Should I worry?

icemantoo

Within a month I will be a 14 year survivor of RCC and 73 years young. As such I see a Uro every year for a checkup, kidney Ultrasound  and Uro handshake. For about 3 years I have had BPH and on medication for it, but on exam a few weeks ago he says currently not enlarged. Brother had PC in his 50's and dad at about my age Both had surgeries for it. My current concern is my PSA is 4.7 v. 3.6 last year. Uro scheduled me for a new blood test and I go back in 3 weeks for the result. Right now I am not excited to join a new Cancer club, but regularly help newbies with Kidney Cance.

Old Salt

Presumbly

RCC= Renal Cell Carcinoma

Do take the proper precautions prior to your next PSA test. No sex, no biking etc.

Hopefully the result will be comforting.

Swingshiftworker

Time for a Biopsy?

Is RCC renal cell cancer? 

Since you apparently have a  history of prostate cancer (PCa)  in your family (and apparently have had cancer yourself already), you are certainly at risk for Pca as well.  Have you ever had a prostate biopsy done? 

My primary care physician referred me for a biopsy in 2010 when my PSA went from  2 to 4 over a year or so.  That's when they found my PCa.  Doesn't mean you have it too but, with your history, it may be the time to consider having a biospy done. 

Skid Row Tom

Be cool Iceman

You've got several things in play here.  First, a 4.7 PSA is normal for your age on an age adjusted basis. Your PSA velocity (3.6 to 4.7) MAY be a reason for concern, but PSA is like blood pressure....it varies from hour to hour and day to day.  Prior to your next test, don't  sabotage  your results...for 48 hours before your test, don't  ride a bike, don't  put any excess pressure on your prostate (like some exercises), and don't  ejaculate.  You may want to abstain from red meat for that period. Also, make sure your doctor does NOT give you a digital exam prior to your blood test. Regardless of the outcome, ONLY a biopsy can truly rule cancer in or out.  Good luck!

VascodaGama

Evident hereditary PCa in the family

Iceman,

Welcome to the board. I do not understand your doctor’s intent in waiting for the next PSA. Is he trying to save you from the consequences and risks of the biopsy?

Swing above alerts you about the evident hereditary PCa case running in your family (your children are at risk too). Your risk for being positive is four folds and that is a more than justifiable reason to advance with detailed tests and exams, if you really want to resolve the “mystery”. Do I have prostate cancer?
The PSA histology in BPH cases is typically represented as a sawtooth graph, with sharp increases and declines. Cancer comes out more like smooth continuous increases.

My opinion regarding your condition goes to your present fitness. You are a survivor, have endured treatments and probably have occult illnesses, not shared by your doctor, requiring special care and medications. These aspects will be taken into consideration if ever you confront a positive case. Your age also will limit the options.

I would suggest you to explore again this side of “the world of cancer” and get informed in case things get sour. So far you have no PCa diagnosis. In any case, as much you got rid of RCC successfully, you can achieve the same goal if PCa is ever found. Be positive.

Best wishes,

VGama

 

icemantoo

Sounds like I may be in for a biopsy?

Sounds like I may be in for a biopay based upon what the new PSA and newer blood test will show in 3 weeks. What does a biopsy entail?

Until last year I had a Urologist near Detroit who was an accomplished Surgeon, Chief of Urology at a suburban Detroit Hospital and Associate Professor of Urology at the new Oakland University Medical School. I have since moved to Florida and my Uro up  North vetted my new Uro in Florida thru his contacts at the   University of Miami Medical School so I think I am in good hands.

 

Icemantoo

icemantoo

hopeful and optimistic said:

BPH

When one has an enlarged prostate, the prostate places pressure on the uretha, and so the PSA level is higher. This may be true in your case.

I wonder if the doctor did a digital rectal exam (finger wave) to check for abnormality.

most doctors perform a 12 core biopsy, each core is random in each of 12 parts of the prostate. The procedure takes about 15 minutes, and is uncomfortable, The cores, i guess are taken like a staple gun that snaps to get the sample.

There is also a more accurate biopsy procedure that is given at select institution. An MRI is first given that looks for and ranks suspicious lesions by probablity of being cancerous; then these results are locked into a three dimensional biopsy machine, and these suspicious lesions are targeted. ....also a similar method lets the urologist do the biopsy in real time in the core of an mri machine.

 

DRE

My initial reference to a Urological handshake is what my Uro up North refers to a DRE as. So yes I have had a DRE, a few weeks ago and at least the last 1o years by a URO rather than a GP.

 

Icemantoo

hopeful and optimistic

icemantoo said:

Sounds like I may be in for a biopsy?

Sounds like I may be in for a biopay based upon what the new PSA and newer blood test will show in 3 weeks. What does a biopsy entail?

Until last year I had a Urologist near Detroit who was an accomplished Surgeon, Chief of Urology at a suburban Detroit Hospital and Associate Professor of Urology at the new Oakland University Medical School. I have since moved to Florida and my Uro up  North vetted my new Uro in Florida thru his contacts at the   University of Miami Medical School so I think I am in good hands.

 

Icemantoo

BPH

When one has an enlarged prostate, the prostate places pressure on the uretha, and so the PSA level is higher. This may be true in your case.

I wonder if the doctor did a digital rectal exam (finger wave) to check for abnormality.

most doctors perform a 12 core biopsy, each core is random in each of 12 parts of the prostate. The procedure takes about 15 minutes, and is uncomfortable, The cores, i guess are taken like a staple gun that snaps to get the sample.

There is also a more accurate biopsy procedure that is given at select institution. An MRI is first given that looks for and ranks suspicious lesions by probablity of being cancerous; then these results are locked into a three dimensional biopsy machine, and these suspicious lesions are targeted. ....also a similar method lets the urologist do the biopsy in real time in the core of an mri machine.

 

foamhand

If your concerned...do it.

In my case, PSA numbers wern't enough of a warning. My PSA was 4.6 and went to 7.1 in 6 months, yet I was diagnosed early stage 4 regional Pca. Most people I've read at my stage had much higher PSA numbers, so if you want to really be sure, have the biopsy. It is some what uncomfortable and annoying, but not extremely painful, at least it wasn't bad in my case.

Skid Row Tom

PSA and biopsy

I'm  guessing that your doctor is more concerned about the velocity of the PSA than the number (4.7).  If PSA #2 is greater than 4.7, he will most likely schedule a biopsy.  Lower than 4.7, he may schedule PSA #3 in 3-6 months to monitor the situation.  No competent, caring doctor would put anybody through a prostate biopsy on a whim. "Hopeful and Opt" described it well. I had all my work done at Johns Hopkins. In my case, no Valium was given, although others had it.  A probe with a light, camera, needles for biopsy samples, and a cooling tube is stuck up your butt. To me, it felt like a broom handle. The doctor manipulates it around, you'll  hear and slightly feel 12 snaps as the doctor collects samples. Then, the instrument is withddrawn.  You'll  have to take antibiotics for awhile.  Maybe the most startling  aspect of this, and NOBODY talks or warns you of this....the first couple of times you ejaculate, it will be quite bloody.  Nothing to worry about, but if you're  not expecting this...it's  panic city. Just remember, if it's  cancer, it's  war. Assemble the best team you can, be tougher than the cancer, and have at it.  I wish you the best.

Max Former Hodgkins Stage 3

Bio

Iceman,

Like Tom, I must say that a prostate biopsy is an unpleasand experience, and I have had about a dozen surgeries in my life, mostly from being run over by a car years ago, as well as two cancers.  The worst pain I can distinctively recall was having a chest tube thrust into my chest in the E.R. with no deadening agents, through nine broken ribs.  The bio is nothing like that.

The main section of the biopsy device is an ultrasound, to guide the core removal gun. The regions of the gland have to be mapped, and each core labeled. A "routine" bio in the US nowadays ordinarily consists of 12 cores (samples), but a doctor can pull more or less. After the probe was inserted, I received two deadening (pain) shots, which were themselves very painful.  The doc waited a while and then began, but the pain was stunning; it was hard to imagine that it had been numbed.  After she pulled the 11th core, the gun "broke," and she left it inserted while she walked down to hall to get some tech to "fix" it, which only took a moment. She said that removing and reinserting would be more unpleasant than leaving the device in place.

I had thought of asking her to just be done before she exited the room, but she got all 12.  A good thing: Only one core came back positive for cancer, and it was the 12th.  Upon surgecial removal of the gland a month later, it was biopsied as Stage II.

The proceedure lasted maybe an hour or less (including her stroll down the hall).  I do not recall the recovery at all, so it must have been pretty mild.  I had a bone marrow biopsy for lymphoma in 2009. You bend over a table and a slim rod is thrust into the top of the hip plate, and a corkscrew like hook pulls out the marrow tissue. That proceedure also hurt worse than the prostate biopsy. A nurse practioner did my bone marrow extraction in the oncologist's office.

While painful, I absolutely would not let fear of pain influence getting a biopsy.  ONLY a biopsy can confirm prostate cancer:  PSA, vector, nothing else confirms the disease, or will give you a Gleason Score.  I tend very much to err on the side of caution, but with your family history and previous cancer, I would REQUEST the proceedure.   Just me.

Good luck with all of this,

max

Swingshiftworker

Different Experience

I guess I was lucky when I had my biopsy.  No issues whatsoever.  Took a high dose antibiotic (don't remember what it was) that I was given before and after the procedure.  The urologist did his business.  It was uncomfortable but not painful.  Had a little blood spotting after but nothing serious.  By comparison, it was no more difficult than when I had the 3 gold markers placed in my prostate prior to my CyberKnife treatment.  No big deal in my case.   Doesn't mean that there can't be complications -- there are -- but I don't think the procedure is necessarily problematic.

Old Salt

Another biopsy report

My experiences were similar to those of Swingshiftworker. Had to take Cipro before the procedure and had to clean out my gut. On the day of the procedure, a clear liquid diet and the Fleet enema. Once at the ambulatory urosurgical center, a sedative prior to the (transrectal) ultrasound procedure. A beautiful (in my old eyes) nurse held my hand and talked to me during the procedure as I was semi-awake. 15 cores were taken because I had a suspicious nodule (at no extra cost!). No heavy bleeding afterwards or unual side-effects. Clearly, I had a great urologist.

 

Will Doran

Biopsy went OK

Iceman,

My Biopsy was very simular to what Old Salt said.  However I was fully awake.  Dr. Miller talked to me the entire time of the proceedure.  It was uncomfortable, but not much pain.  No after effects.  And, yes the Nurse was a big help.  I had a PSA of 69, When diagnosed.  I was listed as an aggressive upper end Stage three.  I had no prior symptoms. The Biopsy led to robotic assisted surgery in December of 2013.  I am now coming up on three years since diagnosis.  My PSA has stayed at <0.010 ever since the surgery.

So, if Biopsy is suggested, I'd say listen to your doctors.  It had been suggested that I should have a biopsy about 5 years prior to this and was advised by others that the biopsy wasn't necessary. I was a avid road cyclist and my PSA was only up about 1/2  point above what was wanted.  So, it was attributed to the cycling.  But hind sight is always better.  But I can't go back now. 

Good luck

Peace and God Bless

Will 

icemantoo

Alls well

Had a new 4K Prostate Blood test and result came back of 5% Prostttate Cancer risk in lifetime. Therefore no biopsy for now. but PSA test moved from Annually to semi-annually.

Back to Kidney Cancer board where I help the newbies. Nobody in their right mind volunteers to join us there where the first thing they do is yank out a kidney. For me that was 14  years ago.

 

 

Icemantoo

Old Salt

That's good news!

Switching to a six-months schedule for PSA testing makes sense in light of the information you gave us