hunter49 said:

Hey Max my story is similar

Hey Max my story is similar with the bounce in PSA but had absolutely no symtoms other than peeing at night.  My DRE's (all 6 of them) were normal but my biopsy came back posative 3 out of 15 cores all same area 90% Gleason 3+4.  Had surgery and good thing I did the tumor involved both lobes and was upgraded to 4+3.  Lucky it grew inward and had no posative margins or lymph nodes. SO far clean almost 3 years.  One ppoint you did not mention is your age.  I would also state that most times your biopsy comes back clean so in short getting biopsy is a smart move.  Good luck

Hunter,

My age is 58.  I had severe trauma 27 years ago (chest cavity crushed, and rod placed in femur; the incision in my hip is 11 inches long), and recurring prostate infections for about a year afterward, after having a 25-day cath removed when I exited ICU.  I had impotence for about a year, which the orthopedic surgeon said would "go away," which it did spontaneously. I mention this only because it involves prostate "issues" from years ago. 

I have had BPH for about six years (first discovered on CTs for lymphoma six years ago).  I have been lymphoma-free for five years, so that is not really an issue, or even perhaps relevant at this point (lymphoma seldom enters secondary organs, and virtually NEVER enters the prostate; when lymphoma does go into a secondary organ, it is almost always either the bone, or sometimes, the lungs).

I have PAIN occasionally throughout the lower pelvic area, and down the ureathra all the way to the meatus. I would say a few days out of the month.  A dull discomfort.  Asprin does not much help it, but then it totally goes away.  I have been treated with antibiotics for this several times over the years.

I am quite worried about the biopsy now (which I never was before).  It is WEDNESDAY, 8 October. 

I will share all results as soon as I have them. I hope to get my prostate WEIGHT (grams) on Wednesday, which I know now is quite significant in selecting a treatment option, if it ends up being cancerous.  I have read that a very large prostate recommends surgery verses radiation, but several factors would be involved in making that decision.  Any thoughts from anyone are very welcome.

Thanks to all,

max

hopeful and optimistic said:

Just looked at you information again

 WHY BIOPSY

PSA is higher when one has BPH. The larger prostate puts presure on the uretha, and thus there is a higher PSA. . In your case the PSA's that you have are at acceptable  levels with an enlarged prostate.

 

There is another test called a PCA3 to give an indication if a biopsy is needed, if you so desire. This a urine gene test. The doctors vigorously massages the prostate, the patient give urine a, and then sent to Boswich labs for analysis. Please click my name for more information about this test.

 

I do believe that this doc does not have enough information to do a biopsy. I would call the doc to cancel the biopsy appointment.

 

 I agree with Beau 2

I appreciate your insights here, H & O.  I have previously read a little about the PCA3.  If I had to plan this thing again I believe I would do both a Free PSA (blood test) and the PCA3, and go from there.  My family doc and a lot of people in the medical community view  prostate biopsies as overutilized, and of course there is even a move toward minimizing PSA results in some circles.   I have learned quickly that prostate diagnosis and treatments are characterized by a vast number of choices and decisions, whereas many cancers often have only one treatment. They are no-brainer cancers: "Do this, or die" is the way a diagnosis is presented with them. Sometimes a "PS -- you need to start tomorrow" is added.

Between my recurring discomfort and the continuoulsy rising annual trend for my PSA (rounded off to about a point a year), she recommended the biopsy.  I suspect my family doc, if I had asked him about it, would recommend against. I know that most or all of my numbers and symptoms might also be explained by BPH, and hope that is what it is. And finally I know that biopsy is a "cash cow," but just need the peace of mind on a personal level. Combined, the Free PSA and PCA3 might have gone a long way toward pecae of mind, but I have not read anyone suggesting that they are as definitive as a biopsy.  Perhaps someday we will know that they are indeed as good.

I will share what, if anything, I have learned Wednesday evening, and the pathology results later.  Thank you again.  I will need your advice later, either way !

max

hopeful and optimistic said:

Dear Max,
Good luck with the

Dear Max,

Good luck with the biopsy, which will bring you peace of mind.

Don't forget to take the antibiotics.

I wonder does your doc give an extra antibiotic injection at the time of the biopsy.

Please make sure that at least 12 cores are taken.

You will do fine

Best,

Hopeful

The urologist did not mention an antibiotic shot, but there may be one. I'll know in 19 hours.

I will request that there be at least 12 cores, but I can't imagine a doc wanting fewer anyway. I also want to know my prostate weight before I leave her office tomorrow.

The guys who have told me about their biopsies all have claimed that it is not too bad.  In lymphoma, a bone marrow biopsy is common (but virtually never a bone scan).  The bone marrow proceedure requires that you lean over a table, and a rod is thrust into the top of the hip. The nurse then digs around inside the hip until she has enough tissue to submit to the lab.  It is staggering for many, but I do not recall mine being that bad.

All of this reminds me of a line in the old film Pulp Fiction: "We are gonna get medieval on your a-- !"

I appreciate your positive thoughts,

.

Swingshiftworker said:

IMRT, IGRT, CK & other EBRT Technologies

IMRT is one of the most commonly available radiation technologies and it is often used for follow-up treatment following failed PCa surgery.  IMRT can used as a 1st option for PCa treatment but it is not the most precise method of delivery currently available (lack of precision can lead to some side effects) and requires 4-8 weeks of daily treatments (20-40) in order to complete the treatment program.  However, many men have been treated w/IMRT successfully.

Apart from IMRT, you should also look into low vs high dose brachytherapy (BT), proton beam therapy and CyberKnife (a form of SBRT - sterotactic body radiation therapy) as other alternatives.

CyberKnife is currently the most precise and advanced in terms of radiation delivery (which results in the lowest risk of side effects) and only requires 4-5 treatments over a week.  BT involves the temporary  HDR (high dose rate) and permanent LDR (low dose rate) placement of radioactive seeds in the prostate but problems can result for improper mapping, placement and/or movement of the seeds.  There are also PBR (pulse dose rate) and IG (image guided) BT which are attempts to "improve" the basic BT procedure but they require specialised equipment that is not generally available.  In initial studies, CK was most often compared w/HDR BT in terms of results and efficacy, becase they both involve the treatment of PCa with very high, temporary radation dosages within the entire protate capsule. 

Proton beam therapy (PBT) uses protons (rather than x-rays) to treat PCa but requires the use of a linear accelerator (ie., cyclotron) in order to generate the protons, which substantially limits the availiable treatment sites and greatly increases the cost of treatment.  Like IMRT, PBT involves a 4-8 week (20-40/day) course of treatment but also requires the patient to be fitted in a body cast to prevent movement and the insertion of a water ballon in the rectum to prevent damage to it during each treatment.  So, while apparently effective, it is also the least comfortable and convenient treatment of those mentioned.

IGRT involves the reimaging of the prostate w/ultrasound (or other methods) before each treatment is given.  3D CRT (conformal radiation therapy) maps the prostate in 3 dimensions prior to treatment but at only one point in time before treatment.  CK involves the imaging of the prostate during treatment (like IGRT) and 3D mapping of the prostate (like 3D CRT) but it does both of these things in REAL TIME during treatment.  So, it is a significant advancement beyond these and the other external beam radiation technologies (EBRT).

Swingshiftworker,

I called my cancer center today and asked if a radation oncologist I met years ago does IGRT, and he does. He is one of the guys on the staff who has been around some time, and I had already learned that the new radation oncologists use IGRT, so it is common at their facilities.

You discuss several of the advantages of radiation over surgery. I read that a very large prostate is a better candidate for surgery than radiation, since it presents more space for "cold spots." Have you heard of this or do you have any thoughts ? Is this though outdated due to newer equipment ?  As you might have read below, the biopsy equipment calculated my prostate weight at 55 grams, or very large indeed.  I am a relatively small guy, 5'5", around 165. I have never been very overweight (I weigh more now that ever in the past).

max