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PSA 30, 12 months ago PSA 25, but not informed; had biopsy today.. PLEASE ADVISE!!!

Paul M
Posts: 12
Joined: Nov 2012

I am 52 years old, with no famiily history of cancer of any kind. Three weeks ago I went to my family Dr. related to some recent high blood pressure readings, turned out BP slightly on the high side, but no need for medication. The Dr. was looking at my history and noticed ~ 12 months ago, my blood results indicated PSA of 25, but i was never informed of this. The next morning, I went for another PSA blood test. Dr. called me 2 days later and said my PSA is now 30. A week later, Eurologist did DRE, seemed normal in size and no nodules.. so far so good.. Which brings me to today (11/16/12), I had the prostate biopsy. Appointment scheduled 2 weeks with the Eurologist to go over the results. Any advise / feedback from those with expertise or experience is greatly appreciated!!! Regards, Paul

Euskal
Posts: 1
Joined: Nov 2012

Hi, Did you take antibiotics? You should tell your doctor treatment for 4 weeks and repeat PSA, might be Prostatitis. Greetings

Paul M
Posts: 12
Joined: Nov 2012

Thank you.. Because PSA was so high at my age, recommend was a biopsy right away. Thanks!

Paul M
Posts: 12
Joined: Nov 2012

Euskal, thanks! Will ask the Dr... !

Beau2
Posts: 229
Joined: Sep 2010

Hey Paul,

Welcome to the forum .... Sorry you have to be here!

With a PSA of 30 there is something going on with your prostate and it may be prostate cancer. The results of your biopsy will give you a much better idea of where you stand.

If it is prostate cancer, I would recommend that you do not rush to treatment. If it is prostate cancer, take some time and carefully study all of the treatment options available to you; educate yourself on the specifics of the prostate cancer you may have (I heard there were 24 varieties), and choose a plan that best suits your needs.

A good place to start may be at the library ... check out Dr. Patrick Walsh's book, "Surviving Prostate Cancer". It could be very helpful in interpreting the results of your biopsy.

Paul M
Posts: 12
Joined: Nov 2012

Beau2, thanks for the info. Will consider all options.. I'm just stressing out...

Beau2
Posts: 229
Joined: Sep 2010

Yeah, the possibility of PCa brings a lot of stress to your life. I still get stressed waiting for my PSA test results.

Fortunately, you have a bunch of guys on this forum who have been where you are. Their understanding and advice can help you destress.

Paul M
Posts: 12
Joined: Nov 2012

Thanks for the support!

VascodaGama's picture
VascodaGama
Posts: 1526
Joined: Nov 2010

Paul
You haven't been diagnosed with cancer yet. Only the biopsy can tell your fate.
The high PSA could be related to other causes so that you should wait. Sex the night before drawing blood or inflammation, etc., could cause a substancial rise in the PSA.

Usually doctors recommend antibiotics before the biopsy but yours did go straight to get a definite conclusion. The negative DRE and by the touch he may have the impression that BPH is not present. In any case, you are not alone. Many here will help you understanding facts. Just do not rush even if you unfortunatly get a positive result.
Do things timely and coordinatly.

Get second opinions on the cores of the biopsy and get image studies with 3-tesla MRI and Bone scyntigaphy scan. If cancer is the cause of the high PSA then it may be possible to detect something.

Wish for the best.

VGama

Paul M
Posts: 12
Joined: Nov 2012

VGama, thank you for the info. Appreciate all the feedback I've recieived in just a few days! Paul

Swingshiftworker
Posts: 623
Joined: Mar 2010

As Vasco said, no advice can be realistically suggested until you get your biopsy results back. Let us know what they are and you more and enough "advice" from us here.

Good luck!

Paul M
Posts: 12
Joined: Nov 2012

Will do, ~11 days until I get the results.. Thanks!

Paul M
Posts: 12
Joined: Nov 2012

I received the bad news 11/29/12...
Biopsy Results: 7 of 12 samples tested positive for cancer..
Left Zone = 100%
Left Center = 92%
Right Center = 18%
Right Zone = 0%
Going next week for CAT & Bone scan....

hopeful and opt...
Posts: 1291
Joined: Apr 2009

The gleason score measures the aggressive of the cancer. So on the biopsy report, which you need to have a copy of, as well as all medical information so you can bring to other doctors with various specialties and discuss intelligently, the gleason score of each core is listed. So it could be a 3+3=6, a 3+4=7, a 4+3=7, 4+4=8, etc, etc until a 5+5=10

At any rate please post the gleason score for each core that was positive and the percent of involvement of each of these cores, that is the percent that was cancerous for each of these cores.

Now this is very, very important. Doing these gleason scores are very subjective, so you want to have the slides sent to an independent world class pathologist who specializes in doing the pathology for prostate cancer so that you are not under or over treated. Everything is based on the results of the biopsy so you want it to be accurate.

By the way, what is your age?

We are here for you

VascodaGama's picture
VascodaGama
Posts: 1526
Joined: Nov 2010

Paul

Gleason 7 is for Intermediate risk for metastases. The image studies recommended by your urologist will add info on your status to get a definite clinical stage. That will provide you with the parameters required to define options of treatment.
You may choose a palliative type or radicals but only the radicals can assure you cure.

In my opinion, at 52 years old with a high PSA and a Gleason pattern of 4, you should try the best to get rid of the cancer. However, if metastases are present (extra capsular extensions) surgery would not cure you. In such a case radiotherapy got higher chances to lead you to a successful outcome.
In any case, for 100% assurance of success one needs to know exactly where cancer is set. You could not throw arrows in the dark and expect to hit the target.

Proper image studies become essential and you should try your best when choosing the equipment/methodology used. Old machines doing CT and bone scans are not that reliable in terms of resolution even with a PSA of 30 ng/ml that could be from a tumour big enough to be detected.
I have no medical enrolment to advice you but I am stressing about the quality of the image studies because of your intermediate status for metastases, which could eliminate surgery as an option.

In this forum you may research in past posts about advices from other survivors. I just recommend you to decide things coordinately and timely. You need to be on the top of your case and act the soonest but you got time to get second opinions (on everything) and do not follow a single urologist’s opinion. Your family should be involved in your decisions.
Try reading books on PCa as much as you can and prepare a list of questions before your next visits with the doctors.

Here are good links for a start;
List of questions;
http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

A compendium on Prostate cancer and care;
http://www.lef.org/protocols/prtcl-138.shtml

A book on PCa;
“Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (third edition); which may help you understanding options between surgery and radiation.

Welcome to our boat.
Wishing you luck in your journey.

VGama

hopeful and opt...
Posts: 1291
Joined: Apr 2009

Confirming what VGama advised

"However, if metastases are present (extra capsular extensions) surgery would not cure you. In such a case radiotherapy got higher chances to lead you to a successful outcome.
In any case, for 100% assurance of success one needs to know exactly where cancer is set. You could not throw arrows in the dark and expect to hit the target.

Proper image studies become essential and you should try your best when choosing the equipment/methodology used. Old machines doing CT and bone scans are not that reliable in terms of resolution even with a PSA of 30 ng/ml that could be from a tumour big enough to be detected."

So the tests that you have scheduled for dec 7 are not the best, and can give you a false sense of security, not finding the cancer if there is extracapsular extension.

A much better diagnostic test is the following, usually found at major centers of excellence.

There is an MRI scan for prostate cancer that is done with a special coil in the rectum. This are certain major hospitals that have a Tesla magnet. There is a 1.5 Tesla magnet, the effective resolution is limited to tumors 0.5cc or larger. There is also a 3 Tesla machine which may have a bit finer resolution.

The most effective MRI for the prostate is called a MRSI (MRI/MRS) and includes the ability to identify cancer metabolites using spectographic analysis.....Basically using the spectoscopy with the MRI provides more accurate results, both the MRI and the spectroscopy are done at the same time.

The MRI is generally covered by insurance, however the spectroscopy is considered investigational and is not covered by medicare which I use.

The test indicates if there is any nodule involvement, if there is involvement in one or two lopes , wll show size of prostate, any evidence of extracapular extension, will stage your disease.

.

Paul M
Posts: 12
Joined: Nov 2012

Thank you all for ongoing support and info!

Age 52:

PSA 25 Nov-2011 (was not notified of prior year results)
PSA 30 Nov 03, 2012

DRE Nov 08, 2012 Results seem normal; discomfort when pressed hard..

Biopsy Nov 16, 2012 Results below:
RPZ Benign 4 cores
RCZ 3+4=7 1/2 cores, present in 18%
LCZ 3+4=7 2/2 cores, present in 92%, HGPIN
LPZ 3+4=7 4/4 cores, present in 100%, perineural invasion by adenocarcinoma is present, HGPIN

CAT & Bone Scan scheduled for 12/07/12

hopeful and opt...
Posts: 1291
Joined: Apr 2009

.

Paul M
Posts: 12
Joined: Nov 2012

CT & Bone Scan negative; However currently researching cancer centers offering advanced diagnostic equipment. I am located ~ 60 miles from Philadelphia, PA.... I agree with support provided here and thank you for taking time to help me and other people!

hopeful and opt...
Posts: 1291
Joined: Apr 2009

The difference between a successful outcome and one that is a failure can be dependent on your medical team, and facilities available for diagnostic and treatment.
U.S. News and World Report publish a listing ranking institution by specialization in the United States.
Additionally, you want to hire the most qualified, experienced doctors for your medical team.
Location should not be the critical factor in choosing facilities and personnel, however in the Northeast where you live; you are lucky enough to have several facilities available to you. Living here in CA.; I am not completely familiar with who the best are in the Northeast, however Johns Hopkins and Memorial Sloan Kettering come to mind.
Additonally there are doctors that stand out. Generally these doctors publish a lot. There is a site called pubmed that list millions of published medical information where you can research.
Just curious...where do you live in relation to Philly.

Paul M
Posts: 12
Joined: Nov 2012

I live 60 miles north of Philly, near Allentown, Pa
My current Urologist is with St. Luke's Center for Urology, Bethlehem, Pa; and for my age, he is recommending robotic surgery.
I have appt next Wed for a 2nd opinion with a Urologic Oncologist at Lehigh Valley Urology Specialty Care Unit.
Also, tonight, I talked with folks from Cancer Treatment Centers of America...
i have also been given three referrals for the "Best Doctors" dealing with prostrate cancer based on where i live; that are covered by my health insurance, and also accepting new patients. All three located in Philadelphia.. Thomas Jefferson University Hospital, Fox Chase Cancer Center, and Perelman Center for Advanced Medicine.

Anyone have experiences with these centers or have other recommendations ???

Regards,

Paul

Samsungtech1
Posts: 350
Joined: Jan 2011

I had prenural invasion, and had spread to bladder, seminal vessels, etc. I had mine taken out because the dr told me this was the root of problem and as long as it was in there I was in dire straits. I had never been to a doctor since 1982. Did not even know there were different drs. I said cut it out. Had radiation after that to bladder area. Had a biopsy in feb 2010 and had 5 nodules in lungs. Not sure if any way would have made a difference. I would make sure your x ray, ct scan etc are explained to you in detail.

I wish you well. Read all you can, and share all info. No one here is a Dr. But the insight by some of these gentlemen is beyond precious.

Good luck,

I think Cancer Centers of America are a really good advertising scam. Sure it works for some, but best to know your DR. And Hosp. Results. Not just what is cherry picked. UVA, down in Charlottesville, VA is world reknown. You want the best, this is one. Almost went there, but staying in hotel was a turn off. Since found out they have extended stays there.

Mike

ncobjim
Posts: 35
Joined: Nov 2010

I am about 30 miles north west of Philadelphia. Near Pottstown.
Had RP in 2006, IMRT in 2010. Currently rising PSA had me looking for top doc
in Medical Oncology. Looked at all three centers you have and now at the Perelman
Center. So far i have been impressed. I think all three are very good.

Good luck!

Jim

VascodaGama's picture
VascodaGama
Posts: 1526
Joined: Nov 2010

Paul

I am glad to know that you got to a decision.
Now you need to find that Doctor in which you trust. The outcome of a treatment is very much dependent on the team caring for you before, during and after the treatment; and the quality of the facilities (modern machines and the latest equipments can make a difference).

Though I am not in the US or ever visited the facilities you indicate, it seems that Fox Chase Cancer Center may give you the less biased choices and wider views on the way to treat you. They got famous specialists and work in almost all the fields to care for PCa. (based on past posts and reading materials)

Visiting them and contacting directly the doctors of each speciality will provide you the details you need to feel satisfied with your decisions. No regrets in future.

You can also inquire about the curriculum of each doctor and about any “after care program” they provide and on any future treatment in case you need additional therapies. You could even request for additional testing (Dexa scan, testosterone test and DNA profile) before starting the therapy.

I hope you find that “special” team and that the whole case becomes a past chapter in your life.

Wishing for the best.

VGama

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