Newly Diagnosed at 56 years old, PSA 5.9, PSA Free 9.1% and PIRAD 5 lession

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lasermarketing
lasermarketing Member Posts: 28 Member
edited October 2023 in Prostate Cancer #1

New to the site

Little on me, 3 weeks ago I had a 6.5 PSA at my family doctor. Since i have no family history of prostate, this was my first physical in many years (mainly due to covid). Was mainly going to check my cholesterol.

Went to Urologist 2 weeks later and my PSA dropped to 5.9. I was on hard core vitamins, exercise and diet, which might of elevated my number at 6.5. I stopped it all, and my number could be even less now.

Urologist did the rectal exam and all was normal. He did the urine analysis, and again all was normal. The alarming number was a 9.1 Free PSA %. He said that raised me from 25% to 60% having cancer.

Had an MRI, and they found:

"One lesion PIRADS 5. Left posterior peripheral zone base to mid gland with broad capsular contact and capsular buldge" About 30% of my prostate has this lesion.

"Mildly enlarged left pelvic sidewall lymph node. Nodal metastasis in a different consideration"

"Sequela of prostates in the peripheral zone"

"BPH of the central gland"

other notes were Bones (no aggressive osseous lesions), urinary bladder, seminal vesicles, colon all normal.

I have a needle biopsy on Wed, and according to an online calculator I found, I am looking at 18% advance, 43% low stage and 39% no cancer. Seeing I have a PIRADS 5, I am just assuming it's cancer. Just praying it's not the 18%.

Sounds like doctor is already telling me about the robotic surgery he does with hormone therapy.. Just not sure what is the best course at my age.....

It's possible I have an infection that is causing the lymph node to be mildly enlarged. I have had issues with my lymph nodes under my arm pits for the last 6-8 months, so it could be from infection.

Just hoping I caught this early enough, since I am only 56. My preference is Hormone Therapy or TULSA with active surveillance. Perhaps TULSA will work (it can be repeated) until the time is here to have the surgery or radiation. Right now the doctor kind of has me scared, like I have 5-10 years if the cancer is aggressive. Even if we do the surgery and hormone therapy now, not sure that puts me back at 20 years, or 5-10.

Anyway, glad I found this site to vent to....... I am waiting to tell my friends and family, once I have the biopsy report back.

Comments

  • Old Salt
    Old Salt Member Posts: 1,422 Member
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    It's so hard to wait but as you already know, only a biopsy can tell whether you really have prostate cancer. The MRI result will help the urologist with sampling the suspicious lesion.

    It's a bit early to discuss possible therapies. Let's wait for the biopsy data.

    Good luck!

  • centralPA
    centralPA Member Posts: 314 Member
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    @lasermarketing , while there is never a good time 56 is a little early to join the shitshow, sorry you find yourself here.

    My thinking, based on all of my reading, is that if there is a decent chance the cancer has left the prostate, I’d not want surgery. The risk of miserable side effects is high, and if it has escaped, you’ll just be enjoying radiation too. But that is me, and plenty of others differ.

    How is your BPH? Are you having trouble with urinary function? That can cause you to lean one way it another.

    What is the size of your prostate? It should be on the MRI report. That can influence the therapy chosen.

    This is all talking until you get your results back. When you do, plan to have your pathology sent to John Hopkins U for a second opinion. Way too important not to get a second set of eyes in this slides.

    Go to the NCCN.org website and download their prostate cancer info. Very informative. You want to go into your uro meeting knowing what to expect to hear. No surprises, just confirmation.

    Best of luck, shipmate!

  • lasermarketing
    lasermarketing Member Posts: 28 Member
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    Thanks for the info guys....

    prostate pretty normal at 28cc

    I did finally break down and used the JustAnswer to talk to a Urologist earlier. He had thousands of 5 star reviews and looked pretty good. Just looking for any additional info, to get me to Wed biopsy.... I know my local Dr is going to be very cautious and not promise anything to good.

    This doctor was opposite and said it is very unlikely I have anything aggressive, based on the data I gave him. He would be learning more towards BPH, but the low PSA Free % is suspicious to possible cancer.

    He just mentioned my PSA would be a lot higher than 5.9, if I had aggressive cancer. Plus the fact my rectral exam was normal, urine normal and no prostate history in my family. He thinks the Lymph node could just be from inflammation, which my local doctor said too. Another possibility is HPV or something. No way to test for it, but I have been dealing with lumps under my arm pits for 6-8 months. I thought I was just allergic to a new roll on fragrance. I did take a standard STD and all was negative, but no way to test for HPV. But I read 60% of males have it, so that is a possibility. Plus it can inflame the lymph nodes at pelvic and arm pits.

    I will just hold my breath and wait for the biopsy report. But after talking to this other urologist, with nothing on the line today, I feel a little better.

  • Clevelandguy
    Clevelandguy Member Posts: 1,088 Member
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    Hi,

    Have to agree with Old Salt, the biopsy will tell you how aggressive the cancer is if you have any. If they find cancer a good test for finding where and how much is a PMSA PET and bone scan. These two tests should pinpoint the location and if the cancer has spread outside of the Prostate. Just hope and pray it’s HPV virus or BPH.

    Dave 3+4

  • lasermarketing
    lasermarketing Member Posts: 28 Member
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    Appreciate it, yes PMSA PET is the next step after my needle biopsy. My local doctor said the same thing, but he wanted to do it at surgery time. He really pushes everybody to the robotic surgery.

    I do feel much better with comments on this board and even asked a second "justanswer urologist" last night. lol He said the same thing as the other online doctor, very doubtful its aggressive and a flip of a coin on low grade or BPH, based on my data so far.

    I know there is still a chance it could be aggressive, but perhaps that 18% is more like 10%. The online cancer calculator, ( riskcalc.org/PCPTRC/ )did not take the fact that my rectal exam was totally normal. If I did have an aggressive cancer on 30% of my prostate, you would assume the doctor could feel something. At least that is my hope.

    Thanks again!

  • Rob.Ski
    Rob.Ski Member Posts: 156 Member
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    Biopsy will tell you what you are dealing with. Until then, it's speculation. Waiting can be difficult but, like the others have said biopsy is only thing confirming cancer. PSA can be that high from other conditions. Hopefully. Sounds like you'll have results relatively soon.

    Hoping for the best, not PCa.

  • centralPA
    centralPA Member Posts: 314 Member
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    No way to test for it, but I have been dealing with lumps under my arm pits for 6-8 months.

    In a way, it’d be unusual for your upper lymph nodes to be aggravated and not your pelvic ones. So I hope that is what is going on for you.

    Some other readings include:

    The book available as an Ebook, THE KEY TO PROSTATE: CANCER 30 EXPERTS EXPLAIN 15 STAGES OF PROSTATE CANCER by Dr. Mark Scholz. I’ve marked my copy thoroughly with highlighting in the Kindle version.

  • lasermarketing
    lasermarketing Member Posts: 28 Member
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    Not good, kind of not bad. ------ Here is the biopsy overview from my Local Urologist. Attached is the pathology report. Unfortunately, there is 10/12 biopsy sites positive for cancer, with both sides showing Gleason 4+3 (gleason grade group 3). You are in a category considered unfavorable intermediate risk. We will need to get the PSMA PET scan ordered and done as next step. The concern for SV invasion, lymph node containing cancer, and other potential areas of cancer spread will be defined better by the PET scan.

  • lasermarketing
    lasermarketing Member Posts: 28 Member
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    i have an appointment with one of the top oncologist in Texas, on Wed. He is big in SBRT, which is probably what he will recommend..

    Still leaning a little to surgery, as long as it's Local or Regional. I know my Urologist already talked about surgery, removing areas effected and then flushing it with 2 years of Hormone Therapy... Only if it has not moved past the regional area. With my PSA only 5.3, I am a little hopeful it's still contained. But yeah, my tumor is filled with crap.

  • Old Salt
    Old Salt Member Posts: 1,422 Member
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    Very unfortunately, you have now joined us as a prostate cancer patient. But most of us, at the very least, are still able to type away on our keyboards and lead more or less normal lives. As you surmise, it MAY still be possible to get rid of all of your cancer, but the PSMA PET scans should show whether that is realistic or not. BTW, it looks like your local urologist is following proper procedure.

    Best wishes for a favorable scan result.

  • lasermarketing
    lasermarketing Member Posts: 28 Member
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    Thank you Old Salt... I think mentally i was prepared for Gleason 8 or 9, but was praying for Gleason 7 (3 + 4) or better. So I guess i landed in the middle... PSMA Pet scan is final test and then decision making time....

    One note on family, my step father died of prostate cancer 2 years ago, age 79. His brother gave me some details on his results. In his late 60's, he had the robot surgery and about 12 years later, it came back. For some reason, radiation was not an option for him. Because they did not know where to treat? All they could do it give him Hormone Therapy and I think Chemo... I thought even before PSMA PET scans, they could still see where it came back, for treatments. if still in the region area.