Screening PSA 40 - worried wife

Double Whammy

Hello-

I'm from the breast cancer board and uterine cancer board (have had both).  Now it seems we may be moving on to my husband having prostate cancer.  At this point we know next to nothing - PSA screening was 40 (it was 3.3 last year), urologist feels a hard spot on prostate, says if he was to bet, he'd bet he has prostate cancer, biopsy scheduled for October 7.  We understand we really won't know anything until after biopsy.

 I'd like some feedback about the PSA level.  This is obviously higher than 4 and seems like a big jump from 3.3 a year ago.  From your experience, does this level and increase seem excessive?  We have no idea if 40 is considered really high or just high.  Oh, my husband is 69.

How much discomfort/pain will he experience after the biopsy?  My experience with the medical folks is that they tend to downplay side effects.  Hoping he will heal and experience no post biopsy pain.

Thank you.

 

Kongo

PSA Test

Double,

I'm sorry that circumstances find you visiting this forum.  I seems to me that you've had enough cancer issues in the rear view mirror to now begin dealing with this.

PSA tests are notoriously poor predictors of prostate cancer and many activities or conditions can cause PSA to spike that have nothing to do with prostate cancer.  For example, sex within a day or two of the blood draw increases PSA levels.  UTI, prostatitis, and BPH are common conditions that result in increased levels of PSA.  Certain types of exercise that put pressure on on the prostate (like bike riding) increase PSA values.  Certain OTC medication (Advil, for example) raise PSA levels.  If your husband's internist conducted the PSA test after he did the DRE the PSA will be elevated.  And PSA has been shown to vary at different times of the day and it naturally increases as men get older.

Having said all that I think it is very unusual to see such a large jump in a year.  Typically, prostate cancer is very slow growing and you would expect to see an elevated PSA but perhaps not one so high.  This makes me suspect (in my lay opinion) that something besides PC is behind this rapid rise.  Something like a UTI or prostatitis.  Assuming your doctor understands how to properly do a DRE and that he did the examination AFTER the blood draw, then a PSA of 40 with a suspicious DRE certainly warrants the biopsy.  A PSA of 40 after a previous reading of less than 4 is very, very high.  Something is going on and he needs to get to the bottom of it.

A small percentage of men undergoing transrectal biopsies contract sepsis during the process, which as you know can be very serious.  Please encourage your husband to follow the directions his doctor will give him about pre-biopsy preparation (enema) and take the prescribed antibiotics religiously.

I think biopsy experiences vary greatly from man to man.  I personally found the biopsy painful and uncomfortable although an anasthetic was used.  He may experience some soreness afterward, some blood in his urine, and a discolored ejaculate.  The biopsy will inflame the prostate causing another increase in PSA and it will take about six weeks for all the swelling and other side effect to diminish and PSA to return to a baseline level.  Other men I know had no problem at all with the biopsy.  

Should the biopsy come back negative his doctor will likely want to put him on a month or so of Cipro or other antibiotic to deal with a UTI which may have no physical symptoms.

I hope these issues are not serious and that they find a cause for this PSA spike that can be easily dealt with.

Best,

 

K

Rakendra

Kongo said:

PSA Test

Double,

I'm sorry that circumstances find you visiting this forum.  I seems to me that you've had enough cancer issues in the rear view mirror to now begin dealing with this.

PSA tests are notoriously poor predictors of prostate cancer and many activities or conditions can cause PSA to spike that have nothing to do with prostate cancer.  For example, sex within a day or two of the blood draw increases PSA levels.  UTI, prostatitis, and BPH are common conditions that result in increased levels of PSA.  Certain types of exercise that put pressure on on the prostate (like bike riding) increase PSA values.  Certain OTC medication (Advil, for example) raise PSA levels.  If your husband's internist conducted the PSA test after he did the DRE the PSA will be elevated.  And PSA has been shown to vary at different times of the day and it naturally increases as men get older.

Having said all that I think it is very unusual to see such a large jump in a year.  Typically, prostate cancer is very slow growing and you would expect to see an elevated PSA but perhaps not one so high.  This makes me suspect (in my lay opinion) that something besides PC is behind this rapid rise.  Something like a UTI or prostatitis.  Assuming your doctor understands how to properly do a DRE and that he did the examination AFTER the blood draw, then a PSA of 40 with a suspicious DRE certainly warrants the biopsy.  A PSA of 40 after a previous reading of less than 4 is very, very high.  Something is going on and he needs to get to the bottom of it.

A small percentage of men undergoing transrectal biopsies contract sepsis during the process, which as you know can be very serious.  Please encourage your husband to follow the directions his doctor will give him about pre-biopsy preparation (enema) and take the prescribed antibiotics religiously.

I think biopsy experiences vary greatly from man to man.  I personally found the biopsy painful and uncomfortable although an anasthetic was used.  He may experience some soreness afterward, some blood in his urine, and a discolored ejaculate.  The biopsy will inflame the prostate causing another increase in PSA and it will take about six weeks for all the swelling and other side effect to diminish and PSA to return to a baseline level.  Other men I know had no problem at all with the biopsy.  

Should the biopsy come back negative his doctor will likely want to put him on a month or so of Cipro or other antibiotic to deal with a UTI which may have no physical symptoms.

I hope these issues are not serious and that they find a cause for this PSA spike that can be easily dealt with.

Best,

 

K

PSA Test

Perhaps you have aleady changed your diet, but with this kind of cancer history, if you have not as yet given your diet a complete overhaul, now would be a great time to look at this.  Red meat today is especially dangerous due to growth hormones, but processed food and dairy are also negative. My heart goes out to you and hope things improve.  Your positive atitude will help.

   My PSA was 200, so 40 is very high, but there are also test results much much higher than mine.  My Biopsy was a piece of cake.  I had the Michael Jackson sleeping pill, had no side effects from either the procedure or anaesthesia.  Poster have told of Drs who do not anaethetize enough and cause patients much discomfort, which is NOT necessary.   Be sure to get a second opinion on the Biopsy results.  The Gleason score is pretty much in the eye of the beholder, so mistakes are easy and two opinions give more confidence. Welcome to the board, and thanks for your input.  Love, Swami Rakendra

lewvino

I'll add my welcome to our

I'll add my welcome to our forum also and hope all will go well for you and your husband.

For me the biopsy was 'manageable' but discomfort was experienced. I believe some of the needle bigs were more extreme than others depending on where in the prostate the doctor was trying to reach. Your husband will have blood with BM for several days and I also had some bleeding in my underware from the experience.

Some docs will give a mild sedative and others do not. See what your husbands urologist offers.

As Kongo has mentioned yes 40 is HIGH but other factors could be the cause which he has outlined for you.

The doctor will also give him some pills to take before the biopsy and make sure and take these. A friend of mine did not take and he experienced a severe infection since they needle biosopy is done through the rectum wall. So follow the doctors orders exactly!

Keep us posted and my mother is Breast Cancer survivor also.

Lewivno

 

 

 

Double Whammy

lewvino said:

I'll add my welcome to our

I'll add my welcome to our forum also and hope all will go well for you and your husband.

For me the biopsy was 'manageable' but discomfort was experienced. I believe some of the needle bigs were more extreme than others depending on where in the prostate the doctor was trying to reach. Your husband will have blood with BM for several days and I also had some bleeding in my underware from the experience.

Some docs will give a mild sedative and others do not. See what your husbands urologist offers.

As Kongo has mentioned yes 40 is HIGH but other factors could be the cause which he has outlined for you.

The doctor will also give him some pills to take before the biopsy and make sure and take these. A friend of mine did not take and he experienced a severe infection since they needle biosopy is done through the rectum wall. So follow the doctors orders exactly!

Keep us posted and my mother is Breast Cancer survivor also.

Lewivno

 

 

 

Thank you for the feedback

Just feels so good to hear from those who have been there.  I found that most helpful to me as I went through my cancers.  Other folks just don't get it. 

Kongo, none of the scenarios you've outlined that can contribute to elevated PSA except BPH apply here.  He has complained of urinary issues for 3 years which have been attributed to BPH.  Rakendra, I read the Anti Cancer Book by Dr. Servan Schribner when I was going through my stuff and "managing your terrain" makes so much sense.  Unfortunately, I have become inconsistent and I doubt there is any way that my husband is going to change anything (I'd love to be surprised, tho).  Lewvino, we have prescriptions for antibiotics to start before the biopsy as well as the good ol' Fleet enema. 

We will indeed have a second opinion once we get the first one.  In addition, I volunteer as a peer navigator for newly diagnosed breast cancer patients and there is a very active group of prostate cancer peer navigators at my cancer center, most of whom I know because we talk to each other on occasion.  While my husband is not one to join support groups and such, if he is diagnosed with prostate cancer, I will connect him with the prostate cancer guys.  Those guys are great and from my experience on the breast cancer side, all patients who I have navigated have been really pleased with the guidance, comraderie and understanding we provide.  It's a really great program and I wish I had someone when I was overwhelmed with everything.  My cancers were both diagnosed and treated at the same time, hence the screen name.   

I will follow-up with you here in mid October after we get the biopsy results and know something.  Thank you again.

 

 

 

moonlitnight

PCa

Hi Double Whammy.  First, my very best wishes to you. This must be very worrying for you, having experienced cancer yourself, but in our experience this disease is very manageable and we got in after the horse had bolted. My husband's PSA went from 4.0 to 32 in four months. Subsequent biopsy and bone scan in February of this year showed metastases from neck to foot. Aside from a pain in his collarbone, no symptoms. He went on ADT (bicalutamide and degarelix) and the PSA is now down to .36, and could be lower. He has had no problems with these drugs, except for occasional ED and had a long and jovial conversation about real estate while having his core biopsies done. Said he didn't feel anything uncomfortable. He then deliberately lost 50 pounds and went off his heart meds (statin and antihypertensive). He is very upbeat and firmly believes that  this is survivable. We have gathered a great team together - wonderful oncologist, urologist, and naturopathic physician. A month ago, he sprained his ankle and last week had an x-ray in the foot where the bone scan had shown a metastasis. We were a little concerned since the ankle remained painful for a long time. The radiologist said he could see no sign of the metastatic lesion and that this was a common sprain. It is now better. So what I am saying is that this is obviously a very serious disease, but our own experience to date and the experiences of two friends with metastatic PCa (both well over 10 years on from metastatic diagnosis) has been very positive. We do credit diet, lifestyle, a great team, the right drugs, and an attitude that focuses on wellness and not disease as contributing greatly. Both our friends with the PCa are vegetarian.  Of course, in most cases, the cancer becomes castrate resistant (meaning the ADT drugs no longer work to keep it at bay) and other therapies have to be used, including other ADT drugs. But we now have Zytiga, Xtandi and Provenge in the mix and more drugs being fast tracked every couple of months it seems. So it's not all doom and gloom.

Just want to say too that prostatitis can cause very high levels of PSA. Wishing you and your husband the very best. MLN

VascodaGama

moonlitnight said:

PCa

Hi Double Whammy.  First, my very best wishes to you. This must be very worrying for you, having experienced cancer yourself, but in our experience this disease is very manageable and we got in after the horse had bolted. My husband's PSA went from 4.0 to 32 in four months. Subsequent biopsy and bone scan in February of this year showed metastases from neck to foot. Aside from a pain in his collarbone, no symptoms. He went on ADT (bicalutamide and degarelix) and the PSA is now down to .36, and could be lower. He has had no problems with these drugs, except for occasional ED and had a long and jovial conversation about real estate while having his core biopsies done. Said he didn't feel anything uncomfortable. He then deliberately lost 50 pounds and went off his heart meds (statin and antihypertensive). He is very upbeat and firmly believes that  this is survivable. We have gathered a great team together - wonderful oncologist, urologist, and naturopathic physician. A month ago, he sprained his ankle and last week had an x-ray in the foot where the bone scan had shown a metastasis. We were a little concerned since the ankle remained painful for a long time. The radiologist said he could see no sign of the metastatic lesion and that this was a common sprain. It is now better. So what I am saying is that this is obviously a very serious disease, but our own experience to date and the experiences of two friends with metastatic PCa (both well over 10 years on from metastatic diagnosis) has been very positive. We do credit diet, lifestyle, a great team, the right drugs, and an attitude that focuses on wellness and not disease as contributing greatly. Both our friends with the PCa are vegetarian.  Of course, in most cases, the cancer becomes castrate resistant (meaning the ADT drugs no longer work to keep it at bay) and other therapies have to be used, including other ADT drugs. But we now have Zytiga, Xtandi and Provenge in the mix and more drugs being fast tracked every couple of months it seems. So it's not all doom and gloom.

Just want to say too that prostatitis can cause very high levels of PSA. Wishing you and your husband the very best. MLN

Preparing for your appointment

 

DW, welcome to the board.

You have received valuable opinions above, so that I would just add a note on the importance of being prepared for your husband’s next urologist’s appointment.

Let me start by saying that the biopsy is the only way to diagnose prostate cancer and in your husband’s case, it cannot be avoided, but it is invasive and it will leave scars (and blood) in the area where the needles perforate. Typically doctors do further screening before engaging in a biopsy. Surely his doctor is basing the facts in two valuable markers; the PSA and the DRE, both positive for a possible case of cancer.
However, I think it better to prepare for the diagnosis with additional image studies that will help in getting a proper clinical stage, required to decide on a treatment.

He could request to have a free-PSA test and PAP, and do a bone scan and MRI/CT in higher resolution machines of 3-tesla. The effects of the biopsy will prejudice the interpretation of the results/films, if done before.

I would take this opportunity to prepare a list of questions for the next meeting. Here is a link to Mayo’s Clinic to get ideas;
http://www.mayoclinic.com/health/prostate-cancer/DS00043/DSECTION=preparing-for-your-appointment

Another consideration is financial and the family matters. Insurances will not cover if taken after a positive diagnosis.

I wish him luck and peace of mind.

VGama 

 

moonlitnight

VascodaGama said:

Preparing for your appointment

 

DW, welcome to the board.

You have received valuable opinions above, so that I would just add a note on the importance of being prepared for your husband’s next urologist’s appointment.

Let me start by saying that the biopsy is the only way to diagnose prostate cancer and in your husband’s case, it cannot be avoided, but it is invasive and it will leave scars (and blood) in the area where the needles perforate. Typically doctors do further screening before engaging in a biopsy. Surely his doctor is basing the facts in two valuable markers; the PSA and the DRE, both positive for a possible case of cancer.
However, I think it better to prepare for the diagnosis with additional image studies that will help in getting a proper clinical stage, required to decide on a treatment.

He could request to have a free-PSA test and PAP, and do a bone scan and MRI/CT in higher resolution machines of 3-tesla. The effects of the biopsy will prejudice the interpretation of the results/films, if done before.

I would take this opportunity to prepare a list of questions for the next meeting. Here is a link to Mayo’s Clinic to get ideas;
http://www.mayoclinic.com/health/prostate-cancer/DS00043/DSECTION=preparing-for-your-appointment

Another consideration is financial and the family matters. Insurances will not cover if taken after a positive diagnosis.

I wish him luck and peace of mind.

VGama 

 

Free PSA

Hi VGama,

By Free-PSA, are you meaning the standard test? Since my DH's PSA is .3 after six months on a double blockade protocol, and we'd like to see that at <.005, we are doing a PCA3 test to determine how much of this PCA is actually from PCa cells and how much is from healthy prostate cells. It could be that some of the PSA is from healthy cells (we hope). Perhaps this would be a good test for DW's DH to undergo as well. Do you have an opinion on this test? MLN  ETA I just read about this test in a new book on prostate cancer, and it was explained as I have explained it. Now I can't even see it. I just looked it up online and it is described as for use prior to a biopsy. Our natoropathic oncologist also recommends it for my husband so I will chat to him about it next week and let everyone know what he says.

 

Double Whammy

moonlitnight said:

Free PSA

Hi VGama,

By Free-PSA, are you meaning the standard test? Since my DH's PSA is .3 after six months on a double blockade protocol, and we'd like to see that at <.005, we are doing a PCA3 test to determine how much of this PCA is actually from PCa cells and how much is from healthy prostate cells. It could be that some of the PSA is from healthy cells (we hope). Perhaps this would be a good test for DW's DH to undergo as well. Do you have an opinion on this test? MLN  ETA I just read about this test in a new book on prostate cancer, and it was explained as I have explained it. Now I can't even see it. I just looked it up online and it is described as for use prior to a biopsy. Our natoropathic oncologist also recommends it for my husband so I will chat to him about it next week and let everyone know what he says.

 

Biopsy over

Thanks again, folks, for all the feedback.  He had the biopsy this morning and said I wasn't nearly as bad as he anticipated.  He was really a basket case.  Now we wait.  I hope we will hear on Friday, but might not hear until next week.  Stay tuned.  I will report back when we know something.

lewvino

Double Whammy said:

Biopsy over

Thanks again, folks, for all the feedback.  He had the biopsy this morning and said I wasn't nearly as bad as he anticipated.  He was really a basket case.  Now we wait.  I hope we will hear on Friday, but might not hear until next week.  Stay tuned.  I will report back when we know something.

Glad he was able to tolerate

Glad he was able to tolerate the procedure well. Thanks for keeping us updated. Your post brings back memories and I was a basket case myself 4 years ago! Now when I was told In Aug. 2013 that my Cancer was back it was more of a 'kick in the cut and lets get started on Salvage IMRT'.

I attribute my change in attitude to becoming more informed about my cancer and the help that others have given through this forum and other online forums.

Again Best wishes,

lewvino

Double Whammy

lewvino said:

Glad he was able to tolerate

Glad he was able to tolerate the procedure well. Thanks for keeping us updated. Your post brings back memories and I was a basket case myself 4 years ago! Now when I was told In Aug. 2013 that my Cancer was back it was more of a 'kick in the cut and lets get started on Salvage IMRT'.

I attribute my change in attitude to becoming more informed about my cancer and the help that others have given through this forum and other online forums.

Again Best wishes,

lewvino

Pathologist must have had a lot of time on his/her hands because we got the dreaded phone call this afternoon.   You all know the words "you have prostate cancer".  Gleason score was only 6, but because of the high PSA, a bone scan is next.  And, given he has been complaining of both urinary symptoms and back pain for well over 3 years, my mind keeps going to the dark side.  I'm not liking this.

 

hopeful and optimistic

Double Whammy said:

Pathologist must have had a lot of time on his/her hands because we got the dreaded phone call this afternoon.   You all know the words "you have prostate cancer".  Gleason score was only 6, but because of the high PSA, a bone scan is next.  And, given he has been complaining of both urinary symptoms and back pain for well over 3 years, my mind keeps going to the dark side.  I'm not liking this.

 

I wonder,

how many cores were 3+3=6 and what was the involvement of each core , that is what percent was cancerous in each core. Also how many cores were biopsied.

Size of prostate.

Any other pertinent information in the pathology report.

Suggest that you get a second opinion of slides by a world class pathologist who specializes in prostate cancer so that you are not under or over treated.

Did you have any other diagnostic tests, such as an MRI preferably a Tesla 3.0 that give indication of extracapsular extention , if the cancer is in one lobe or two, extent of cancer in the prostate, 

 

Beau2

hopeful and optimistic said:

I wonder,

how many cores were 3+3=6 and what was the involvement of each core , that is what percent was cancerous in each core. Also how many cores were biopsied.

Size of prostate.

Any other pertinent information in the pathology report.

Suggest that you get a second opinion of slides by a world class pathologist who specializes in prostate cancer so that you are not under or over treated.

Did you have any other diagnostic tests, such as an MRI preferably a Tesla 3.0 that give indication of extracapsular extention , if the cancer is in one lobe or two, extent of cancer in the prostate, 

 

G6 and Urinary problems

DW,

Sorry that your husband was diagnosed with prostate cancer; however, I am glad that the biopsy was only a G6.

As others have pointed out, and as you apparently are doing, further testing is warranted to better define if/what treatment he may choose.

I also had urinary problems before i was diagnosed with PCa. These problems were due to a large prostate, 70 grams, that pushed against the bladder, they were not due to PCa.  Once the prostate was removed the urinary problems went away.

At a G6, he probably does not have to rush into any decisions concerning treatment.  Dr. Patrick Walsh's book, "Surviving Prostate Cancer", may be a book you could read to help you in your decision making process. Many of the guys on this forum can give you information on their personnel experiences with AS and various treatment options.  

Best wishes, and good luck as you move forward.