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High PSA, Clear CT Scan, Positive Core Biospy

jwoodie
Posts: 21
Joined: Feb 2013

Hello everyone.  I am new to this forum but already impressed with the information sharing and support I have seen.  During the past 8 years my PSA has climbed steadily from 8 to 60, but with five negative needle biopsies (75 samples) until a positive core sample (through the urethra) was taken last month, with one chip showing a 3+4 cancer.  I have also had recent clear CT and bone scans.  Because of the 60 PSA, my current Doc (Kaiser) thinks it has probably spread but also recommends surgery.  If not for my high PSA, I might opt for a less invasive tratment with fewer side effects for what now seems to be a small, centralized tumor. I am 65 years old and otherwise in good health.  Any thoughts or suggestions on how I should proceed? 

hopeful and opt...
Posts: 1293
Joined: Apr 2009

 

How much cancer is in the core that is positive, that is what is the percent that is cancerous, the extent? The smaller the percent of cancer in the core the more likely that the cancer is localized.

You may wish to to treated for an infection, with a drug such as cipro to eilminate any chance that the high psa is due to infection. The PSA rises from other causes other than prostate cancer, ie urinary infection Additionally the psa is higher from maniulation before the psa, such as sex, bike riding, hard stool.( To be honest psa of 6o is very high, so you need to discuss this with your doc)

It is very important for you to have a second opinion on the slides of the biopsy where there cancer has been shown. This needs to be done by an independent world class pathologist outside the Kaiser organization. You do not want to be under or over treated.

You may have read another current thread where discussion of MRI was made to determine extracapsular extension , and where and how much suspecious lesions are found in the prostate. ( ONe purpose of this test is to see suspecious lesions outside of the capsule, to see if localized treatments, such as sugery is appropriate. This is done by an MRI using a tesla 3.0 magnet. Now Kaiser does not have this capability within it's organization. If you choose to pursue this, a major institution of excellence such as UCSF is a great choice.

"If not for my high PSA, I might opt for a less invasive tratment with fewer side effects for what now seems to be a small, centralized tumor"

Eventhough surgery is invasive, and the side effects are age related, that is someone who is 50 is less likely to experience side effects than someone who is 70, this treatment choice is still a localized treatment, so if the cancer is outside the capsule which "might" be because of the high psa. you will still need other treatment modalities such as hormone and radiation. The side effects of all these treatments; surgery, hormone and radiation is cummulative

By the way if the cancer is localized there are other localized treatment choices available other than surgery, however I believe that you first need to know where you stand and how extensive your cancer is; is it localized or not.

 

 

jwoodie
Posts: 21
Joined: Feb 2013

Thanks for the reply!  The positive biopsy was on one of five "chips" taken by a core sample (through the urethra).  The lab doesn't know whether it is a small tumor or the edge of a larger tumor.  I recently read about a "prostate MRI with a coil in the rectum" as a way to check for local spread.  Do you know about this procedure?

 

I am going to seek a second opinion, although I am not expectant of a definitive diagnosis.  With my high PSA, small tumor and clear body scans, I seem to be a walking anomaly.  And being 65, I fall precisely in the middle of "grey area" for choosing one therapy over another.  Oh, well...Smile

Samsungtech1
Posts: 350
Joined: Jan 2011

Jwoodie,

You reallyneed to find out. Where the cancer is.if it is localized I would say Cyberknife.  Just from what I have read around here it seems the best option for localized PCa.  You really need to get better testing, and a second opinion from John Hopkins, with your slides.

Mike

hopeful and opt...
Posts: 1293
Joined: Apr 2009

generally does not recommend a bone scan for those with a Gleason less than 8 since the likelihood of determining a cancer that has metasized to the bone is very low. The bone scan is simply not that accurate. An MRI is significantly better able to see possible cancers. These machines are very high tech, and at major centers of excellence there are powerful magnets; there are 1.5 tesla and better yet with better definition there is a tesla 3.0 magnet. At these centers of excellence the personnel are better qualified to use these equipments than elsewhere.

About 4 years ago I had an MRI using a 1.5 tesla machine, with a coil in the rectum. I've had other ones of late, using a 3.0 tesla, but no coil in the rectum but an injection with a contrast -  enhancing solution. 

Here is a quote from a Dr. L. Klotz, an active surveillance expert about MRI's."

.

The imaging world is much simpler conceptually. That approach has already borne tremendous fruit, and the data show that MRI has a negative predictive value upwards of 95% to 97% for not harboring clinically significant cancer. That data needs to be validated because it all comes from small studies.

Q: Are there other imaging modalities that might help us in the future?

A: My understanding is that the multiparametric based on diffusion-weighted imaging and contrast-enhanced imaging have replaced spectroscopy, which has all kinds of technical demands and rigor associated with it. The nice thing about diffusion-weighted and contrast-enhanced imaging is that it requires no special technology. Any MR machine can do it, even 1.5 Tesla. I don't see spectroscopy as having a big role going forward. I'm very impressed with multiparametric MRI compared to the other modalities at this point, but this field is evolving."

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second opinion: you need to have a second opinion on the results of the slides that shows a 3+4=7. There is a possibliity that the Pathologist that read this , because of expertise, read a 3=4 instead of a 3=3 , or no cancer. Any doctor that you see would improve diagnostic ablility with a second opinion by a pathologist

 

 

Swingshiftworker
Posts: 626
Joined: Mar 2010

The scan you want to get is the MRI/MRSI scan which uses an endorectal coil inserted in your rectum to determine the amount and location of choline (a marker for cancer) within and/or near your prostate.  MRSI stands for "magnetic resonance spectroscopic imaging."

I got a post-CyberKnife treatment MRI/MRSI scan in Oct at UCSF which showed NO cancer anywhere in or near my prostate despite a relatively high & erractic PSA history.  The scan was authorized when my PSA rose 2x's in a row 2 years following treament which was an indication of possible treatment failure that worried my RO enough to authorize the scan.  My PSA score subsequently fell in the following test but is still at a relatively high post-treament level (above 1).  However, the concern over the possibility of latent or recurrent PCa because of my PSA scores has now been ruled out by the MRI/MRSI scan.  So, whatever is causing my PSA to remain elevated appears to be unrelated to cancer.  Would not know this w/o having gotten the scan.

Here's a link to the UCSF MRI/MRSI Group which explains the technique: http://prostate-cancer.org/the-role-of-combined-mri-mrsi-in-treating-prostate-cancer.  My MRI/MRSI scan results will be included in any subsequent reports on the procedure.

FYI, I was a life-long member of NorCal Kaiser until I got my PCa diagnosis there.  Kaiser does not offer CyberKnife (CK) nor the MRI/MRSI scan for the treatment or diagnosis of early stage PCa.  NorCal Kasier only offered me the choice between surgery (open or robotic) and brachytheraphy (BT) for treatment.  After doing some research, it became immediately apparent to me that there were many other choices available elsewhere.

I "discovered" CK on my own without any help from anyone else and immediately decided the it offered me the best chance of recovery with a very limited risk of side effects.  CK is IMHO currently the best method of treatment for early stage PCa because it provides the most accurate (to the sub mm level) and versatile (almost 360 degrees) method of radation delivery which can adjust for both organ and body movement during treatment.  No other method of radiation treatment can do this, which is why other methods still present greater risks for ED and incontinence than CK does.

Fortunately, I was able to change insurance carriers w/in my medical group during the open enrollment period (which delayed treatment 6 months) from Kaiser to CA Blue Shield (which covered both CK and the MRI/MRSI).  Paying for the procedures out of pocket would have been very expensive and few people can afford them w/o insurance.  Hopefully, you can change carriers, if you decide to leave Kaiser for a form of treatment that Kaiser does not offer.

Good luck!!!

 

Jacquet
Posts: 22
Joined: Jan 2013

jwoodie,

 

We have a similar experience. my PSA is around 20. Bone and MRI were fine. last biopsy (rectal) showed one core out of 12 at 10%, gleason score of 6. So yes I have prostate cancer and that needs to be treated, but my doctor and several others I have ssen believe that an infection could be responsible for alarge part of the PSA issue. On the CIPRo and another antibiotic heavy for a month, then another PSA check to see if it comes down which would indicate the infection hard a large part in it.

 

Hope it all goes well. Explore the options.

 

jackO

BLUEpac6
Posts: 31
Joined: Jun 2012

Injan.2009 I had a psa of 110.Biopsy was a gleason score of 9 and agressive carsenoma out of prostrate.Had bone scans twice and mri and cat scans. all were negative.Two different surgeons I went to turned me down for surgery that the cancer was out of prostrate and to dagerous to operate..I was scheduled to have seeds and radiation and had to take a hormone shot and wait 90 days for procedure to start.In mean time a friend who was worried about me was telling his urologist about me and the doctor called me and said you need to have the prostrate sugericaly removed beacuse if cancer comes back there would not be many options left.He put me in touch with Dr. seth LernerBayor clinic Houston.Aug.2009 he removed the prostrate with no side effets except sexually.anyway to make a long story short ayear or so later my psa rose to .06 and he said I would need salvage radiation.In july 2011 Irecieved 35 radition treatments with no  pain or side effects at all.For the last year my psa has been less than.01 and on feb. 20 2013 I had psa checked and was .0008.Everybodies case is differnt.As bad as my prognosis was Iam doing with no side efects at all exceot sexually.I hope yours turns out well.

stalagluft6
Posts: 1
Joined: Mar 2013

Original seed implant done at psa of 5, with relatively low gleason score. I have had 27 core, post therapy biopsy, multiple ct scans with nothing detected and steadily soaring psa after 3 years. Just had PET scan with hot spot in prostate area. will undergo another biopsy this week. would never recommend seed implant because i have had no peace of mind. wish i had known about this site sooner. expect to have biopsy show return of cancer. anticipate recommendation of chemo or radiation. I am 66 years old and in reasonble good health.

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