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PSA trending up What should I do?

bobz
Posts: 2
Joined: May 2017

I a 70 year old guy who PSA is trending up.  6.1 in February.  My GP recommend I see a Urologist.  Yesterday he said I had a "firmness" on one side.

He recommended a biopsy.   Do I really need to do that?

I do not have frequent need to pee,  never have to get up at night.  I don't belive the prostrate is enlarged..atleast no one has told me that.

I've read several places that surgery, if cancer is confirmed, is not often beneficial to people my age.

I have also read the biopsys are not risk free, 20% or so have infections or other problems relating to the biopsy.

So evan if the biopsy confirms cancer (25% I've read) but treatment is not recommend...why do it???

Should I wait, keep getting PSA tests and getting pysical exams (for enlargement , more "firmness" etc).  This seem the prudent route to me.

What do you think?

Thanks in advance.

 

 

Old Salt
Posts: 720
Joined: Aug 2014

Yes, it is my humble opinion that a biopsy is appropriate since you reported that your PSA is trending upward. The 'firmness' that the urologist mentioned is subjective, and it is my impression from (Internet!) reading that it is unreliable to predict cancer. But the PSA readings are not subjecive and that's what matters most right now.

You bring out some biopsy statistics. Why don't you ask your urologist for HIS statistics, especially the one related to infection. 

Finally, even if the biopsy reveals the presence of cancer, surgery is by no means the only way to address it, but it's way too early to discuss that issue. In the meantime, relax, and be advised that we do have accumulated a lot of knowledge on this forum that we are more than willing to share.

VascodaGama's picture
VascodaGama
Posts: 2927
Joined: Nov 2010

Bobz,

You are absolute correct on the assertions above. Why diagnose something that may only cause problems?

However, it all started from the reason that took you along the years to test the PSA. You have been screening for a health condition that should be addressed if found anomalous. This is what your GP has found and now he is just proceeding to the next step; a biopsy.

Continuing with the screening without a definite result is senseless. The PSA doesn't guide further on the issue, just informing that something is happening (benign or cancerous). The positive DRE ("firmness" on one side) is also limited but highly suggestive of a more aggressive condition. You are asymptomatic but the condition could be more critical if any cancer in fact exists and that have spread away from the prostate. As commented by Old Salt above, there are several treatments which include benign or cancerous situations that you should care before the problem develops further.

I wonder about your fitness at the age of 70 or any other illness you may be confronting. We believe to be fit till something occurs and start accepting occurrences under the disguise of the "old age". Surely many prefer to continue life as usual doing nothing, but accept to die when the body can't respond anymore. However, one may avoid such suffering via a treatment.

The next step is to know the reason for the findings by the GP. A biopsy is invasive but you can get also a diagnosis close to 100% via sophisticated image studies that would always be required in future if in a positive biopsy senario. These are non invasive and can provide a clue on the situation. Choline based PET and MRI exams are more reliable than the traditional bone scan, CT or MRI, in particular when the PSA is lower than 10 (yours is PSA=6.1 ng/ml). The multi-parametric magnetic resonance imaging (mpMRI) has become sort of standard and is practiced at big PCa institutions.

Please read this;

http://www.medicalnewstoday.com/articles/274625.php

In any case, a biopsy is the best and simple way to analyze your condition and is not so invasive as many comment. I did it and felt no pain or found post effects. Surely you need to know what is happening. Whatever you decide, the result will give you peace of mind.

Best wishes.

VGama

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3181
Joined: May 2012

bob,

A biopsy is extremely low risk for any side-effects. Possibly slight bleeding for a day, a bit of pain or soreness. Infection ?  You are a lot more likely to get an infection (cold, flu) riding on a train or jet.  And if you got an infection from the biopsy, it would be easily fixed.

You say you've heard that "surgery would not be good at your age."  So, if the biopsy is positive, don't have surgery. Have radiation or Active Survellance instead. Fact is, most surgeons are hesitant to do a prostectomy on someone over 70 anyway, at least unless you are in exceptional cardiac health.

max

 

Old-timer's picture
Old-timer
Posts: 196
Joined: Apr 2011

I endorse what VASCO, OLD SALT, and MAX recommend. I underwent a biopsy 26 years ago and do not recall that it was very painful. Learning that I had prostate cancer was an unpleasant thought, but I continue to enjoy life at the age of 91. Best of luck to you.

Jerry

bobz
Posts: 2
Joined: May 2017

I did not have the presence of mind to ask the Urologist the questions I put to you.  I will ask him this next week

You inputs have give me a better perspective.

Thanks to you all! 

Clevelandguy
Posts: 390
Joined: Jun 2015

Hi,

I think I would request an MRI with dye first to help guide the urologist during his biopsy samples.

Dave 3+4

GeneRose1's picture
GeneRose1
Posts: 64
Joined: Aug 2016

Bobz, A 6.1 PSA means "something". What was your last PSA and when did you have it done? How fast a PSA climbs or doubles can tell you a lot about how dangerous that cancer is. The PSA is the canary in the coal mine and I highly recommend you get a biopsy and if it turns out to be prostate cancer, follow it up with an aggressive course of action (radiation, surgery, Hormone-blocking therepy - you can read all about that right here in this forum). For several years, I had pretty high PSAs in the range of 4.5 - 6.5. We did nothing. Once it hit 7.4, I got a biopsy and, within a month, surgery to remove my prostate. Since then, the cancer has made several return appearances and has now spread to my spine and pelvis. I often think that if I had gotten the surgery or some other form of treatment one or two years earlier, I wouldn't be in the jam that I'm in right now. Take care and all the best.

GeorgeG
Posts: 127
Joined: May 2017

My viewpoint is that first you should ask yourself , what would I do if they confirm cancer? If the answer is nothing then why put yourself through more potential bad news and anxiety. Some patients/doctors/countries don't even do PSA tests after a certain age because most prostate cancers are slow growing and there are other competing moratlity issues for many older men. A man that lives until 85 has a very high chance of dying with, but not of prostate cancer. Please keep in mind though that if you decide to ride it out, by the time you would have strong symptoms if it is cancer, there are treatments to help you manage your condition but it is unlikely to be cureable at that point. It may be the right decision for you but just think it through. 

However, if you are otherwise healthy with no significant competing mortality risks (likely to live into your 80's) and you are both mentally and physically capable of tolerating treatment and you understand the side effects vs the likely outcome then you should consider being treated. My father underwent a major cancer operation at age 87 but he was amazingly strong for his age (fought in two wars, worked construction for 40 years), tolerated the operation well and lived for many more years.

A high and rising PSA is a red flag but not enough information to decide what you have and what if any treatment is appropriate. They may also want to see how fast it is rising, what your history or baseline was and what your free PSA is. A biopsy is the standard of care at this point and there is some risk of side effects but they are pretty low. If you would not seek treatment then again maybe, you should not proceed because even a low risk of side effects would make no sense but if would decide to get treated if its cancer then its a small risk as part of the process to live a normal life expenctancy. There are a few new options. A Tesla 3 endo rectal coil MRI with contrast is the first prostate image technology that can provide imaging that is useful at this stage and can help determine what you have. They can then use that image to join (fusion biopsy) with the guided biopsy to make sure that they sample the most suspicious areas to confirm. After the 3T MRI you can decide if you want to proceed to biopsy depending on what they find. I paused at this point myself but my doctor impressed on me that no doctor at a major facility would treat me without the biopsy confirmation (at least for now) so I proceeded. Some pain, some bleeding but it was not bad for me. The first few ejaculations are a little unerving (bloody) but that clears up as well. There are cancers that are slow growing and not agressive and may be suitable for watchful waiting and there are more aggressive, more advanced cancers that have to be dealt with quickly to have a chance at a good result. There are also some benign explanations for a rising PSA. Again, without further testing you don't know where you stand. If you decide to get further information and if cancer is confirmed then there are many options. Surgery, radiation, freezing, sound waves, etc. Some are more suited for older men that may have some health issues.

I was 61 when I was diagnosed and I have an advanced form of the disease that does not have the greatest outlook but I am otherwise very healthy with literally no known additional medical issues. I did the 3T MRI with contrast, a fusion biopsy, radical prostatectomy (surgery) and now hormone therapy and radiation. An 81 year old friend of mine developed a high PSA but opted to do nothing because of his age and other health issues. Sadly he passed last year and as expected, it was not from prostate cancer so in that regard he made the right call.

One of the best things that you can do is do some research and select really good doctors so that you get good, well informed advice. If you like to read, get Patrick Walsh's book or Balentine Carter's book (he did my surgery). Both books are excellent.

Good luck to you, I hope this helps.

Swingshiftworker
Posts: 1013
Joined: Mar 2010

I agree w/the others above.  Get the biopsy. 

That's the only way you'll know if you have prostate cancer or not.  Just note that you could get a false negative result and still have cancer even if it doesn't come up in the biopsy.   But, if you get a positive, then you'll know and can decide what to do if anything at all about it.

Yes, there is a risk of infection and bleeding but problems are generally rare.  That's not to say that your biopsy can't "go bad" -- it can -- but it's the only choice if you want to know whether you've got it or not.

As GeorgeG notes above, you could just avoid the decision and hope for the best.  Of course, the worst case is that you've got it and that it progresses quickly and by the time you realize it, it'll be too late.

Most men get a biopsy when presented w/the choice.  But, it your life and your choice.

Good luck! 

GeorgeG
Posts: 127
Joined: May 2017

Another thought. My wife and I have unfortunately have a ton of experience with cancer and various doctors/hospitals (ourselves, family, close friends etc.). Given the type of questions that you are asking, we have found that the best places for open minded opinions that explain both sides of your choices and have the most up to date study data to help guide you are the research hospitals and even better if the doctors are on salary. If you have access to such a place (Mayo, Hopkins, MSK, UCLA, Northwestern, etc.) you have a much better chance of getting a very informed recommendation that considers your age, health status, etc before giving you a recommendation based on extensive study data. They have tables that summarize the outcomes for thousand of patients and can give pretty accurate estimates as to your outlook. Some patients don't find that type of stark info helpful but it sounds like you want to know where you stand. Take a look at US News and World Report and their annual hospital rankings for Urology. and also for cancer. We have found the top places to be excellent. If you decide to get treated, make sure that the doctor has done a bunch of them. My surgeon has done over 4,000 operations and while the number does not need to be that high, make sure its hundereds.

 

Best of luck and treat every day like a gift.

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