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my psa came back 27.5 today was normal 18 mon ago what to do

nihongo1st
Posts: 3
Joined: Nov 2015

I just got word today frommy primary care doc that my psa was 27.5 she said call a uorlogist. I have urologist appnt for tuesday>
I have my mind made up: NO BIOPSY just take prosatate out, then retest psa in 6 weeks.
IMO I see no need to go througa biopsy, which is NOT a treatment. or necessary if I have already decided to to have it taken out>

Am I worng? Plz let me know what you think?  I am 73. has been 18 months since last psa which was normal. I am in shock and depressed

hopeful and opt...
Posts: 2218
Joined: Apr 2009

I am sorry for the shock and depression that you are feeling. To be honest all  of us with prostate cancer, go through these negative feelings for the first few months after diagnosis. Although a PSA of 27 is very high please be advised that the PSA is an indicator only, and does not diagnosis prostate cancer. There can be various reasons for high PSA's to include infection, sex , bike riding,  digital rectal exam , or even a hard stool before the PSA.

Did you have a digital rectal exam by your primary care doc? If so what were the results?

What was your PSA 18 months ago?, any other PSA's?

 

One cannot be diagnosed with prostate cancer without a biopsy. a doctor will not treat without a biopsy. The biopsy is one of the diagnostic tools that let you and the doctor know what is going on, and what needs to be done.

If you are diagnosed, which requires a biopsy,  please be advised that all prostate cancer is not the same. Some are benign, and require no treatment, only actively monitoring what is going on, and receiving treatment only if there is progression. Others are very aggressive where a primary treatment such as surgery or a form of radiation will not work to cure the cancer, because the cancer has escaped the prostate, and other treatment such as hormone therapy is required in conjunction with radiation. Additionally if primary treatment is necesary, my layman opinion is that other primary treatment is as effective with less side effects of incontinence and erectile disfunsion that happens fairly often with surgery.

By the way I personally have had 5 biopsies . It's not 15 minutes of  pleasure, but I must say that It is a necessary evil. The consequences of not having one can be extremely high.

 

Please come back with any questions

 

Best,

h

 

 

VascodaGama's picture
VascodaGama
Posts: 2961
Joined: Nov 2010

In what basis have you made up your mind? I think that you are wrong.

In fact I wonder what has your primary care doctor tell you apart from recommending you to visit the urologist. You may have been misinformed or are so afraid of the possibility in having cancer that your mind is causing you to reasoning the worse. However, this marker, the PSA, is not exclusive to prostate cancer. Urinary infections or Benign Hyperplasia (BPH) could be behind the increase. An error by the laboratory is also a possibility.
More over, any prostate manipulation done within 24 hours before drawing blood for the test can cause a surge in the serum. Having sex or riding a bike or hard stool or massaging of the prostate (DRE), etc, are all conditions that increases PSA count.
You have not share information regarding your PSA histology or the level that you consider “normal” but at your age the level is typically higher than the usual folk. I wonder if you have experienced any other symptom or condition that lead you to think “in taking it out”.

Dissecting the prostate gland to avoid “trouble” is not the way. The consequences are far extensive than a simple biopsy, if that is your worrisome. In any case you should draw conclusions after the consultation with the urologist. A case of inflammation can be treated with a simple antibiotic protocol, and Hyperplasia has its own way of treatment without the need of risking surgery to dissect the gland. Prostate cancer (PCa) is diagnosed via a biopsy. The procedure will add information regarding the aggressivity of the disease, if any.

There are several treatments for prostate cancer but those should be chosen only after knowing details of the actual status of the disease and the patient. Digital rectum examination and image studies should be done before any decision.

Please note that you have not been diagnosed with cancer yet. I recommend you to prepare a list of question for your next meeting with the urologist. Here are examples you can adapt to your own list. Also read details about prostate issues to understand the meaning of it all;

http://www.mayoclinic.org/diseases-conditions/prostate-cancer/basics/preparing-for-your-appointment/con-20029597

http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

http://www.lef.org/Protocols/Cancer/Prostate-Cancer-Prevention/Page-01

 

 Information regarding the biopsy;
http://www.harvardprostateknowledge.org/understanding-your-prostate-pathology-report

http://www.prostatecentre.com/sites/default/files/Prostate_Cancer_Patient_Education_Booklet.pdf

 

Welcome to the board.

Best wishes for a negative-to-cancer diagnosis.

VGama

 

Beau2
Posts: 261
Joined: Sep 2010

i doubt you will be able to find a doctor who will remove your prostate without first doing a biopsy .... I would guess it could be considered malpractice.

Old Salt
Posts: 720
Joined: Aug 2014

As others have already written, there could be other reasons for the high PSA test result. Errors do occur and the first thing to ask your urologist is a repeat PSA test. The urologist should also do a digital rectal exam (DRE). In case one or the other raises suspicion, a biopsy should be next. If positive for cancer, scans should be done to see if the cancer has escaped the prostate. With all that information, you can decide whether a prostatectomy is right for you.

My best wishes with the decision process.

 

 

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Nihongo: This is a fairly typical feeling among men -- albeit a bit extreme on your part -- who find out  that they've got prostate cancer BUT, if you knew anything about the potential negative side effects, the LAST thing you'd want to do would be to just cut the damn thing out.

As others have mentioned, there may be other reasons why your PSA has risen and you should rule those other things out 1st.  While a biopsy has its risks too, I do not think any urologist or radiologist would proceed with any plan of treatment without FIRST requiring a biopsy (or some other means of cancer detection) to be performed.  So, it's a non-starter to say you will not have a biospy done -- no one will treat you otherwise and no one will just cut out your prostate because you are "afraid" that you might have PCa.

This also begs the question of whether any urologist would consider performing surgery on you at your age (73) because, generally, surgery is NOT recommended for men w/PCa around or past your age because of the significant risks associated with prostate surgery.  So, your treatment choices may be limited to radiation (which I highly recommend over surgery when that choice can be made) and/or ADT (androgen deprivation therpay).

This, of course, assumes that the cancer, if you have any, is still restricted to the prostate and has not migrated elsewhere in your body.  In this case, your only choice may be ADT and chemotherapy but you will have no idea what you are dealing with unless and until you have a biopsy and other cancer detection tests done 1st.

So, you just need to relax and take the time to research the problem. 

There is ALOT of info that you need to know and you have the time to find it.  Prostate cancer is generally NOT an aggressive cancer but you won't know if yours is aggressive or not unless you have several PSA tests available to measure your "doubling rate" and a biospy to know what grade of cancer you have. 

We survivors can help you some but you will need to do more of the research yourself in order to make an INFORMED choice about what needs to be done. You should get started doing that NOW!!!

 

 

 

nihongo1st
Posts: 3
Joined: Nov 2015

Thanks to all for the advice and feedback.
I have decided to first get a pca3 done. its noninvasive and reportedely can differintieae btween prostatitis and prostate cancer

http://patient.info/forums/discuss/should-i-have-a-prostate-biopsy--361246

From I have read itsa resonable consevrtiv test to detremie whether a biopsy is actually necessary. It is not yet approve by the FDA but is avilable, if you wish to pay out of pocket

It involves didgital massge of each lobe of the prostae then cathing a sample of urine and sending to the lab>
after thats done, I'll get back to all of you who were kind and cocerned enough to respond to me, and urge caution.

Thanks very much! we shall talk soo,,,

hopeful and opt...
Posts: 2218
Joined: Apr 2009

 

https://labtestsonline.org/news/120323pca3/

FDA Approves PCA3 Gene Test to Aid Decisions about Repeat Prostate Biopsies

 

March 23, 2012

FDA has cleared for marketing a molecular test that may help reduce the need for repeat biopsies and their associated complications for men with previous negative prostate biopsies. The new prostate cancer gene 3 (PCA3) assay is the first urine-based molecular diagnostic assay approved as a decision aid for possible prostate cancer. PCA3 is a protein produced only in the prostate gland, a walnut-shaped structure in men that is below the bladder. This test, which has been available in Europe for several years, measures the urine level of PCA3 messenger RNA (m-RNA), a signal from genes that tells the prostate to produce the PCA3 protein. Increased amounts of the m-RNA (over-expressed) are produced by 95% of prostate cancer cells.

The PCA3 test does not provide a definitive answer as to whether a man has a cancer or not. A positive biopsy remains the gold standard in diagnosing prostate cancer. Rather, the test is intended for use in men 50 years of age or older who have high prostate-specific antigen (PSA) values and one or more previous negative prostate biopsies for whom repeat biopsies would usually be recommended. Prostate biopsies can sometimes have false-negative results, leading to the need for repeat procedures.

The recently approved test compares the amount of PCA3 messenger RNA (m-RNA) to the the level of PSA RNA in the first urine sample collected after a digital-rectal examination (DRE). Labs report a score based on the ratio of PCA3 RNA to PSA RNA called the PCA3 score. Doctors consider the test results in conjunction with other laboratory and clinical data to determine the likelihood that a repeat biopsy will be positive.

In a multicenter study of the test's performance, 49.6% of 466 subjects had PCA3 scores less than 25. Of these men, 90% subsequently had a negative biopsy result, while 10% had a biopsy positive for prostate cancer. Of the 235 men with PCA3 scores over 25, 34% had positive biopsies and 66% had negative biopsies. The results suggest that scores less than 25 indicate decreased likelihood of a positive repeat biopsy result, so patients with such scores might consider delaying repeat biopsies.

The PCA3 test may help doctors and their patients with elevated PSA levels make decisions about care related to possible prostate cancer. These choices are often difficult and confusing. Although PSA can help detect cancer, there are sometimes false-positive results, and major health organizations disagree on the usefulness of PSA for prostate cancer screening. Biopsies used in follow-up to positive PSA results to diagnose cancer can cause discomfort, anxiety, and sometimes complications. Their accuracy depends on the number of tissue samples and the sites from which they are taken. Concerns over missing clinically significant cancer may prompt additional biopsies. As the PCA3 test gains wider acceptance, it may aid some men and their doctors in decisions about their future care.

Old Salt
Posts: 720
Joined: Aug 2014

I agree with the other posts stating, in essence, that a biopsy is the appropriate test for you at this time. But as I wrote earlier, the high PSA result needs to be confirmed.

Regarding a biopsy, do some searching to find a urologist who is recommended. It should be an almost painless procedure; it was for me!

 

PS: an MRI-guided biopsy is 'state of the art' but may not be readily available (and would be, I guess, considerably more expensive).

nihongo1st
Posts: 3
Joined: Nov 2015

http://humanevents.com/2013/08/06/what-to-do-if-you-have-a-high-psa-score/

I wish they would allow an mri before insisting on painful biopsies. Docs seem to love procedures...

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3229
Joined: May 2012

 

Compared to surgical removal, the pain and discomfort of a prostate biopsy is nothing (I have had both).  Undoubtedly, a biopsy is even easier than long-term (fractionated) radiation, which can require going for treatments every day for months (IGRT,  IMRT), whereas a biopsy is over in about 30 minutes, and might hurt for a day or two.  Even if you were to receive an MRI today, it would not be conclusive in determining whether or not you have prostate cancer, and could not be used to justify a prostectomy or other treatments.  Your PSA is vectoring (as indicated by your doubling-rate) very rapidly.  

I agree with every word written by Swingshift above.  Note well that, as he stated, you are at or above the age at which surgery is the recommended line of attack. There are undoubtedly exceptions to this.

I would get a biopsy sooner rather than later, but that is just the way I do business.  Among medical tests, a prostate biopsy is relatively cheap. I do not recall the specifics, but it may be no more expensive than a CT.  Compared to the costs of surgery or other treatment modalities(radiation, drugs), the cost of a biopsy is a trifle.

Doctors use tests out of thoroughness, and because administering tests is cheaper than defending against malpractice lawyers, and less emotionally stressful than facing mourning family members after a patient has died.

max

hopeful and opt...
Posts: 2218
Joined: Apr 2009

In my case where I have had five biopsies, I have found that it is not the worst experience. The prostate is numbed before the cores are taken, so any discomfort is minimized; for some of the biopsies that I had, I experienced no pain at all....you want to make sure that at least 12cores are taken (which is fairly standard). I usually have some discomfort, not pain for an hour or two afterward...I don't, but some take a tylenol. The next morning I go about my usual business.

After the biopsy there can be some blood in the urine for a day or two, and in semen up to a couple of weeks.

Additionally, although it is not recommended and in my opinion not necessary, I know only one guy out of all the guys that I know (which are considerable ) who have had biopsies,  who was put under for the biopsy.

You really need to have this biopsy. It can save your life.

At any rate, I agree with Max, have the biopsy sooner than later.

 

PS Swingshift is 101 percent correct that surgery is a very poor choice for a 73 year old. The side effects of the exact same competent surgery for an older preson can be great, while non existant for a younger person.

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