High PSA

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.

«1

Comments

  • gumbyrun
    gumbyrun Member Posts: 58
    go for the biopsy

    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 optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    I wonder what your history of

    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
    CC52 Member Posts: 103 Member
    A Difficult Diagnosis

    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
    stoniphi Member Posts: 54
    CC52 said:

    A Difficult Diagnosis

    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

     

    I should add...

    ...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
    Old Salt Member Posts: 934 Member
    Horror stories on the Internet

    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
    tall floridian Member Posts: 95
    Old Salt said:

    Horror stories on the Internet

    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.

     

    Thank you all for responding

    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
    Max Former Hodgkins Stage 3 Member Posts: 3,736 Member
    Welcome

    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
    tall floridian Member Posts: 95

    Welcome

    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

     

     

    Hi Max

    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
    tall floridian Member Posts: 95

    Hi Max

    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.

     

    Call from urologist

    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 optimistic
    hopeful and optimistic Member Posts: 2,333 Member

    Call from urologist

    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.

    Good idea for you to have a

    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
    Swingshiftworker Member Posts: 1,013 Member

    Call from urologist

    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.

    Radiation or Active Surveillance

    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 optimistic
    hopeful and optimistic Member Posts: 2,333 Member

    Radiation or Active Surveillance

    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!!!

    Active Surveillance programs

    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
    stoniphi Member Posts: 54

    Active Surveillance programs

    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. 

    I must add....

    ...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
    Swingshiftworker Member Posts: 1,013 Member
    stoniphi said:

    I must add....

    ...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.

    BT vs CK?

    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
    jerryj080 Member Posts: 13

    BT vs CK?

    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.

    Options

    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
    tall floridian Member Posts: 95
    jerryj080 said:

    Options

    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.

    Test results from biopsy's in

    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".

  • Swingshiftworker
    Swingshiftworker Member Posts: 1,013 Member

    Test results from biopsy's in

    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".

    No SURGERY!!!

    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 optimistic
    hopeful and optimistic Member Posts: 2,333 Member

    No SURGERY!!!

    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. 

    NO SURGERY!!!

     Can't agree more..

  • tall floridian
    tall floridian Member Posts: 95

    NO SURGERY!!!

     Can't agree more..

    High PSA

    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
    VascodaGama Member Posts: 3,512 Member
    Coding in Medical Records is meaningful

    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