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Fiance referred to urologist over psa

ANWANK
Posts: 13
Joined: Dec 2017

Hi all. So my fiance went to dr for a check up and they checked his PSA while there. He is a 45 year old male. His results show only a 4.04. What I have read is that this isn't really high at all so I am not sure why the dr wants him to see a urologist over this. He does have a family history of prostate cancer. His father died from it and his brother just had his prostate removed earlier this year over it. But his brother's score was around 16 I believe. Is the dr just being extra vigilant or is this score a concern at his age? I like to have some idea of what the possibilities could be so that I am prepared to be there for him in any case. Thank you all for any information and many blessings to you all.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

Good idea to to see a urologist, a specialist............The PSA is an indicatior only, and a doctor also looks  at the historical rate of change, I wonder if there had been other PSA's. Also a digital rectal exam( finger wave in the anus) may or may not be normal. With a PSA of 4 there, and family history there is a possiblity of prostate cancee..

Your finace may wish to ask the uroloigst for a FREE psa and PCA3 as tools to see if a biopsy is appropriate.

Best to be viligent............and if there is cancer, early detection is treatable.

ANWANK
Posts: 13
Joined: Dec 2017

I am going to his appointment with him because he does not always get what the doctors are explaining to him. I will definitely ask about these tests. 

Tech70
Posts: 53
Joined: Nov 2017

I was diagnosed with very low risk PCa in November with a PSA of 3.5.  However, it had risen from a reading of 2.7 the previous year and so my family doctor recommended seeing a urologist.  I have no history of PCa in my family.  There are a number of tests that can predict the probability of detecting PCa on biopsy prior to actually doing a biopsy.  Can't hurt to check things out.

VascodaGama's picture
VascodaGama
Posts: 3015
Joined: Nov 2010

Your fiancée's PSA is high for his age and the fact for having a father and brother with the disease, he is at 4 times higher risk for contracting the cancer then other man. At 45 any PSA value above 2.3 is of concern. Surely this high value can be a cause of hyperplasia or infection (UTI) too. I think he should visit the urologist and follow proper procedures to find the reason of such PSA.

Best,

VG

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RobLee
Posts: 259
Joined: Feb 2017

As noted, your fiance's PSA is high for a man his age, though it is not yet cause for alarm.  However, he should have this tested again after a few months, as well as possible other tests. I do not mean to scare you, but if the urologist dismisses his PSA, that does not mean that everything is okay. 

My PSA was rising steadily and my urologist told me pretty much what others have said here, that it is of no concern if it rises slowly and other tests are negative. Such was my case. But a year later my PSA was 9 and he did a biopsy, which was also negative. Again, to me this meant "there's nothing wrong". More PSA tests over the next two years showed a doubling every 12 months. When it reached 25 I went to another urologist. By then it was already too late.

Hopefully your fiance has a doctor who is better at piecing together the evidence rather than waiting until it is too obvious to ignore. Just saying he needs to be his own advocate and stay on top of this before it gets out of hand.

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3295
Joined: May 2012

Anwank,

A static (one-time) PSA result does not tell a doctor very much, unless of course it is very high.

But as several guys mentioned, his number is high for his age. I had Stage II disease, and my PSA was never at any time over 4.1, and I was 58 years of age at the time of diagnosis.  A better indicator of disease is vectoring (also called Doubling Rate), or the rate of increase over time.  But if there is sufficient cause for investigation, only a biopsy can answer whether or not prostate cancer (PCa) is present.  In case he is ordered one, I will say that biopsies are brief, outpatient tissue draws that are also relatively cheap, in the medical scheme of things.

My family doctor was of a new, popular line of thought, which says "PSA is usually no big deal; it is overused."  This line of thinking is derived from insurance companies.   He told me in 2014 to ignore my 4.1, despite annual increases over the previous two years.  

I instead went straight to a urologist, and she said to get a biopsy right away.  And it came back  positive.

Disregarding clinical data, while trendy, is not medical care, it is medical neglect.  Doctors sometimes say "I can live with these results for now."  But that is not the question: the question is can the patient live with them ?   As Vasco wrote, your fiance's father and brother both having had PCa dramatically increases his risk statistically.  And PCA that hits men at much younger than normal ages is ordinarily more aggressive than disease discovered in older men  (the average age of diagnosis for PCa in the US is 67).  Even if he is not sent for biopsy, he is of enough risk that at least an annual PSA should be done, if not every 6 months.

It is good that he was referred to a urologist -- be thankful that he was.

max

ANWANK
Posts: 13
Joined: Dec 2017

Thank you to all of you for ur responses. I do know he has never had a prior psa test. The dr performed this because of his dad and more recently his brother. She did do a rectal exam and said everything seemed good. Also checked his urine and no uti or anything like that. His appointment is at the end of this month and it is just stressful now waiting for it. I am the worrier of this unit! But he has no idea how worried I am now!

hopeful and opt...
Posts: 2224
Joined: Apr 2009

At the urologist appoitment, s/he might order a PSA.  There are various factors that increase the PSA level. Bycycle riding, sex before, even a hard stool, so please no "beautiful  moments" for a few nights before. 

 

ANWANK
Posts: 13
Joined: Dec 2017

I did read about that. I already told him that we can not do anything for at least 72 hours prior and he is not to "relieve" himself because it could effect the test results if they test him again. I am a little stressed tonight because his brother that had treatment recently is being brought back in for testing because of issues he is having. Doctor wants to make sure it had not spread again. I have been learning over the last few days that his father had an aggressive cancer that spread and ultimately took his life, now there is the concern that his brother two years older than him may have some problems again. I am trying to stay positive and hopeful in the midst of all the information coming at me. He is also starting to understand the seriousness of all of this and I could see it on his face tonight that for the first time he was worried.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

Great that you are doing your research, this is critical....read books, atteend support group(s) --ustoo.org is an organization that sponsors local support groups worldwide, google them.

At the appoinment, you may wish to ask if you can record the session. At any rate you can take notes. 

A bit of information....there is a correlation between prostate and breast cancer among family members...so the women in your fianace family need to get those mamagrams. Inform all blood relatives, even cousins. It's the right thing to do.

Diet is important, heart healthy is prostate and breast cancer healthy. I for one am fairly stringent; do not eat dairy or red meat...primarily eat veggies and fish. UCSF published a diet for health to include but not limited to prostate cancer.

https://www.google.com/search?authuser=0&ei=XfpSWurwPMGZjwTd2oW4Cg&q=ucsf+diet+for+prostate+health&oq=ucsf+diet+for+prostate+health&gs_l=psy-ab.3...24212.27182.0.29301.9.9.0.0.0.0.134.1014.2j7.9.0....0...1c.1.64.psy-ab..1.2.223...35i39k1.0.Vw6kTDSNYlU

 

ANWANK
Posts: 13
Joined: Dec 2017

Thank you to everyone for your responses and advice. His appointment was today. They repeated his PSA test so should know the results within a couple of days. Doctor recommended genetic testing to check for gene mutations because of his family history and for his two son's sake. They will be calling us within 24 hours. He will go in, be sedated and have biopsy. I asked the dr based on things I have read if it is true that trus biopsy is shooting darts in the dark. He said that if his biopsy comes back negative, he will submit for MRI biopsy but because of my fiance's insurance, they will not approve it until this biopsy has been done. Dr seemed to answer all my questions and did not sugar coat anything which I appreciate. So now it's a waiting game again

ANWANK
Posts: 13
Joined: Dec 2017

So his biopsy is scheduled for Feb 19. Still waiting on the last psa results. I am not really expecting any big change in it but would still be nice to know the result! I guess one silver lining of all of this and that the urologist he goes to is going to give him some medication at the biopsy to help lightly sedate him. I have seen some of the stories of these biopsies, and while many experiences are different, some have been disturbing and I do not want him to go through that, especially if his biopsy comes back negative and has to be repeated. Because the way his doctor talked, if it was negative he is going to submit to insurance for the MRI guided biopsy. I get the impression from the doctor that he expects a PC diagnosis. I suppose I should be relieved that the doctor is being so vigilant. He did explain to us that my fiance should not have a psa higher than 2.5 and typically it should only be about 0.7 or so. And we also found out that his brother got his treatment through the same practice so I guess that helps the doctor to be able to see his brother's medical records. So that is all I know for now. Again, I appreciate everyone's advice and support on here. You all have a blessed day

hopeful and opt...
Posts: 2224
Joined: Apr 2009

So far Ive had seven. Never was sedated. 

I know a man who insisted on being put under for the biopsy, but this is not standard operation procedure.

Good luck.........he will be fine

ANWANK
Posts: 13
Joined: Dec 2017

I could not imagine going thru that so many times unsedated. The dr office did call with another result. Said it was the percent free psa or something to that effect. the number was 15.7% Is this good or bad? I have no idea!

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3295
Joined: May 2012

Anawank,

In most clinics, ordinary PSA results are known about 5 minutes after the blood is drawn. I always get my PSA results during the doctor visit, as soon as he walks in following my blood draw. 

If you have however been describing a "free PSA test," I never studied the technology, and am unaware how long those results ordinarily take.  Someone will answer your question shortly.

Traditionally, PCa biopsies get little or no deadening, and I've never heard of anyone getting heavy sedation, but I guess it is available in extreme conditions upon request.   Bone marrow biopsies are similiar: When I got one, it was with almost no deadening, although the proceedure is fairly brutal and primitive (I had a bpone marrow biopsy for Lymphoma, not PCa, but I suppose the test is the same for both). I didn't even know I was getting a bone marrow biopsy until after my meeting with the oncologist. At the end, he said "follow the nurse for your bone marrow extract." I had no deadening that I can recall from my PCa biopsy, but did receive antibiotics beforehand.

Wishing the best for him,

max

contento
Posts: 76
Joined: Jul 2017

I don't know for sure if 15 % is a good # or not given the age factor. I think it's in the gray zone and the doc will probably recommend a biopsy.

I had 3 biopsy's. Two were givin with a local anesthesia and the other I was put out.

The local was fine and there wasn't any pain to speak of it was just a scary thing to go through.

The last biopsy I had the doc wanted to put me out so I did. Obviously you feel nothing in this case.

contento

VascodaGama's picture
VascodaGama
Posts: 3015
Joined: Nov 2010

A,

Free PSA is a test used to validate the Total PSA result when one wants to ascertain the possibility in existing cancer. In other words, low percentage of free serum PSA indicates high probability of existing cancer. High percentages (above 10%) equals to low probability in having cancer, even with high values of total PSA results (your fiancé’s case). Some doctors tend to use the Free PSA result to compare with negative biopsies, in the intent to avoid judgments of false negatives. Some even use the Free PSA to postpone a biopsy.

Sincerely, I think it better for your fiancé with apparent PCa cases in his family, to get the answers to his case via the 14 needles traditional template biopsy. At the moment nobody has diagnosed him with cancer except that he is at high risk for having it. If worried, he can repeat the biopsy two years later in case this one comes negative this time.

Best wishes,

VG

ANWANK
Posts: 13
Joined: Dec 2017

Ok everyone, so he had his biopsy today. And I am so thankful because they sedate you for it through the doctor he sees. So he slept through the entire thing. We should know the results by Friday. The doctor did tell me his prostate is bigger for his age so I thought that was a good sign. I also saw on his paperwork that it said his P2PSA was 21.9. I have never heard of this test before and they never gave us that result so I really have no idea what that is or what it means. Thanks everyone for the support

 

VascodaGama's picture
VascodaGama
Posts: 3015
Joined: Nov 2010

I am glad for knowing that he did a biopsy. It is still the best way to confirm the existence of cancer. The P2PSA is another test (more sophisticated than the traditional PSA) to evaluate probabilities in existing cancer. It is also used to avoid biopsys or postpone them, but just like the free PSA it does not diagnose cancer. The biopsy analyses a small volume of the gland's tissue which may also miss a tumor but it is the real conclusion used to advance with other tests (image studies, etc) to get a clinical stage, followed by a treatment.

Let us know the results. You can paste here the copy of the report if want our opinion.

Best,

VG

ANWANK
Posts: 13
Joined: Dec 2017

Ok so obviously the biopsy results are not back yet but I did get the operative report. It says that his prostate volume is 58.8 and englarged in transitional zone. Which seems to me he would probably just have bph then? They took 12 cores. It does say his prostate health index score is 69 which I know is not good at all. But if he has bph, I would imagine that would effect this score?

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3295
Joined: May 2012

Anwank,

MOST men over 50 have BPH/BEP.  The symptoms of BPH are mostly IDENTICAL to PCa.  Hence, the presence of BPH in any given man is no evidence for or against PCa.  You will know the answer within a few days however.

max

VascodaGama's picture
VascodaGama
Posts: 3015
Joined: Nov 2010

The probability of existing cancer in terms of an index above 36 (PHI) is greater. Surely any effect influencing the values of the PSA would affect the PHI. However, this index is just checking for probabilities in having cancer when comparing with the average values from a series of PHI trials involving the results of numerous cases. The biopsy is still the way to diagnose existing cancer.

Let us know the final results.

Best,

VG

 

ANWANK
Posts: 13
Joined: Dec 2017

His results came in today and we were told it is cancer. So now we go Monday to discuss treatment. A brief history. He is 45. His father and brother both had this cancer at young ages in their 40's and 50's. I have read that if u have an enlarged prostate you are not a good candidate for radiation. Is this true? And I also read that if u have radiation it can complicate it if you end up needed the surgery later. At his age, is he even a good candiate for AS? I do not have the pathology report but will get it Monday. Dr just said 3 cores were positive and it is Gleason 6. Thank you anyone for advice and for what we need to be asking the dr Monday.

Old Salt
Posts: 720
Joined: Aug 2014

 I have read that if u have an enlarged prostate you are not a good candidate for radiation. Is this true?

Not generally (!) true

 

And I also read that if u have radiation it can complicate it if you end up needed the surgery later.

Very few surgeons are qualified to do surgery after radiation. But there are many treatment options if radiation fails.

At his age, is he even a good candiate for AS? I do not have the pathology report but will get it Monday. Dr just said 3 cores were positive and it is Gleason 6. 

We need more info; where are the cancers located? All on one side (lobe) and how close to the margin are important factors to consider. Please get advice from an AS specialist. Note that this is a rather 'personal' decision as well. Some patients are not 'designed' for AS protocols because they would worry too much.

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VascodaGama
Posts: 3015
Joined: Nov 2010

ANWANK

I am sorry for the results of the biopsy but you do understand that this diagnosis relieves you both from the anguish of probabilities in confronting this hereditary disease. A negative biopsy would always be questionable. I would like to know more details on the results but 3 cores with Gleason score 6 is good news. The next step will involve exams to locate the bandit. This is traditionally obtained with CT and Bone scans. However, I would prefer to get those images with a 3tMRI or the sophisticated PET/CT which is presently the most recommended exam in PCa diagnosis. After that, his doctor will provide a Clinical Stage with which a treatment can be planned.

In this regard, you better wait for his doctor's opinion, do some researches, get second opinions from several other specialists and discuss with the whole family before deciding on an option. In my opinion, for a man of 45 yo, Active Surveillance is the best if appropriate in his status. The quality of life is in jeopardy and he is too young to risk permanent effects from radical treatments. In any case he should think to treat if the bandit shows to be aggressive.

I agree with Old Salt's opinions above. Without a due clinical stage obtained from reliable due exams nobody should decide on a treatment. You need to advance in this journey without rushing. Move coordinately and timely but do not sleep on the matter.

Each case is unique of the holder and should not be paired with others. What works for one may not do well for another. His father and brother hereditary history should not be taken as the way to follow but simple as reference examples. While waiting, I would recommend you to get additional tests that may influence treatments. For instance; a colonoscopy to look for any asymptomatic ulcerative colitis. A DEXA scan for bone health and a full lipids account.

Here are some links to help you understanding the matters of PCa. You should prepare in advance a list of questions for the doctors you are metting;

A practical guide to prostate cancer diagnosis and management;
http://www.ccjm.org/index.php?id=105745&tx_ttnews%5Btt_news%5D=365457&cHash=b0ba623513502d3944c80bc1935e0958

Prostate Cancer Staging;
http://emedicine.medscape.com/article/2007051-overview

List of Questions;
http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

Books;
https://csn.cancer.org/node/311252

 

Please note that we are not doctors. Our opinions are based on own experience and researches done along our journey as survivors.

Best wishes and luck in his journey.

VGama

Tech70
Posts: 53
Joined: Nov 2017

would be very helpful in deciding what course of treatment he might want to follow.  It's accepted by Medicare, but at his young age, you might want to check with his insurance company.  Medicare was billed $4520 and they paid around $3100 in my case.  I think Genomic Health (the company that does Oncotype DX test) has a program of financial assistance for those whose insurance won't cover the test.

Coldbiker's picture
Coldbiker
Posts: 22
Joined: Jan 2016

Some are suggesting expensive testing, he Is young, family history, had positive biopsy not bad now. Surgery side effects are immediate and tend to get better but not always, tougher on younger men, radiation some effects during and after tend to get worse as time goes by. Doctors tend to bottom line it . Surgery it’s gone might come back years later, many men choose that. Radiation takes awhile to know the results. AS really delays the decisions and treatment as long as everything stays stable. I’m an outlier PSA 1.5 for years, at age 62 a lump  had a biopsy because my family doctor is proactive. Gleason 6 5 out of 12 cores. AS 5 years. three biopsy’s later psa still under 2.8 7 cores 6 1 core 7 4+3 1 core small 8 4+4. 20 20 hindsight should I have skipped AS, urologist says he wouldn’t have recommended surgery and is at a loss as why the quick progression. My prostate is small so no BPH. Treatment decisions haven’t changed much hormone therapy added to mix,  just happening now.

ANWANK
Posts: 13
Joined: Dec 2017

As previously stated, he has decided to go with the Da Vinci surgery. Met with Dr today and will be having it in 6 weeks. Did get a copy of pathology report. Here is a rundown of it

 

 

Left Lateral base: Benign prostatic tissue

Left Lateral Mid:Benign prostatic tissue

Left Lateral Apex: Prostatic Adenocarcinoma, Gleason score 6 (3+3) 1 of 1 core positive 12%

Left Medial Base:Benign prostatic tissue

Left Medial Mid: Focal High Grade PIN

Left Medial Apex: Benign prostatic tissue

Right Medial Base: Benign prostatic tissue

Right Medial Mid: Benign prostatic tissue

Right Medial Apex: Prostatic Anenocarcinoma Gleason score 6 (3+3) 1 of 1 core 17%

Right Lateral Base: Microscopic focus of Atypical glands

Right Lateral Mid: Benign prostatic tissue

Right Lateral Apex: Prostatic Adenocarcinoma, Gleason score 6 (3+3) 1 of 1 core positive 4%

Comment: Immunoperoxidase stains including antibodies to basal cells (p63 and high molecular weight cyokeratin) and P504S (a marker preferentially expressed in prostate cancer) were used to confirm the diagnosis in the core from the left lateral apex. They atypical glands lack a stainable basal cell layer and display glanular cytoplasmic positivity for P504S, supporting the diagnosis of adenocarcinoma.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

Prostate cancer is very slow growing.

Good idea to interview various treatment specialists to receive input.

There is a difference among surgeons, and successful outcome. Interview more than one.

There is an image test, 3T MRI that may indicate if there is extracapsular extension, that is if the cancer has escaped the capsule (which in this case is not likely, but still very improtant to have). This would affect treatment choice.

VascodaGama's picture
VascodaGama
Posts: 3015
Joined: Nov 2010

At 45 years old no one is suspected of having bone metastases, so that the info in above report would lead to think that he has a contained case. In such regard surgery or radiation are options that may eliminate the bandit for good. Among the typical risks in Robot surgery are Erection Dysfunction and Incontinence. One also looses the possibility in fathering a child again (banking sperm is recommended). Radiation treatment is linked with the risks of Colitis and Urethritis (scar tissue). It also affects the seminal vesicles to a certain extent (sperm).

I agree with Hopeful's above comment that an additional image exam will provide a better clinical stage. It is important to your husband to know the risks involved in the treatment of choice so that he can evaluate the situation before committing.

Best wishes for the best outcome.

VG

ANWANK
Posts: 13
Joined: Dec 2017

Dr said it was T1C, I believe. My guy is completely against radiation. He did not even want to meet with the radiation oncologist. He says he would rather have the surgery and be done with it and doesn't want to take the chance of getting radiation, it coming back, then having to find a surgeon to do the surgery on a radiated prostate and not be able to have the nerve sparing surgery. We do have the best urologist in our city. He is the chief of urology at several hospitals here and was the first to perform the Da Vinci here. He has been doing them for 14 years in our area now. I definitely checked on that! So I feel like he is in good hands. The doctor has a great bedside manner and spent over an hour with us yesterday just talking and giving him all his options. He was very upfront about the risks with the surgery and how it would change things. He is sending my fiance to biofeedback to learn to do certain exercises for urinary control and said he would be prescribing cialis and a vacuum pump. Anything else I should know about this surgery beforehand so I can help prepare him?

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3295
Joined: May 2012

 

Anwank it soulds like your "guy" has become well informed in a brief amount of time.  It is good that his surgeon shared all likely effects of surgery in detail beforehand.  The biofeedback is very likely kegel exercises, that will quicken urinary control post-op.

It is curious that he repudiated radiation without ever even speaking to a rad oncologist, but he is his own man, with his own reasons.  Be aware that under-estimation of Staging is fairly common, whereas over-estimating virtually never happens.

Best of luck to the both of you,

max

lighterwood67's picture
lighterwood67
Posts: 207
Joined: Feb 2018

 My story:67 year old male; PSA 4.72 increasing over the last 3 years; Digital Rectal Exam, prostate is not swollen; father had prostate cancer elected removal (the cancer did not cause his passing); I requested a 3T MRI prior to biopsy; MRI indicated 2 lesions one a PIRAD 5 and one a PIRAD 4; biopsy confimred prostate cancer in the PIRAD 5 lesion; PIRAD 4 no cancer. Urologists recommends: Prostate removal with pelvic lymph node dissection.  I am looking at an experienced urologists who only does robotic guided prostate removal now (over 1,000 procedures).  He did offer hormone and radiation but did not think that was the best route due to tumor and it being only in the left apex of the prostate.  I feel very comfortable with this surgeon.  My wife and I decided on the removal of the prostate and lymph node dissection procedure.  On the lighter side, during our interview the surgeon did ask us did we have sex.  My wife did not say anything, I told him everytime I can catch her, but she is very fast.  Anyway go to preop March 5 and surgery on March 20.  Gleason 4+3=7.

 

 

 

ANWANK
Posts: 13
Joined: Dec 2017

Very sorry that you have been diagnosed. I am new to this forum as well and it has been a wealth of information. I feel like I have learned so much here. I am not sure if you meant to post on the main board instead of in reply to my post but that is ok. And u sound like my fiancee, he would have definitely said something like that about catching me!

Tdoyle
Posts: 36
Joined: Oct 2017

I am fairly new here and my diagnosis is very similiar to his.  I am still learning and taking in all the great advise the great people on this site have to offer. I had the MRI T3 last week, which is a good test to see if everything is contained. In my case it was and my last psa was 5.23 and I am 53 years old. I have been on a rollercoaster ride since I found out about the cancer, doctors in the town I live in did test and i was diagnoised having  mets to bone. Talk about scared. I went for 2nd opinion to UAMS cancer institute and had more test run and here I am.  I have decided to go with AS for the time being and hopefully I can continue this for a long time, the thoughts of surgery and the possible side effects scare me....This is just my 2 cents and not trying to change any decisions anyone has made...Like these knowledgeable people always say it is his decision and what ever it is, it will be the right one for him.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

Please start a new thread.

Click discussion boards above, and then click "add new forum topic" in upper left corner, found under "Discussion Boards"

lighterwood67's picture
lighterwood67
Posts: 207
Joined: Feb 2018

Ok. 

VascodaGama's picture
VascodaGama
Posts: 3015
Joined: Nov 2010

ANW,

Trusting the doctor caring our case is a good step for a successful therapy. There will be a catheter with attached bag for urination during 10 days. This is most uncomfortable when we move but I recommend your man to try walking everyday two times about 400 meters for better healing and discharge of accumulated liquids and gases. There will be pain so that he should request pills from his doctor before leaving the hospital. Max above is talking about kegels which will activate the muscles that help controlling incontinence but I would start them after allowing the area to heal proper.

The PSA will be the test to follow after op and I would recommend it to be done at the same laboratory in assays with two decimal digits (0.XX ng/ml). The first PSA (after op) should be lower than 0.06 ng/ml at one month and it should be maintained thereafter. This value is indicative of surgery success and after 6 months it confirms remission. Cure is never mentioned by physicians but one may believe in it if remission lasts 5 years.

Best,

VG

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