CSN Login
Members Online: 8

You are here

High PSA

tall floridian's picture
tall floridian
Posts: 95
Joined: Dec 2011

I'm a 73 year old male, in 3 year remission of 4th stage lymphoma cancer who at my last annual physical was told by my primary physician that my PSA level was at 16. He sent me to a urologist who recommends a biopsy and radiation if cancer is found. I have read so many horror stories about radiation and even biopsy side effects and wonder if there's a natural way to combat prostate problems. I would appreciate any advice this forum can afford me-your experieces good or bad and any recommendations for alternate natural treatment.

gumbyrun's picture
gumbyrun
Posts: 58
Joined: Dec 2009

My recommendation would be to get the biopsy so you have the information you need to make your personal decision. Keep us in the loop. 

hopeful and opt...
Posts: 2226
Joined: Apr 2009

I wonder what your history of PSAs are? 

Were there any abnormalties found in the digital rectal exam (finger wave)?

Did the urologist mention what your prostate size is? Large prostates place pressure on the uretha , so there is more PSA secreted and the PSA level is higher.

Any other diagnostic tests?

 

..........................

If there is prostate cancer found resulting from a biopsy, there are various options available. there are various forms of  radiation, IMRT, SBRT , seeds. Proton.

There is also focal laser, HIFU,  and other treatments.

 There is also "Active Surveillance with delayed treatment, only if necessary" for low level disease, determined by a biopsy,  which I am doing, that is being closely monitored, and only have treatment if the disease progresses...I have been doing this ( no active treatment) for seven years.  

 

.....................

It is important for you to eat heart healthy...heart healthy is prostate healthy.

...........

 

I've been studying this beast for 7 years...to my knowledge there are no alternative natural treatments.

 

CC52
Posts: 103
Joined: Nov 2013

Prostate cancer cannot be determined by PSA alone, and they are but a small piece of the story. As I understand it, a high PSA may not be indicative of cancer any more than a low PSA should be meant to show no cancer, at least prior to any treatment that is. Post treatment, PSA is used more effectively to monitor a recurrence of cancer activity. To know with certainty, a biopsy will be required. 

Your family history, particularly if your father had Pca, may prove to be a factor for you.

I'm not aware of any natural remedies either, although diet and excercise have been shown to be important factors in keeping PSA levels in check.

Best wishes,

CC

 

stoniphi's picture
stoniphi
Posts: 54
Joined: Mar 2015

...that I have had the surgery, the radiation and the chemo and find that those side effects are not as bad as many seem to think they are. Get the tests, then think about your options before you act. We will be here as well. Smile

Old Salt
Posts: 720
Joined: Aug 2014

Yes, one can find horror stories about biopsies. But the fact is that, when done by a competent urologist, a biopsy should have minor or no side effects.

A PSA level of 16 demands further investigation and raises the following questions:

1. Did your primary care physician do a Digital Rectal Exam?

2. Did you have earlier PSA tests? If so, it would be insightful to compare them with your current result.

 

We can address side effects of radiation treatments (there are many, as pointed out by others in this thread) at a later time. First, we need to know the results of the biopsy, and then we can start a focussed conversation about possible therapies and their side effects. Perhaps you won't need or don't want any therapy. Wouldn't that be great?

I am a firm believer in traditional medicine, and believe that at this stage of your life you should forget about 'natural' therapies.

 

PS: I agree with Hopeful and Optimistic that a heart-healthy diet is good for all of us.

 

tall floridian's picture
tall floridian
Posts: 95
Joined: Dec 2011

My father died at age 40 due to kidney failure in 1950,my oldest brother at age 25 after heart surgery in 1959,my middle brother is 78 and has high PSA also but not as high as mine. Two years ago my PSA was 6,last year it was 9 and the latest is 16 hence the urgent urologist sending. I will have the biopsy the middle of July to determine the extent of the problem and then weigh my options from there. I thank you all for responding and will post my results as soon as the biopsy report is ready.

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3311
Joined: May 2012

Tall,

I recognized your picture immediately from the Lymphoma Board.  I have been here since discovering prostate cancer last year. Since then, my gland was surgically removed, and all appears clean, with very little liklihood of escape, based upon what the pathology report showed.

Your doctor may have suggested radiation if your biopsy is positive because of your age.  Yes, radiation can have significant side-effects, but surgery often has worse side effects, and the older the paitent, usually the worse they are.  Radiation for curative effect (intended to kill all of the disease) is essentially equal to surgery for curative effect in most situations, plus it is usually milder, and with very little if any recovery time.

I am not aware of scientifically-established nutritional cures for prostate cancer, but do eat healthy.  This cancer is usually very slow-moving, and it may be that just monitoring it ("Active Survellance") might be clinically sound for you, but only the results from the biopsy can indicate that one way or another.  And, you most assuridely need to have a biopsy done; without it, everythng is sheer gueswork.

Wishing you the best,

max

 

 

tall floridian's picture
tall floridian
Posts: 95
Joined: Dec 2011

I'm planning on taking the biopsy test next month upon my doctor's return from vacation. One complication is that I have had a blood clot in both legs in the past and take 7.5 mg of Warfarin so he wants me to stop taking the pill 5 days before the biopsy and take stomach shots of blood thinner in it's place before and after the biopsy. Thanks for responding Max-will keep the group informed of my progress.

 

tall floridian's picture
tall floridian
Posts: 95
Joined: Dec 2011

I received a call from my urologist this afternoon and he stated my Gleason score was 6 and that he will go over the results with my wife and I Thursday afternoon. I was glad to know that it wasn't in the higher range so I may have several options to consider. My biggest concern is my age- I'll be 74 in November and wonder what his recommendation will be. I am in good health now having 4th stage lymphoma in remission and really feeling fine these days. I know he works with a radiation firm so he probably will recommend radiation but I'll get a second and third opinion like Web MD recommends. I have two beautiful granddaughter's to stay healthy for-so will look very closely at my options. Any suggestions from the board will be appreciated.

hopeful and opt...
Posts: 2226
Joined: Apr 2009

Good idea for you to have a copy of the pathology results and any other medcial office notes or other diagnostic tests.

Please post the results of your biopsy to include number of cores taken, how many positive, and the involvement(% cancerous) of each positive. Also include the size of your prostate which will be listed with the biopsy. We will better be able to give inp;ut at that time.

There may be many options availble to include "Active Surveillance with delayed treatment if necessary" which I have been doing for 6 and half years. I have not had any active treatment such as radiation or surgery. Feel fre to click my name on the left to see what I have been doing

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Glad to hear that your PCa diagnosis was relatively benign at Gleason 6. 

Given your age, I think you could opt for active surveillance or radiation.  I believe your concerns about radiation treatment for PCa are unwarranted.  Radiation for PCa in the PAST was risky because they could not control the delivery of the radiation to the tissue sites very precisely.  Current technology is much better and the risks are greatly diminished.  The best radiation treatment for PCa is CK (Cyberknife which is a form of SBRT) which can deliver radiation to the sub-mm level, which in turn greatly diminishes the possibility of any collateral tissue damage.  CK only requires 3-4 treatments, which can be completed in a week or less.  The other most common form of radiation treatment for PCa is IMRT or IGRT.  The level of precision of these treatment is less than CK and usually require around 40 (5 day a week) treatments to complete.  

However, if you are still wary of radiation, active surveillance would still be an acceptable option as long as you are willing to live w/the knowledge that there is an active cancer existant in your body.  In most programs, you will have to get reguarly PSA testing (quarterly) and get another biopsy done annually.  You can also take steps to change your diet to improve it's resistance to cancer growth and engage in an exercise program that can also help in that regard.  Generally speaking, the diet and exercise recommended for PCa and other cancer patients is that same that would be recommended for anyone interested in living a more healty llifestyle. 

For more specific info in this regard, please consult "Nutrition and Prostate Cancer" published by UCSF here: http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf.

Good luck!!!

hopeful and opt...
Posts: 2226
Joined: Apr 2009

The monitoring programs vary by institution.

At Johns Hopkins and some other institutions that have programs for active surveillance, as Swing mentioned there is an annual random biopsy.

Monitoring patients on AS, differs at other institutions; for example at UCLA there is a multiparmetric MRI and biopsy after one year, then two year intervals. A PSA and a digital rectal exam every six months. There are also other diagnostic tests from time to time. 

Other institutions have other protocols with greater time between biopsies.

Although in my opinion it should be, heart healthy diet is not a requirement of an active surveillance protocol, or the protocol after other active treatment types. 

............................ 

At your age of 74, my opinion is that  AS would be the best option, if the results of the biopsy show that the cancer is not extensive. You will know more when you see results of your biopsy. You may also wish to obtain more testing by having a T3 MRI.

......................

I agree with Swing, of radiation treatment types, SBRT is the best....it is very precise, more precise than the others...and involves only 4 or five treatments, to receive comparable results to radiations that may take 8 weeks. An advantage to SBRT treatments is that you can go about your business on the day of treatment without ill effects from treatment.......  Another good choice are seeds.

 

By the way surgery would be a horrible choice for you. Surgery is very invasive. The results of surgery are age dependent, so an older man is more likely to suffer with incontinence and ED after surgery than a younger man. 

stoniphi's picture
stoniphi
Posts: 54
Joined: Mar 2015

...that I have a good freind who was in a similar situation a few years ago. He went with the radiactive seeds. He is now 94 and has no prostate issues to speak of.

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Low Dose Brachytherapy can be effect but I never liked the idea of having those seeds in my prostate FOREVER. 

Apart from that, if the planning and placement of the seeds isn't done properly, the patient can suffer from serious side effects including ED and incontinence, as well as potential tissue damage to the bladder and rectum.  The seeds can also move on their own which will throw the treatment pattern off.  In addition, you are "radioactive" for about a year (the 1/2 life of the seeds) and have to be careful NOT to be in close proximity to pregnant women, babies and others.

If you're going to consider BT, the better choice would be High Dose BT, which only places the seeds in your prostate temporarily but there is still the risk of improper planning and placement of the seeds during this treatment, as well as the discomfort of the procedure.  Is also important to note that the development and testing of CK was based on and compared directly the HD BT.  The results achieved w/CK were found to be equal to HD BT in effectiveness BUT better in terms of limiting the common side effects.

So, if you're leaning towards HD BT, the better course would be to just choose CK instead.

jerryj080
Posts: 13
Joined: Oct 2013

A Urologist I went to said painful urination is a possibility with seeds. He said patients have told him, "Doc, it feels like I'm peeing razor blades." That was enough to scare me away.

tall floridian's picture
tall floridian
Posts: 95
Joined: Dec 2011

Final diagnosis from my biopsy came in - I'm looking at 3&3=6 Gleason score with 3 of 12 specimens submitted highest PTI=30%,PSA at 19.3 which is high so uroligist's set up a cat scan plus bone scan for August 12th. If it shows clear and not spreading he then recommends removing prostate in Venice, FL where a specialist he recommends works out of Venice Hospital and is rated the best in the area. Looks like my cancer's in both the left and right side-clinical stage=T1c. Also says tumor involves 5% of the total biopsy length. I'm new to this so I'm just leaning on my doctor's advice for now and moving slowly, he says "no rush".

hopeful and opt...
Posts: 2226
Joined: Apr 2009

First a " cat scan plus bone scan " does not provide very much definition, and WILL NOT determine extracapular extention. . They are not effective tests. Additionally the American Urological Association does not recommend a bone scan for patients who have a Gleason under 8. 

The tests that this doc referred youto is not appropriate for proper evaluation....

 

An  MRI T3 will do the job for you.

here are some studies from pubmed about mri's and a high tech pet scan

multiparametric mri t3 

 

The impact of Magnetic Resonance Imaging on prediction of extraprostatic extension and prostatectomy outcome in low-, intermediate- and high-risk Prostate Cancer Patients. Try to find a standard.

 

http://www.ncbi.nlm.nih.gov/pubmed/26154571

 

The impact of multiparametric pelvic magnetic resonance imaging on risk stratification in patients with localized prostate cancer.

 

http://www.ncbi.nlm.nih.gov/pubmed/24785987

 

Preoperative 3-Tesla multiparametric endorectal magnetic resonance imaging findings and the odds of upgrading and upstaging at radical prostatectomy in men with clinically localized prostate cancer.

http://www.ncbi.nlm.nih.gov/pubmed/23040223

 

...........................

Here is one that  

Detection of recurrent prostate cancer after radical prostatectomy: comparison of 11C-choline PET/CT with pelvic multiparametric MR imaging with endorectal coil.

 

  http://www.ncbi.nlm.nih.gov/pubmed/24434294

This above comparason is looks at a high tech PET/Ct.

 

The MRI scan for prostate cancer that is very effective in indicating if there is any nodule involvement, if there is involvement in one or two lobes, will show size of prostate, may show evidence of extracapular extension, will stage the disease. An MRI with the 3.0 Tesla magnet, is the gold standard. It provides a very fine definition.  Major hospitals that have MRI machines with a 3.0 Tesla magnet. 

In my layman’s opinion it is advisable to have such a test before any treatment. If the cancer is outside the prostate you may wish to reconsider a treatment decision.

................................................

Second, the criteria for Active Surveillance at Johns Hopkins is two cores or less Gleason 6, with less than 50 percent involvement in each...it is more relaxed for men who are over 70, you are within these guidelines.....PSA 10 or less......( by the way I wonder what the size of your prostate is, since the larger the prostate, the more PSA is secreted, and effects the PSA numbe, which may be your case.....one looks for a ratio of prostate size to PSA of 0.15 or less...please let us know the size of your prostate, it should be in the biopsy report).....................normal or slight bump on the prostate...........

Active surveillance is the prefered treatment decision, if you are eligible....which appears that you are.

...................................

Surgery is the very worse choice that you can make.....the side effects for a man of 73 are more likely to happen.....additionally there is a difference between surgeons.....generally local surgeons do not have as good results as nationally known surgeons.

................................

With your numbers , you are in no rush at all to make any decision at this time.

Do research, attend support groups, read book, post here, a source for support groups is USTOO.org....which lists local support groups, and information about prostate cancer; see the "hot sheet" that they publish.

 

Best

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Whatever you do, do NOT submit yourself to surgery for this cancer.  It can only cause problems for you that you do not want to face at this stage in your life.  If you think you need treatment, which is not clear, radiation will be sufficient. 

hopeful and opt...
Posts: 2226
Joined: Apr 2009

 Can't agree more..

tall floridian's picture
tall floridian
Posts: 95
Joined: Dec 2011

I'm looking at my copy of my prostate pathology report and don't see the size listed unless it's under a different name. I see elevated PSA (790.93) Where do I look for it's size? I see a diagram of my prostate with left,base,and right but nothing that says size.

VascodaGama's picture
VascodaGama
Posts: 3033
Joined: Nov 2010

Tall,

I think your case being the typical diagnosis process in prostate cancer occurrences. High PSA leads to a biopsy that identifies the presence of cancer. My note here is for those reading your posts that may not be aware of the terminology used by the pathologist/laboratory that analysed your specimens. The coding of 790.93 stands for “Elevated PSA” and the percentage of PTI may regard the amount of the oncogene PTI 1 found in your prostatic carcinoma. The clinical stage of T1c is erroneous if in fact they found cancer in both lobes of the prostate (T2c).

At first glance you would be classified in the group of low risk for metastases because of the low grade of Gleason s-6 found in the 3 out of 12 cores. However, this is not enough to set you in such group and your doctor is requesting additional information from image studies. He wants to certify that cancer is in fact contained which would provide the possibility for the surgery option. As commented above by Hopeful these typical exams “cat scan plus bone scan” are not very effective and commonly provide false negatives. The MRI 3.0 Tesla provides better images but it may also not complete the diagnosis process.

The worrisome items in the pathologist report goes to the high PSA at 19.3 (ng/ml) which also has shown a fast doubling (PSADT) of less than 14 months, in any case, the PTI-1 gene may be the “baddy” in the story because it rules out the existence of hyperplasia (a cause in enlarged glands), and because it is typically found in extracapsular extension cases. I wonder about the DRE (digital rectum exam). Was it performed? Did they find any particular extruding bumps in the biopsy’s ultrasound?

My PCa case is similar to yours regarding the elevated PSA in a low Gleason score. I was PSA=22.4 and Gleason 6. This was confirmed at separate laboratories (second opinion) which gave me more power in the decisions ahead.
At your age and with other health issues you may confront limitations in future treatments and medications. You need extra vigilance and need to be more cautious, but you do not need to rush. I would recommend you to get second opinions from other specialists. Urologists typically recommend surgery as much as radiologists recommend radiotherapy. All treatments are subjected to risks and side effects that you should be aware in advance. The final decision is yours. They will request you to sign an agreement relieving the doctor (and the facilities) from any wrong outcome.

Here are links regarding the PTI 1 Human Prostatic Carcinoma Oncogene;

http://www.ncbi.nlm.nih.gov/pubmed/8988032

http://www.cumc.columbia.edu/psjournal/archive/archives/jour_v17n2_0005.html

Regarding the Coding in Medical Records is here;

www.cdc.gov/nchs/data/icd/icd9cm_guidelines_2011.pdf

For PCa;
https://www.supercoder.com/coding-newsletters/my-oncology-hematology-coding-alert/reader-questions-79093-describes-elevated-psa-article

Best wishes and luck in your journey.

VGama

 

tall floridian's picture
tall floridian
Posts: 95
Joined: Dec 2011

What did you decide for your treatment and how are you doing now? My primary care physician did a digital rectum exam and his words were "irregular' - urologist did also and said "I feel a hard spot". Also what age are you? I know age's a factor in my case- I'll be 74 in november. I thank you for responding and like you say will proceed cautiously and slowly.

VascodaGama's picture
VascodaGama
Posts: 3033
Joined: Nov 2010

Tall

I am 65 (66 in October) and was 50 years old when diagnosed with PCa. “Backwards” calculations indicate that the cancer may have expressed its intent to spread at the age of 46.
You can read my PCa history in these threads and their links;
http://csn.cancer.org/user/133775
http://csn.cancer.org/forum/126/search?body=vgama&title=

 

The positive DRE you describe here is very significant in your diagnosis and reinforces my above comments. Even the clinical staging increases in class because of the meaning that such finding could bring to the real status of your case. If in fact extra capsular extensions become apparent than the case would be graded up to T3 which relates to advanced localized status. This is a class that may rule out the success of a surgery.

http://www.psa-rising.com/prostatecancer/staging.htm

Your doctors comments regarding the bumps ("irregular' - urologist did also said "I feel a hard spot") indicate that either; they touched calcium deposits or tumours. Moreover, these formations can be felt at the capsule of the gland therefore with high probabilities of spread in the outer surface of the gland.
I wonder if your biopsy used an automate gun or the conventional gun method. These are different and the later obliges the doctor to be attentive at the image in the ultrasound when directing each needle. With this method they can analyse those bumps and certify its contents. Is the cancer contained or does it exist away from the gland?

Where does these all lead us is to the decision on a treatment. Either one looks for curative intent or just a palliative way to handle the matter. At 74 you are in the limit age for a therapy with curative intent, as recommended in the NCCN guidelines. However, many do try cure through a radical (surgery or radiation) and are successful. Some do surgery just with the intent of debulking the big tumour giving them long years of survivorship but not cure.

Radiation therapy can accomplish the job as much as surgery. The choice goes to the fact of owns preferences and believes. Both treatments got risks and side effects. Incontinence issues are common in surgery executions. Bowell issues are common in radiation executions. A palliative way to control the advance of the cancer would be hormonal manipulations which therapy can be executed intermittently, providing the patient with periods of relief from the drugs side effects. This causes conditions of menopause (hypogonadism) with its traditional symptoms (hot flashes, fatigue, irritability, etc). Some guys experience mild effects and some unbearable nasty conditions. The good is that one can stop the treatment whenever he wants and return to normalcy status.

I would recommend you to get educated on each treatment, their risks and side effects and discuss the matter with your family before deciding on anything.

Here are some reading materials that may help you in your decisions;

https://books.google.co.uk/books?id=16TbQ6as4uAC&pg=PA1&lpg=PA1&
dq=choosing+the+right+treatment+for+your+prostate+cancer+johns+hopkins&
source=bl&ots=RUO2tcFIuM&sig=KdfOBDSchbX6w12IDUn8JqvrZRE&hl=en&sa=X&
ei=bZ4GVaOdMsWsUfq5hFA&ved=0CC4Q6AEwAA#v=onepage&q=choosing%20the%20
right%20treatment%20for%20your%20prostate%20cancer%20johns%20hopkins&f=false

Books which contents may be biased by their author’s profession;

“Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (third edition); on options between surgery and radiation.

"Beating Prostate Cancer: Hormonal Therapy & Diet" by Dr. Charles “Snuffy” Myers; which informs on “patient’s language” all about hormonal manipulations.

Try getting second opinions on the suggestions of your physician and prepare a list of questions to expose to them when consulting. Here are some ideas to your list;
http://www.cancer.net/navigating-cancer-care/diagnosing-cancer/questions-ask-doctor

http://csn.cancer.org/node/224280

A copy of the NCCN Guidelines;
http://www.nccn.org/patients/guidelines/prostate/

Hope for the best,

VGama 

Please note that I have no medical enrolment. I have a keen interest and enthusiasm in anything related to prostate cancer, which took me into researching and studying the matter since 2000 when I become a survivor and continuing patient.

 

 

 

stoniphi's picture
stoniphi
Posts: 54
Joined: Mar 2015

...that the 2 extracapsular extentions my T3c cancer had put out were clearly visioned with the cat scan I received along with that pesky bone scan which showed no (large enough to see) mets and lots of arthritis.

 

Get more info as best you can before making a decision and weight the docs advice heavier than ours here. Wink We are patients like you and highly motivated, but not doctors.Embarassed 

CC52
Posts: 103
Joined: Nov 2013

Tall,

I want to echo the advice of several here that advise avoiding surgery. The factors of your situation indicate two favorable options, as have been mentioned:

#1 - Active Surveillance. Although 3/12 positive cores may disqualify you for AS, the combined Gleason 3+3=6 along with your age could be to your advantage. (Note: I had 3 of 18 cores positive at age 61 with a Gleason of 3+4=7, and AS was not an option for me). 

#2 - Radiation. I had Cyberknife (SBRT) 10 months ago, and so far very positive results. It is a very precise administration of high doses of radiation over 3-5 treatment sessions, each lasting about 30-45 minutes. After much study on the various types of radiation treatments available, I choose CK because results indicate it is THE most effective in treating PCa with minimal side effects. It does require the placement of markers (fiducials) into the prostate that provide the CK technicians the ability to "see" the prostate during treatment. The procedure to place the markers is painless (it is called surgery, but the markers are placed with needles through the perinenum with no incision). From start to finish, about 4 weeks.

No matter what, take your time. And before you make any decision about treatment you have to get a 2nd or even 3rd pathology review from other labs. Bostwick and Johns Hopkins are known to be the most reliable.

Best wishes - CC

Subscribe to Comments for "High PSA"