PSA 30, 12 months ago PSA 25, but not informed; had biopsy today.. PLEASE ADVISE!!!

Paul M
Paul M Member Posts: 17
I am 52 years old, with no famiily history of cancer of any kind. Three weeks ago I went to my family Dr. related to some recent high blood pressure readings, turned out BP slightly on the high side, but no need for medication. The Dr. was looking at my history and noticed ~ 12 months ago, my blood results indicated PSA of 25, but i was never informed of this. The next morning, I went for another PSA blood test. Dr. called me 2 days later and said my PSA is now 30. A week later, Eurologist did DRE, seemed normal in size and no nodules.. so far so good.. Which brings me to today (11/16/12), I had the prostate biopsy. Appointment scheduled 2 weeks with the Eurologist to go over the results. Any advise / feedback from those with expertise or experience is greatly appreciated!!! Regards, Paul
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Comments

  • Euskal
    Euskal Member Posts: 1
    Information
    Hi, Did you take antibiotics? You should tell your doctor treatment for 4 weeks and repeat PSA, might be Prostatitis. Greetings
  • Beau2
    Beau2 Member Posts: 261
    Advice
    Hey Paul,

    Welcome to the forum .... Sorry you have to be here!

    With a PSA of 30 there is something going on with your prostate and it may be prostate cancer. The results of your biopsy will give you a much better idea of where you stand.

    If it is prostate cancer, I would recommend that you do not rush to treatment. If it is prostate cancer, take some time and carefully study all of the treatment options available to you; educate yourself on the specifics of the prostate cancer you may have (I heard there were 24 varieties), and choose a plan that best suits your needs.

    A good place to start may be at the library ... check out Dr. Patrick Walsh's book, "Surviving Prostate Cancer". It could be very helpful in interpreting the results of your biopsy.
  • Paul M
    Paul M Member Posts: 17
    Euskal said:

    Information
    Hi, Did you take antibiotics? You should tell your doctor treatment for 4 weeks and repeat PSA, might be Prostatitis. Greetings

    Information
    Thank you.. Because PSA was so high at my age, recommend was a biopsy right away. Thanks!
  • Paul M
    Paul M Member Posts: 17
    Beau2 said:

    Advice
    Hey Paul,

    Welcome to the forum .... Sorry you have to be here!

    With a PSA of 30 there is something going on with your prostate and it may be prostate cancer. The results of your biopsy will give you a much better idea of where you stand.

    If it is prostate cancer, I would recommend that you do not rush to treatment. If it is prostate cancer, take some time and carefully study all of the treatment options available to you; educate yourself on the specifics of the prostate cancer you may have (I heard there were 24 varieties), and choose a plan that best suits your needs.

    A good place to start may be at the library ... check out Dr. Patrick Walsh's book, "Surviving Prostate Cancer". It could be very helpful in interpreting the results of your biopsy.

    Advice
    Beau2, thanks for the info. Will consider all options.. I'm just stressing out...
  • Paul M
    Paul M Member Posts: 17
    Paul M said:

    Information
    Thank you.. Because PSA was so high at my age, recommend was a biopsy right away. Thanks!

    Euskal, thanks! Will ask
    Euskal, thanks! Will ask the Dr... !
  • Beau2
    Beau2 Member Posts: 261
    Paul M said:

    Advice
    Beau2, thanks for the info. Will consider all options.. I'm just stressing out...

    Stress
    Yeah, the possibility of PCa brings a lot of stress to your life. I still get stressed waiting for my PSA test results.

    Fortunately, you have a bunch of guys on this forum who have been where you are. Their understanding and advice can help you destress.
  • Paul M
    Paul M Member Posts: 17
    Beau2 said:

    Stress
    Yeah, the possibility of PCa brings a lot of stress to your life. I still get stressed waiting for my PSA test results.

    Fortunately, you have a bunch of guys on this forum who have been where you are. Their understanding and advice can help you destress.

    Stress
    Thanks for the support!
  • VascodaGama
    VascodaGama Member Posts: 3,511 Member
    Paul M said:

    Stress
    Thanks for the support!

    Not yet diagnosed
    Paul
    You haven't been diagnosed with cancer yet. Only the biopsy can tell your fate.
    The high PSA could be related to other causes so that you should wait. Sex the night before drawing blood or inflammation, etc., could cause a substancial rise in the PSA.

    Usually doctors recommend antibiotics before the biopsy but yours did go straight to get a definite conclusion. The negative DRE and by the touch he may have the impression that BPH is not present. In any case, you are not alone. Many here will help you understanding facts. Just do not rush even if you unfortunatly get a positive result.
    Do things timely and coordinatly.

    Get second opinions on the cores of the biopsy and get image studies with 3-tesla MRI and Bone scyntigaphy scan. If cancer is the cause of the high PSA then it may be possible to detect something.

    Wish for the best.

    VGama
  • Paul M
    Paul M Member Posts: 17

    Not yet diagnosed
    Paul
    You haven't been diagnosed with cancer yet. Only the biopsy can tell your fate.
    The high PSA could be related to other causes so that you should wait. Sex the night before drawing blood or inflammation, etc., could cause a substancial rise in the PSA.

    Usually doctors recommend antibiotics before the biopsy but yours did go straight to get a definite conclusion. The negative DRE and by the touch he may have the impression that BPH is not present. In any case, you are not alone. Many here will help you understanding facts. Just do not rush even if you unfortunatly get a positive result.
    Do things timely and coordinatly.

    Get second opinions on the cores of the biopsy and get image studies with 3-tesla MRI and Bone scyntigaphy scan. If cancer is the cause of the high PSA then it may be possible to detect something.

    Wish for the best.

    VGama

    Not yet diagnosed
    VGama, thank you for the info. Appreciate all the feedback I've recieived in just a few days! Paul
  • Swingshiftworker
    Swingshiftworker Member Posts: 1,013 Member
    Advice Pending
    As Vasco said, no advice can be realistically suggested until you get your biopsy results back. Let us know what they are and you more and enough "advice" from us here.

    Good luck!
  • Paul M
    Paul M Member Posts: 17

    Advice Pending
    As Vasco said, no advice can be realistically suggested until you get your biopsy results back. Let us know what they are and you more and enough "advice" from us here.

    Good luck!

    Will do, ~11 days until I
    Will do, ~11 days until I get the results.. Thanks!
  • Paul M
    Paul M Member Posts: 17

    Advice Pending
    As Vasco said, no advice can be realistically suggested until you get your biopsy results back. Let us know what they are and you more and enough "advice" from us here.

    Good luck!

    Biopsy indicates cancer; Gleason 3 + 4 = 7
    I received the bad news 11/29/12...
    Biopsy Results: 7 of 12 samples tested positive for cancer..
    Left Zone = 100%
    Left Center = 92%
    Right Center = 18%
    Right Zone = 0%
    Going next week for CAT & Bone scan....
  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    Paul M said:

    Biopsy indicates cancer; Gleason 3 + 4 = 7
    I received the bad news 11/29/12...
    Biopsy Results: 7 of 12 samples tested positive for cancer..
    Left Zone = 100%
    Left Center = 92%
    Right Center = 18%
    Right Zone = 0%
    Going next week for CAT & Bone scan....

    Paul
    The gleason score measures the aggressive of the cancer. So on the biopsy report, which you need to have a copy of, as well as all medical information so you can bring to other doctors with various specialties and discuss intelligently, the gleason score of each core is listed. So it could be a 3+3=6, a 3+4=7, a 4+3=7, 4+4=8, etc, etc until a 5+5=10

    At any rate please post the gleason score for each core that was positive and the percent of involvement of each of these cores, that is the percent that was cancerous for each of these cores.

    Now this is very, very important. Doing these gleason scores are very subjective, so you want to have the slides sent to an independent world class pathologist who specializes in doing the pathology for prostate cancer so that you are not under or over treated. Everything is based on the results of the biopsy so you want it to be accurate.

    By the way, what is your age?

    We are here for you
  • VascodaGama
    VascodaGama Member Posts: 3,511 Member
    Paul M said:

    Biopsy indicates cancer; Gleason 3 + 4 = 7
    I received the bad news 11/29/12...
    Biopsy Results: 7 of 12 samples tested positive for cancer..
    Left Zone = 100%
    Left Center = 92%
    Right Center = 18%
    Right Zone = 0%
    Going next week for CAT & Bone scan....

    Intermediate
    Paul

    Gleason 7 is for Intermediate risk for metastases. The image studies recommended by your urologist will add info on your status to get a definite clinical stage. That will provide you with the parameters required to define options of treatment.
    You may choose a palliative type or radicals but only the radicals can assure you cure.

    In my opinion, at 52 years old with a high PSA and a Gleason pattern of 4, you should try the best to get rid of the cancer. However, if metastases are present (extra capsular extensions) surgery would not cure you. In such a case radiotherapy got higher chances to lead you to a successful outcome.
    In any case, for 100% assurance of success one needs to know exactly where cancer is set. You could not throw arrows in the dark and expect to hit the target.

    Proper image studies become essential and you should try your best when choosing the equipment/methodology used. Old machines doing CT and bone scans are not that reliable in terms of resolution even with a PSA of 30 ng/ml that could be from a tumour big enough to be detected.
    I have no medical enrolment to advice you but I am stressing about the quality of the image studies because of your intermediate status for metastases, which could eliminate surgery as an option.

    In this forum you may research in past posts about advices from other survivors. I just recommend you to decide things coordinately and timely. You need to be on the top of your case and act the soonest but you got time to get second opinions (on everything) and do not follow a single urologist’s opinion. Your family should be involved in your decisions.
    Try reading books on PCa as much as you can and prepare a list of questions before your next visits with the doctors.

    Here are good links for a start;
    List of questions;
    http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

    A compendium on Prostate cancer and care;
    http://www.lef.org/protocols/prtcl-138.shtml

    A book on PCa;
    “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (third edition); which may help you understanding options between surgery and radiation.

    Welcome to our boat.
    Wishing you luck in your journey.

    VGama
  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member

    Intermediate
    Paul

    Gleason 7 is for Intermediate risk for metastases. The image studies recommended by your urologist will add info on your status to get a definite clinical stage. That will provide you with the parameters required to define options of treatment.
    You may choose a palliative type or radicals but only the radicals can assure you cure.

    In my opinion, at 52 years old with a high PSA and a Gleason pattern of 4, you should try the best to get rid of the cancer. However, if metastases are present (extra capsular extensions) surgery would not cure you. In such a case radiotherapy got higher chances to lead you to a successful outcome.
    In any case, for 100% assurance of success one needs to know exactly where cancer is set. You could not throw arrows in the dark and expect to hit the target.

    Proper image studies become essential and you should try your best when choosing the equipment/methodology used. Old machines doing CT and bone scans are not that reliable in terms of resolution even with a PSA of 30 ng/ml that could be from a tumour big enough to be detected.
    I have no medical enrolment to advice you but I am stressing about the quality of the image studies because of your intermediate status for metastases, which could eliminate surgery as an option.

    In this forum you may research in past posts about advices from other survivors. I just recommend you to decide things coordinately and timely. You need to be on the top of your case and act the soonest but you got time to get second opinions (on everything) and do not follow a single urologist’s opinion. Your family should be involved in your decisions.
    Try reading books on PCa as much as you can and prepare a list of questions before your next visits with the doctors.

    Here are good links for a start;
    List of questions;
    http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

    A compendium on Prostate cancer and care;
    http://www.lef.org/protocols/prtcl-138.shtml

    A book on PCa;
    “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (third edition); which may help you understanding options between surgery and radiation.

    Welcome to our boat.
    Wishing you luck in your journey.

    VGama

    diagnosis test
    Confirming what VGama advised

    "However, if metastases are present (extra capsular extensions) surgery would not cure you. In such a case radiotherapy got higher chances to lead you to a successful outcome.
    In any case, for 100% assurance of success one needs to know exactly where cancer is set. You could not throw arrows in the dark and expect to hit the target.

    Proper image studies become essential and you should try your best when choosing the equipment/methodology used. Old machines doing CT and bone scans are not that reliable in terms of resolution even with a PSA of 30 ng/ml that could be from a tumour big enough to be detected."

    So the tests that you have scheduled for dec 7 are not the best, and can give you a false sense of security, not finding the cancer if there is extracapsular extension.

    A much better diagnostic test is the following, usually found at major centers of excellence.

    There is an MRI scan for prostate cancer that is done with a special coil in the rectum. This are certain major hospitals that have a Tesla magnet. There is a 1.5 Tesla magnet, the effective resolution is limited to tumors 0.5cc or larger. There is also a 3 Tesla machine which may have a bit finer resolution.

    The most effective MRI for the prostate is called a MRSI (MRI/MRS) and includes the ability to identify cancer metabolites using spectographic analysis.....Basically using the spectoscopy with the MRI provides more accurate results, both the MRI and the spectroscopy are done at the same time.

    The MRI is generally covered by insurance, however the spectroscopy is considered investigational and is not covered by medicare which I use.

    The test indicates if there is any nodule involvement, if there is involvement in one or two lopes , wll show size of prostate, any evidence of extracapular extension, will stage your disease.



    .
  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member

    Intermediate
    Paul

    Gleason 7 is for Intermediate risk for metastases. The image studies recommended by your urologist will add info on your status to get a definite clinical stage. That will provide you with the parameters required to define options of treatment.
    You may choose a palliative type or radicals but only the radicals can assure you cure.

    In my opinion, at 52 years old with a high PSA and a Gleason pattern of 4, you should try the best to get rid of the cancer. However, if metastases are present (extra capsular extensions) surgery would not cure you. In such a case radiotherapy got higher chances to lead you to a successful outcome.
    In any case, for 100% assurance of success one needs to know exactly where cancer is set. You could not throw arrows in the dark and expect to hit the target.

    Proper image studies become essential and you should try your best when choosing the equipment/methodology used. Old machines doing CT and bone scans are not that reliable in terms of resolution even with a PSA of 30 ng/ml that could be from a tumour big enough to be detected.
    I have no medical enrolment to advice you but I am stressing about the quality of the image studies because of your intermediate status for metastases, which could eliminate surgery as an option.

    In this forum you may research in past posts about advices from other survivors. I just recommend you to decide things coordinately and timely. You need to be on the top of your case and act the soonest but you got time to get second opinions (on everything) and do not follow a single urologist’s opinion. Your family should be involved in your decisions.
    Try reading books on PCa as much as you can and prepare a list of questions before your next visits with the doctors.

    Here are good links for a start;
    List of questions;
    http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

    A compendium on Prostate cancer and care;
    http://www.lef.org/protocols/prtcl-138.shtml

    A book on PCa;
    “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (third edition); which may help you understanding options between surgery and radiation.

    Welcome to our boat.
    Wishing you luck in your journey.

    VGama

    duplicate
    .
  • Paul M
    Paul M Member Posts: 17

    diagnosis test
    Confirming what VGama advised

    "However, if metastases are present (extra capsular extensions) surgery would not cure you. In such a case radiotherapy got higher chances to lead you to a successful outcome.
    In any case, for 100% assurance of success one needs to know exactly where cancer is set. You could not throw arrows in the dark and expect to hit the target.

    Proper image studies become essential and you should try your best when choosing the equipment/methodology used. Old machines doing CT and bone scans are not that reliable in terms of resolution even with a PSA of 30 ng/ml that could be from a tumour big enough to be detected."

    So the tests that you have scheduled for dec 7 are not the best, and can give you a false sense of security, not finding the cancer if there is extracapsular extension.

    A much better diagnostic test is the following, usually found at major centers of excellence.

    There is an MRI scan for prostate cancer that is done with a special coil in the rectum. This are certain major hospitals that have a Tesla magnet. There is a 1.5 Tesla magnet, the effective resolution is limited to tumors 0.5cc or larger. There is also a 3 Tesla machine which may have a bit finer resolution.

    The most effective MRI for the prostate is called a MRSI (MRI/MRS) and includes the ability to identify cancer metabolites using spectographic analysis.....Basically using the spectoscopy with the MRI provides more accurate results, both the MRI and the spectroscopy are done at the same time.

    The MRI is generally covered by insurance, however the spectroscopy is considered investigational and is not covered by medicare which I use.

    The test indicates if there is any nodule involvement, if there is involvement in one or two lopes , wll show size of prostate, any evidence of extracapular extension, will stage your disease.



    .

    Biopsy Results... Gleason scores, %'s, etc...
    Thank you all for ongoing support and info!

    Age 52:

    PSA 25 Nov-2011 (was not notified of prior year results)
    PSA 30 Nov 03, 2012

    DRE Nov 08, 2012 Results seem normal; discomfort when pressed hard..

    Biopsy Nov 16, 2012 Results below:
    RPZ Benign 4 cores
    RCZ 3+4=7 1/2 cores, present in 18%
    LCZ 3+4=7 2/2 cores, present in 92%, HGPIN
    LPZ 3+4=7 4/4 cores, present in 100%, perineural invasion by adenocarcinoma is present, HGPIN

    CAT & Bone Scan scheduled for 12/07/12
  • Paul M
    Paul M Member Posts: 17

    duplicate
    .

    CT & Bone Scan negative
    CT & Bone Scan negative; However currently researching cancer centers offering advanced diagnostic equipment. I am located ~ 60 miles from Philadelphia, PA.... I agree with support provided here and thank you for taking time to help me and other people!
  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    Paul M said:

    CT & Bone Scan negative
    CT & Bone Scan negative; However currently researching cancer centers offering advanced diagnostic equipment. I am located ~ 60 miles from Philadelphia, PA.... I agree with support provided here and thank you for taking time to help me and other people!

    So far, so good
    The difference between a successful outcome and one that is a failure can be dependent on your medical team, and facilities available for diagnostic and treatment.
    U.S. News and World Report publish a listing ranking institution by specialization in the United States.
    Additionally, you want to hire the most qualified, experienced doctors for your medical team.
    Location should not be the critical factor in choosing facilities and personnel, however in the Northeast where you live; you are lucky enough to have several facilities available to you. Living here in CA.; I am not completely familiar with who the best are in the Northeast, however Johns Hopkins and Memorial Sloan Kettering come to mind.
    Additonally there are doctors that stand out. Generally these doctors publish a lot. There is a site called pubmed that list millions of published medical information where you can research.
    Just curious...where do you live in relation to Philly.
  • Paul M
    Paul M Member Posts: 17

    So far, so good
    The difference between a successful outcome and one that is a failure can be dependent on your medical team, and facilities available for diagnostic and treatment.
    U.S. News and World Report publish a listing ranking institution by specialization in the United States.
    Additionally, you want to hire the most qualified, experienced doctors for your medical team.
    Location should not be the critical factor in choosing facilities and personnel, however in the Northeast where you live; you are lucky enough to have several facilities available to you. Living here in CA.; I am not completely familiar with who the best are in the Northeast, however Johns Hopkins and Memorial Sloan Kettering come to mind.
    Additonally there are doctors that stand out. Generally these doctors publish a lot. There is a site called pubmed that list millions of published medical information where you can research.
    Just curious...where do you live in relation to Philly.

    Best treatment center near Philadelphia, Pa ??
    I live 60 miles north of Philly, near Allentown, Pa
    My current Urologist is with St. Luke's Center for Urology, Bethlehem, Pa; and for my age, he is recommending robotic surgery.
    I have appt next Wed for a 2nd opinion with a Urologic Oncologist at Lehigh Valley Urology Specialty Care Unit.
    Also, tonight, I talked with folks from Cancer Treatment Centers of America...
    i have also been given three referrals for the "Best Doctors" dealing with prostrate cancer based on where i live; that are covered by my health insurance, and also accepting new patients. All three located in Philadelphia.. Thomas Jefferson University Hospital, Fox Chase Cancer Center, and Perelman Center for Advanced Medicine.

    Anyone have experiences with these centers or have other recommendations ???

    Regards,

    Paul