Please, I need help.

Kongo said:

Take a breath
Mind,

Welcome to the forum as an "associate" member since you haven't officially got a club card. I appreciate the anxiety you feel and your rise in PSA might be an issue to worry about but I think you need to take a breath (or two) and look at the big picture.

Many if not most of the causes for an elevated PSA in the range you're seeing is a result of BPH. Your doctor should have calculated your prostate volume when he did the biopsy. Because of its location in your pelvic area, a large prostate presses against the skeletal bones and forces more PSA into the blood stream causing your numbers to go up. Other things such as sex before a blood test, a DRE before they draw blood, certain types of exercise that press against the prostate (like bike riding), and even some OTC medications can cause elevated PSA. PSA has also been shown to change randomly at different times of the day. All of these contribute to PSA by itself being a notoriously sketchy method for detecting prostate cancer.

Recent advances in imagery, including MRI, is impressive but I wouldn't use that a method for detecting prostate cancer. In its early stages it will be difficult for even the most discriminating imaging system to identify prostate cancer. But the big reason not do do use this method to detect prostate cancer is that it can't give you a Gleason Score which is what you need to determine the type of cancer you have, it's potential severity and aggressiveness, and help you decide what (if any) treatment method you should choose.

As your doctor probably explained to you, a negative biopsy does not mean you don't have cancer. All it really says is that the 1% of prostate volume that was sampled didn't have any cancer. It could be someplace else in the prostate. Urologists know pretty much where adenocarcinoma tends to be found in the prostate and that's where they go looking but it's a hit or miss activity.

Now I also think you may be confused about the cost of an MRI. They're not cheap but they are nowhere near $70K. You can make a few phone calls to verify this if you like but again, what's the point? The only sure way to determine the presence of prostate cancer is through a biopsy.

Before you bend over for another needle poke I suggest you talk to your doctor about other possible causes of elevated PSA such as BPH, a UTI, and the other things mentioned above. If none of those suggest a reasonable explanation then you should consider another biopsy and your doctor can perform what is known as a saturation biopsy which samples 24 or more sites thus increasing the likelihood of detecting something if its there.

Your family history notwithstanding, prostate cancer in men younger than 50 is very rare. With your family history it is smart to be testing, but even with your father's situation it doesn't happen often. Interestingly, men who have mothers who had breast cancer also stand a higher risk of prostate cancer.

Do you have any physical symptoms that could be associated with BPH such as getting up in the night to urinate, or have a lessening of urine stream intensity?

You can also look at your PSA velocity, your PSA doubling time, and PSA density. All of these easy calculations can be done by you or your doctor and can give you additional indications as to whether or not prostate cancer is likely. Finally, you can have them do a free PSA percent test to look at circulating PSA in your bloodstream as a potential cancer indicator. I think all of these tests and calculations, combined with your rise in PSA scores, will give you a good appreciation of whether or not you need another biopsy at this time.

Best of luck to you and I sincerely hope you never join our club.

Best,

K

jbw901 said:

Free PSA as a marker
I thought I'd give you my experience using Free PSA as a secondary marker. In Dec. 2009, I began my PCa journey when my routine physical blood work showed a PSA of 4.2. At that time I had a 12 core biopsy that was negative. The plan was to monitor my PSA and target a biopsy in 24 months if no significant increase in PSA was observerd. For the next 18 months, my PSA was monitored showing a steady increase to 5.4 (not a significant increase). Thoughout that timeframe, the Urologist was also monitoring my free PSA, and it varied from 6% - 14%. As this is a secondary marker for PCa, I opted to accelerate my second biopsy by 6 months, and on that second biopsy cancer was found in a single core.

I opted for robotic surgery and am now almost 5 months into my recovery.

For me, the Free PSA marker was the catalyst for a second biopsy which accelerated the timeline of my decision, treatment, and recovery process by 6 months.