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Newbie - high PSA

Posts: 1
Joined: Dec 2016

Recently I had dificulties urinating and went to see an urologist.

The doc took urine and blood samples and measured prostate volume (by DRE).

Results: prostate volume 5.1;

Urinalysis: some red cells and white cells, but no infection or bacterial culture.

PSA = 22 (this is my first-time PSA).

Doc put me on Flomax and Cipro for three weeks and scheduled biopsy for first week of Jan. He said the high PSA may be due to inflamation (given I have white blood cells), but cancer is highly possible. On my question what should I expect as possible treatment options if biopsy confirms cancer, he said "likely surgery - you are 49, too young, prostate should come out"...

This is so unexpected. Trying to not get too depressed, but the more I read about high PSA the less hope I have that this is something benign and non cancerous..

VascodaGama's picture
Posts: 3299
Joined: Nov 2010


I am sorry for the situation. I hope you find the reason causing the elevated PSA. The DRE is not that accurate for estimating the gland volume or justify the urination problem. Maybe your doctor was trying to verify possibilities of existing benign hyperplasia that could be behind the high PSA. In any case, if diagnosed positive by the biopsy, you should firstly investigate on all possible treatments, about their risks and side effects before deciding on an option. Surgery is not better because of your young age. In fact young fellas have more to loose than the older and such choice may lead to worsen quality of life. Surgery is also not the best treatment if the patient has already an advanced status. Any available option should be decided on due/proper diagnosis and after consulting several specialists (second opinions). The family will also be affected so that one should inform and discuss the matter together.

I was diagnosed with prostate cancer when young at 50 years old. The diagnosis process was also triggered by a high PSA of 22.4 (my first PSA) but I had no urination problem or any other symptom. I was fit and this was found at the routine annual health checkup.
At the time (in 2000) I knew nothing about prostate cancer and thought the tests and exams were erroneous. The biopsy come out positive to cancer and that took me to high levels of stress. I was scared.

Today I look into the problem very differently. I am more educated on the matter so that I know what to expect and manage the time to prepare myself for confronting the next step. In your shoes I would try reading on the matter while awaiting for the biopsy results. If positive, then you should do extra exams such as a bone scintigraphy scan and a MRI to try locating the bandit. With these evidence data in hand then you should consult various specialists to gather opinions and suggestions. Urologists usually recommend surgery as much as radiologists recommend radiotherapy.  The treatment of choice should be the one you and your family feel most comfortable with.

Here are links that may help you in understanding things;



Best wishes,



Posts: 1013
Joined: Mar 2010

Hello Art:

The following is a duplicate of a message that I've posted elsewhere on the forum which lays out your basic choices for treatment.

It reflects my personal biases and the treatment I recommended may not apply to you, but the message lays out all of the treatment choices that are available. 

Of course, it's too early for you to make that choice now but this information will give you to a foundation upon which you can do further research and make the decision that's "right for you" if it is determined that you have prostate cancer,


 . . . People here know me as an outspoken advocate for CK and against surgery of any kind.  I was treated w/CK 6 years ago (Gleason 6 and PSA less than 10).  You can troll the forum for my many comments on this point.  Here are the highlights of what you need to consider:

 1)  CK (SBRT) currently is the most precise method of delivering radiation externally to treat prostate cancer.  Accuracy at the sub-mm level  in 360 degrees and can also account for organ/body movement on the fly during treatment.  Nothing is better.  Accuracy minimizes the risk of collateral tissue damage to almost nil, which means almost no risk of ED, incontinence and bleeding.  Treatment is given in 3-4 doses w/in a week time w/no need to take off time from work or other activities.

 2) IMRT is the most common form of external radiation now used.  Available everythere.  Much better accuracy than before but no where near as good as CK.  So, it comes with a slightly higher risk of collateral tissue damage resulting in ED, incontienence and bleeding.  Unless things have changed, IMRT treatment generally requires 40 treatments -- 5 days a week for 8 weeks -- to be completed.  I think some treatment protocols have been reduce to only 20 but I'm not sure.  Still much longer and more disruptive to your life than CK but, if CK is not available, you may have no other choice.

 3) BT (brachytherapy).  There are 2 types: high dose rate (HDR) and low dose rate (LDR).  HDR involves the temporary placement of rradioactive seeds in the prostate.  CK was modeled on HDR BT.  LDR involves the permanent placement of radioactive seens in the prostate.  1/2 life of the seeds in 1 year during which time you should not be in close contact w/pregnant women, infants and young children.  The seeds can set off metal/radiation detectors and you need to carry an ID card which explains why you've got all of the metal in your body and why you're radioactive.  Between HDR and LDR, HDR is the better choice because with LDR, the seeds can move or be expelled from the body.  Movement of the seeds can cause side effects due to excess radiation moving to where it shouldn't be causing collateral tissue damage -- ED, incontinence, bleeding, etc.   Both HDR and LDR require a precise plan for the placement of the seeds which is done manually.  If the seeds are placed improperly or move, it will reduce the effectiveness of the treatment and can cause collateral tissue damage and side effects.  An overnight stay in the hospital is required for both.  A catheter is inserted in your urethra so that you can pee.  You have to go back to have it removed and they won't let you go until you can pee on your own after it's removed.

 4) Surgery -- robotic or open.   Surgery provides the same potential for cure as radiation (CK, IMRT or BT) but which MUCH GREATER risks of side effects than any method of radiation.  Temporary ED and incontinence are common for anywhere from 3-12 months BUT also sometimes permanently, which would require the implantation of an AUS (artificial urinary sphincter) to control urination and a penile implant to simulate an erection to permit penetration (but would not restore ejaculative function).  Removal of the prostate by surgery will also cause a retraction of the penile shaft about 1-2" into the body  due to the remove of the prostate which sits between the interior end of the penis and the bladder.  Doctors almost NEVER tell prospective PCa surgical patients about this.  A urologist actually had the to nerve to tell me it didn't even happen when I asked about it.   Don't trust any urologist/surgeon who tells you otherwise.  Between open and robotic, open is much better in terms of avoiding unintended tissue cutting/damage and detection of the spread of the cancer.  Robotic requires much more skill and training to perform well; the more procedures a doctor has done the better but unintended injuries can still occur and cancer can be missed because the doctor has to look thru a camera to perform the surgery which obstructs his/her field of vision.

 4) You may also want to consder active surveillance (AS), which is considered a form of treatment without actually treating the cancer.  You just have to get regular PSA testing (usually quarterly) and biopsies (every 1-2 years, I believe) and keep an eye out for any acceleration in the growth of the cancer.  Hopeful and Optimistic (who has already posted above) has already mentioned this and is your best source of info on this forum about it. 

I personally could not live w/the need to constantly monitor the cancer in my body.  Like most other men, I just wanted it delt with.  Some men gravitate to surgery for this reason, thinking that the only way to be rid of it is to cut it out, but I did not like the risks presents by surgery and opted for CK, which is a choice I have NEVER regretted.  I am cancer free, there is no indication of remission, there were no side effects and my quality of life was never adversely affected.  Other men on this forum have reported similiar results.

So, for obvious reasons, I highly recommend that you consder CK as your choice of treatment.  The choice seems obvious when you consider the alternatives but you'll have to decide that for yourself.

 Good luck!

Posts: 650
Joined: Jun 2015


You have to meet with your doctors(oncology & urology) and review all the tests to see if you are better served by radiation or surgery.  Urologists like to do surgery & oncologists like to do radiation.  Each path has its benbefits & drawbacks(side effects).  Only you can make the decision based on the facts and consults with family & doctors. Don't let anyone sway you in one direction or another, it your choice.  I feel that a MRI followed by a biopsy is a good starting place if they think it's cancer.  The doctors I delt with were all top notch and basically left the choice up to me. Lot's of options, lot's to think about.  Good luck on your journey.




Rakendra's picture
Posts: 198
Joined: Apr 2013

New to prostate cancer is like being new to investment.  There are lots of investment advisers, many of whom are looking out for their interests which may not be the same as yours.  Doctors are no different, and ARE business men.  If you want to keep your money or your health, you must learn to make your own decisions, and many people with any kind of cancer have lived to regret decisions made by listening to the advice of the Medical Community.  Ask anyone who has been subject to the poisons of Chemo.  The vast majority of my friends have said they would not do it again.  And this can be said of any medical procedure involving Cancer.  The good news is that if you have to have cancer, Prostate is a good choice.  You have plenty of time to make decisions.  If you do not take lots of time time to educate yourself, you will make mistakes that you will regret.  On this board there are many posts regarding books by the top doctors that you will need to read and study before you make any decision.  True, there is so much information on this board that it is difficult to get thru it all.  The suggestion is that you need to spend many hours in research before you go ahead with any procedure.  Certainly, a biopsy would be a good first step.  Then take lots of time and study before you go further.   Get advice here from the guys who have been there and done that.

        My contribution to the board has mostly been involving positive atitude and acceptance.  I totally believe that a negative atitude will feed the cancer and take away your peace of mind and quality of life.  An accepting, loving atitude will bathe the body in positive vibration that heals and gives quality of life.  I beleive that everything that comes into my life is for my benefit.  You have a lot of work to do - both spiritually and medically.  Good luck in your new adventure.  It is only negative if YOU chose to make it that way.

Love, Swami Rakendra - All ways living love, living love always


Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3580
Joined: May 2012

The best post ever written at this Board....

Rakendra's picture
Posts: 198
Joined: Apr 2013

I love you Max, you always make my day.  I wish a very special Christmas season for you.  Your spiritual life is a boost for all to share.  Thank you for the great Heads Up.  It is wonderful when board members support each other.

Love, Swami Rakendra

Will Doran
Posts: 207
Joined: Sep 2015

Swami, Max & All

Amen, Amen, & Amen.

Love, Peace and God Bless


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