PSA , Biopsy & Avodart

Batch,
Has anyone
Batch,
Has anyone suggested a second biopsy? While it isn't something anyone volunteers for, a biopsy with samples taken meticulously from all over the prostate should help answer that question that lurks in the background...could the first biopsy be wrong and could it be cancer?? My husband's first urologists assured him he only had an enlarged prostate. His second tested more aggressively, biopsied, and found PCA. (Gleason 9, type 3B, even though PSA always 5 or under.) Be your own advocate and get answers.

VascodaGama said:

Hi worriedwife

I am not a medical expert, but from all I learned along my ten years of survival, I find it difficult that a drug for controlling bladder functions could cause a sudden surge of PSA. Without a Prostate Gland in place, an increase on PSA shall be related to a growing activity of cancer cells.
If your husband is undergoing a hormonal treatment to lower the testosterone levels in the body, but is experiencing an increase in PSA, then HT drugs are losing their effectiveness and the treatment needs some adjustment (increase dosage) or withdrawal.
Detrol LA has a similar structure to oestrogens and can interact with ketoconazole (P450 enzyme inhibitor class), a drug used for lowering testosterone for advanced Pca patients. Their use lowers the PSA, do not increase it.
Wishing you the best
VGama

VascodaGama
Thank you for your response. He is not being treated yet. He only had the one
high PSA reading. We will get results of second test next week and then will
go from there. It was just odd that it rose so fast in 6 months.

thanks again.

VascodaGama said:

Sorry for the increase PSA, Batch
Hi batch

Sorry for your last PSA increase. I do not want to say the word but you may have been thinking of cancer. Your last PSA of 8.3 (Nov/2010) is a big increase from 4.68 of last year. Your attempt to stop a BPH failed and the 2-rounds of antibiotics did not “cure” the problem too. Your doctor will want you doing additional tests like a Endorectal MRI and a Transrectal ultrasound color Doppler. These new machines are successful in identifying suspicious markings in guys with PSA near to or lower than the 10th level.
The E-MRI helps to determine if the prostate cancer is confined to the gland, and it is a test used to detect the site of cancer in men suspected of having prostate cancer that is eluding diagnosis with other routine tests.
A new set of biopsy should clear up doughty thoughts, but this time, the sampling should be directional to the marks from the ultrasound tests.

Negative DRE is common in low Gleason pattern cancers even in the presence of a high PSA (myself had negative DER with PSA=22.4 and Gleason (2+3) at age 50).
You may as well try a new set of powerful antibiotics. However, to be assured of a real NEGATIVE, at your age all tests should be done.

Wishing you peace of mind, and good results from your next consultation.
VGama

another 2 cents worth
Batch,
Sorry for the news of an increasing PSA in spite of your courses of antibiotics & Avodart. If I interpreted your info correctly, your last biopsy (12 cores?) was in June 2010, and was negative for any cancerous cores, but your md has determined you to have BPH and has treated you as such. Since your last biopsy was 6 months ago, and with the rising PSA, it might seem wise to find a 2nd opinion urologist, perhaps from a respected teaching hospital/cancer institute, and have another biopsy (especially if you are as concerned as your posts indicate). While a color doppler guided ultrasound biopsy would be best, there are only a few docs/technicians nationwide that can do the color doppler procedure with any amount of reliablity, so if that isn't possible, best to find an expert urologist for the black/white ultrasound biopsy.

While the endorectal MRI with Spectography using Tesla 3 equipment (the '3' is the latest version for high resolution pix and is not yet widely available) is the gold standard for diagnosing ECE (extracapsular/prostatic extension) PCa, it is an expensive test and most facilities/skilled docs will recommend it only AFTER a biopsy has found cancerous cores showing indications of PNI (perineural invasion) or ECE (extracapsular/prostatic extension). The E-MRI may identify PCa local spread outside the prostate to the seminal vesicles and/or the local pelvic lymph nodes. If an E-MRI is ultimately recommended, it should be 6-8 wks after biopsy in order for any prostatic swelling, etc. to minimize. Many times a bone scan and/or a pelvic CT will be recommended before any MRI in order to first rule out distant metastases, especially if the biopsy results indicate a need for those add'l tests. Most times, the pelvic CT and bone scans come back negative as they cannot detect microscopic cancer cells. But we are putting the cart before the horse now, as it is hoped that you will never have to get to this stage of dx.

I don't know the stats for how "common" or "uncommon" a negative DRE is for low or high PSA scores, or whether, in fact, there is any correlation since every PCa is different in every man. My husband had a very low PSA of 2.4 at dx AND had a nodule found on DRE (by a very experienced/skilled urologist), so low PSA does not always rule out negative DRE!--not that this would apply to your presentation. And low PSA does not necessary mean indolent PCa, since more aggressive PCa does not make as much PSA.

Lastly, if you elect to have another biopsy at 6 months (which seems a proactive move) by the same or a different skilled/experienced urologist, I strongly recommend, as did Kongo, that you make arrangements to have the lab results (the actual lab slides) sent out for a 2nd opinion to a well known respected pathology lab (such as Johns-Hopkins, etc) that is an expert in reading PCa biopsy slides and providing 2nd opinions.

Hope you will continue to post your progress.
All the best,
mrs pjd

mrspjd said:

another 2 cents worth
Batch,
Sorry for the news of an increasing PSA in spite of your courses of antibiotics & Avodart. If I interpreted your info correctly, your last biopsy (12 cores?) was in June 2010, and was negative for any cancerous cores, but your md has determined you to have BPH and has treated you as such. Since your last biopsy was 6 months ago, and with the rising PSA, it might seem wise to find a 2nd opinion urologist, perhaps from a respected teaching hospital/cancer institute, and have another biopsy (especially if you are as concerned as your posts indicate). While a color doppler guided ultrasound biopsy would be best, there are only a few docs/technicians nationwide that can do the color doppler procedure with any amount of reliablity, so if that isn't possible, best to find an expert urologist for the black/white ultrasound biopsy.

While the endorectal MRI with Spectography using Tesla 3 equipment (the '3' is the latest version for high resolution pix and is not yet widely available) is the gold standard for diagnosing ECE (extracapsular/prostatic extension) PCa, it is an expensive test and most facilities/skilled docs will recommend it only AFTER a biopsy has found cancerous cores showing indications of PNI (perineural invasion) or ECE (extracapsular/prostatic extension). The E-MRI may identify PCa local spread outside the prostate to the seminal vesicles and/or the local pelvic lymph nodes. If an E-MRI is ultimately recommended, it should be 6-8 wks after biopsy in order for any prostatic swelling, etc. to minimize. Many times a bone scan and/or a pelvic CT will be recommended before any MRI in order to first rule out distant metastases, especially if the biopsy results indicate a need for those add'l tests. Most times, the pelvic CT and bone scans come back negative as they cannot detect microscopic cancer cells. But we are putting the cart before the horse now, as it is hoped that you will never have to get to this stage of dx.

I don't know the stats for how "common" or "uncommon" a negative DRE is for low or high PSA scores, or whether, in fact, there is any correlation since every PCa is different in every man. My husband had a very low PSA of 2.4 at dx AND had a nodule found on DRE (by a very experienced/skilled urologist), so low PSA does not always rule out negative DRE!--not that this would apply to your presentation. And low PSA does not necessary mean indolent PCa, since more aggressive PCa does not make as much PSA.

Lastly, if you elect to have another biopsy at 6 months (which seems a proactive move) by the same or a different skilled/experienced urologist, I strongly recommend, as did Kongo, that you make arrangements to have the lab results (the actual lab slides) sent out for a 2nd opinion to a well known respected pathology lab (such as Johns-Hopkins, etc) that is an expert in reading PCa biopsy slides and providing 2nd opinions.

Hope you will continue to post your progress.
All the best,
mrs pjd

correction
Too late to edit original post dated 12/2/10, but realize clarification/correction needs to be made as follows: replace last two lines of 3rd Paragraph to read: "...does not always result in negative DRE!--not that this would apply to your presentation. And low PSA does not necessary mean indolent PCa, since certain types of more aggressive PCa may not make as much PSA." Thx.

batch2103 said:

Back from my appointment this morning.

After much deliberation, the consensus of opinion is, that I have been able to hang-on to my infection, despite the two previous rounds of antibiotics.

So I am returning back to Flomax, and having a one months course of antibiotics and a muscle relaxant, as I am retaining urine. I go back in a month.

I was encouraged to take a more relaxed approach to my PSA numbers. The digital was 'normal' as was the last previous one.

Of course the other question is despite the unequivocal evidence of the benefits and merits of cycling, in my case. Is cycling adding to and exacerbating the problem?
With the great weather were enjoying right now, off the bike anyway (I hate spin classes).

Thanks for all your very much appreciated feedback.

Batch

Makes Sense
batch,

A lingering infection is certainly plausible given your PSA history and odds are that you probably have nothing to worry about. I wouldn't give up bike riding for a PSA test. The exercise alone probably has more positive effect than whatever incremental PSA addition such an activity might cause. Life is too short to spend it worrying about what might or might not affect a PSA test. If you avoid the bike a few days before the blood draw, the PSA from that component will have been absorbed. Otherwise, just let the doctors know you're an avid biker and take it into account when you look at the score. Or maybe get one of those big, broad bicycle seats with a hole in it that minimizes pressure on the crotch.