOU WILL NEVER KNOW....YOUR CHOICE WAS THE BEST THAT YOU WERE ABLE TO MAKE AT THE TIME WITH THE INFORMATION AND EXPERTISE THAT YOU HAD.....WHETHER OR NOT YOU WOULD HAVE DONE DIFFERENTLY , IN MY OPINION IS NOT AN APPROPRIATE QUESTION SINCE THE DECISION WAS MADE AND YOU CAN'T GO BACK. IN YOUR CASE YOU HAVE BEEN SUCCESSFUL WITH THE CHOICE. YOU WILL ONLY DRIVE YOURSELF CRAZY IF YOU THINK TOO MUCH ABOUT THE APPROPRIATENESS OF THE PAST DECISION WHICH IS NOT REVERSABLE.

YOU'VE STUDIED FOR A WHILE AND DEVELOPED KNOWLEDGE THAT YOU DID NOT HAVE AT TIME OF YOUR DIAGNOSIS. THERE ARE ALSO NEW DIAGNOSTIC TESTS AVAILABLE, SO A DECISION OF TREATMENT THAT YOU MIGHT SUGGEST TO A NEW PATIENT AT THIS TIME MAY BE DIFFERENT THAN WHAT YOU CHOOSE.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

All good points, Ira. I don't really fret over it and I have no regrets. It's more of an intellectual thing. I think many often rethink key decisions they've made along the way and not just with prostate cancer. It's more like, if I had majored in this instead of that or if I'd taken that job instead of the one I did type of thing. I do feel confident I made the best decision for me at the time based on the information I had then. Hindsight is almost always 20/20.

Best

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Worried,

PSA doubling time calculations are essentially meaningless when they are so close together. The more data points over time that you have increases the accuracy of the predictions. It is not a straight line conversion where you can just figure the slope of the line using algebra and plug it into a calendar. It is based on a logarithmic scale. A typical data set for calculating PSA doubling times would go back a few years and have three or more data points. The longer the history and the more points the more accurate it will be.

There are some other calculations that you ought to be interested in. These are PSA velocity which is simply the speed at which the PSA is increasing over time and PSA density. While PSA velocity will have the same criteria as PSA doubling to come up with a good number the PSA density only requires a single data point and the volume of the prostate. You can calculate the PSA density by dividing the PSA by the prostate volume. When they do the biopsy on your husband they will calculate the volume using the ultrasound probe so after the biopsy you can calculate density. The higher the number the more likely the presence of prostate cancer.

Unless the cancer has metastasized to the bones in force a bone scan will probably not show anything but it is a business development opportunity for the urologist. Most men (including myself) who find out they have prostate cancer are directed to get the scans to see if the cancer has spread. Of course at that point we're scared and don't question anything. It can't hurt but probably won't add much insight to your husband's diagnosis. As long as your insurance covers these additional tests you may gain some peace of mind in having them done but if you're paying out of pocket I suggest you be assertive in questioning the doctor on the utility of them. If your husband did have significant metastasis to the bones there would probably be other symptoms associated with that.

It's very good that you're delving into the technical aspects of prostate cancer. It will prepare you to understand what your medical team will tell you.

Best,

K

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