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PSA 10.50 Free PSA 2.20 as of 8/31/2018 Do I have cancer or prostate enlargement?

BLUEBIRD3291
Posts: 9
Joined: Sep 2018

2/29/2004 PSA Free PSA Free % Calc
1.9
6/14/2010 3.52
4/29/2013 5.59 H
12/4/2013 6.96 H
6/18/2014 6.93 H 1.55 22%
12/8/2014 8.31 H 1.87 23%
6/10/2015 7.44 H 1.68 23%
12/10/2015 9.07 H 1.81 20%
7/14/2016 7.79 H 1.80 23%
5/19/2017 9,65 H 1.92 20%
12/15/2017 9.52 H 1.87 L 20% L
8/31/2018 10.50 H 2.20 H
I am 73 years old from Taiwan. I have never accepted my urologist's advice to have biopsy since 2013. I am afraid to take MRI because of worrying about dye may damage my kidneys and liver. My urologist had not find tumor from his finger to examine my prostate via rectum. My family male members do not have prostate cancer. I do not drink and smoke. I have not eaten red meals for the past 15 years. I might take soy milk and almond milk too much to get risk of prostate cancer? I stop to take them now. My urologist told me in December, 2017 that I either have prostate enlargement or cancer. Which one I get?

BLUEBIRD3291
Posts: 9
Joined: Sep 2018

My urologist answered me that value of Free PSA will be considered for the risk of cancer only if the patient has token biopsy. Therefore, my Free PSA 2.20 high will not be used to evaluate the risk of cancer for my PSA 10.50 because i have never taken biopsy. However, i still do not understand the relationship between PSA and Free PSA and under which conditions Free PSA will be used to estimate the risk of cancer? Why the lab. did not calculate "Free % Calc" or %PSA because my PSA > 10 ?

BLUEBIRD3291
Posts: 9
Joined: Sep 2018

almond milk contains 20% of vitamin E. Too much vitamin E will cause prostate cancer. Does almond milk and soy milk will cause prostate cancer?

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3256
Joined: May 2012

Bluebird,

The title of yor thread is "Do I have Cancer or BPH ?"

You shared that a previous biopsy was positve, so you definitley have prostate cancer, since this cancer never goes away without curative treatment (surgical removal or radiation).  You may or may not also have BPH.

No broadly accepted studies hold that lots of vitiman E "cause" PCa.  I'm not saying that no studies suggest this, just that it is not broadly accepted.   Diet in general has nearly nothing to do with the emergence of PCa either, and neither does smoking or drinking alcohol.

Close relatives with PCa is an indicator, but even that guarantees nothing.  PCa strikes vegans as often as it does bacon addicts and chain smokers.

max

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

hi, mr. bluebird

only a biopsy can say for sure if you have cancer in your prostate. i understand your concerns about having an MRI, but if you have an MRI, the results may show that there's no need for a biopsy, because it may not C any lesions [spots]. if the MRI does show lesions, then you can have what is called a MRI targeted biopsy. this type of biopsy will only target the specific areas that were seen during your MRI. unfortunately, i can't speak on the other areas of concerns you have. i hope this was of help to you.

Tech70
Posts: 52
Joined: Nov 2017

I have had two biopsies one with two cores positive Gleason 3+3 and one with one core positive Gleason 3+3.  All positive tissue less than 10% of the core.  As part of the information gathering to decide whether to folow active surveillance, I had a 3T multiparimetric MRI which showed "no lesions of concern."  I am following AS protocol as my cancer is in the very low risk category, further confirmed by geonmic testing of the biopsy samples.  My point being that PCa in the form of microfoci may not show up on an MRI, but you can still have cancer.  Biopsy is the gold standard for PCa diagnosis

Georges Calvez
Posts: 229
Joined: Sep 2018

From those results I would guess that you have a low grade cancer but there is a good possibility that you do not.
PSA is OK for screening for cancer, it really does not tell you much after that.
The only way to find out is the usual palaver of MRI and a biopsy and I cannot stress how much you should have this done.
It will give you peace of mind or catch your cancer in the early stages.
I would guess that the treartment for you if you have cancer will be watchful waiting or a relatively noninvasive treatment, maybe radiation and hormones.
You are 73 and if your PSA continues to rise at the same rate you could be a 100 before you hit 50 so in all likelihood dead from other causes like 97% of men with prostate cancer.

VascodaGama's picture
VascodaGama
Posts: 2969
Joined: Nov 2010

Blue,

 

Your PSA histology shows continuous increases. This is typical in cancer cases. The PSA with ups and downs (similar to a seesaw movement) is typical in Benign Hyperplasia (enlargement of the prostate). In BHP the PSA also increases but it got periods of decreases.

Surely only a biopsy can tell you what's behind the increase. In your shoes I would get it done for peace of mind. The procedure is simple and done in outpatient. The doctor will provide anesthesia and pain killers for later so that you will feel nothing.

Best wishes for a negative to cancer outcome.

VG

BLUEBIRD3291
Posts: 9
Joined: Sep 2018

I have refused to accept my urologist's advice to take biopsy since my PSA rising in 2013. My medical group's MRI centers have two kinds of MRI, one is “3-tesla MRI scanner, the Ingenia Elition 3.0T” and the other one is “3-tesla MRI scanner, Siemens Verio 3T” located at two different cities, apart 25 miles. Which MRI is better? They injects Gadavist to every patient. The staff calculats “6.5 ml of Gadavist from my weight 141 lb and 4.8 oz. My urologist answers my question regarding side effective and damaging on kidneys and liver from Gadavist “I have had hundreds of patients undergo prostate MRI with no problems. My recent samples, 7/30/2018 9 ml of Gadavist, 7/30/2018 8 ml of Gadavist”. Anyone has rare serious side effective from Gadavist? I read a book published by a Japanese doctor who had been trained at a US medical school and has used radiation to treat his patients in Japan for many years. His advice in the book is that no treatment for high cancer because the cancer will be back to kill the patient no matter how and what the treatments. He consider low cancer is not a cancer which will not kill the patient. Comparing to treatment or no treatment for high cancer patients, their survive time are closing but the patients will have much suffer and pain after treatments and no treatment patients will have much less suffer and pain. Is that true? My Chinese professor in New York found prostate cancer and received treatments at age 80. He died two years after from heart attack.

VascodaGama's picture
VascodaGama
Posts: 2969
Joined: Nov 2010

Bluebird (蓝 鸟)

I wonder how much has that book affected your reasoning but the true fact is that many people around the world have done radiotherapy to cure cancer successfully. Surely many have not benefited as much but there are not many other options if one wants to get cured.

In any case one needs firstly to find out if cancer exists, and where it is located. Contained cases can be dealt with surgery dissecting the whole gland. In the presence of spread then radiation, hormonal or chemotherapy are the most recommended treatments. Without a proper initial diagnosis no one should get involved in a therapy.

Both MRI you describe above have the same capability in detecting prostate cancer. However, both also got limitations in finding small size tumours. Anything that is less than 6 mm may not be shown on the image. The MRI exam can be done without a contrast agent (ex; Gadavist) but the results would not be so descritive. Gadavist is not recommended to patients with Kidney disease above grade 4. The half-life of Gadavist is approximately 7 hours meaning that your body gets rid of the stuff in one day.

The best diagnosis for prostate cancer should involve several tests and exams such as the PSA, DRE, MRI, Bone scan, biopsy and symptoms. From these multiparametric data the doctor will ponder and deliberate a clinical stage which becomes the basis to choose a treatment.

The grade of cancer described in the book refers to the level of aggressivity of the cancerous cells. Aggressive ones are more prone to spread so that they are more difficult to get killed, however, the success of the therapy do not depend on the aggressivity of the cancer but on the extent of the spread. In other words, without a biopsy to find the level of aggressivity of the cancer and image studies to find the extent of the spread, no one knows if a treatment is worth do it.

If you are in good health, at 73 years old you still can afford any type of therapy. After 75, surgery may not be recommendable. Older guys that got low aggressive contained cancer may opt for doing nothing and those with indolent types of cancer may prefer to follow a palliative approach using hormonal drugs.

I was diagnosed with PCa in Japan in 2000. That followed surgery in Tokyo. The Japanese medical system is highly regulated and professional. You can go there (3 hours flight) for consultations and diagnosis if you do not trust the doctors in Taiwan.

I was in your country several times years ago and found that holistic treatments are prevalent, in particular at the Wanhua District. Holistic is in my opinion not the best choice to get cured.

Best wishes,

VGama

BLUEBIRD3291
Posts: 9
Joined: Sep 2018

I am in California, USA and I moved to USA from Taiwan in 1972. My urologist is a white American. He indicates that my total PSA is slowly rising and my free PSA is up and down, like a curve, since 2013. For these low and high prostate cancer patients, what are their total PSA, free PSA and %PSA within 5 years period? If it is low cancer, biopsy or MRI may not detect it?

Georges Calvez
Posts: 229
Joined: Sep 2018

I have had three shots at this: two with iodine and one with gadolinium and I am still here but I had and have excellent kidney function.
On a scale of one to ten contrast MRI are not a bad medical procedure, there is a lot worse in the medical foot locker!

Old Salt
Posts: 720
Joined: Aug 2014

As mentioned earlier, only a biopsy can show cancer. And since you don't want to undergo an MRI exam, the choice is easy as to what to do if you want to pursue your question.

I wouldn't worry about almond and soy milk. Their relationship to prostate cancer is speculative. 

Finally, a DRE can only examine a part of the prostate. Therefore, a negative DRE doesn't prove that there is no cancer.

VascodaGama's picture
VascodaGama
Posts: 2969
Joined: Nov 2010

The typical cut off threshold level used by doctors to judge prostate cancer from a "percentages free PSA" result is between 15% to 20 %. That means that higher percentages may not be related to cancer. In any case, the quantity of %fPSA also depends on the volume of epithelial cells at the prostate gland. Small glands got lesser number (higher %) and big glands got higher number of cells producing more PSA, which turns the free PSA as a not so trustful marker to identify cancer. Another means used by doctors is to calculate the density of the PSA but one needs to know the size of the gland.

If you intend to avoid a biopsy, you can try crisscrossing the data from other biomarkers that are used in the PCa diagnosis by some doctors, such as;

PCa3 (genetic analysis of cells in the urine)
PAP (prostatic acid phosphatase)
CEA (Carcinoembryonic Antigen)
NSE (Neuron Specific Enolase)
CGA (Chromogranin A)
PHI (computer generated Prostate Health Index–pro-2PSA)

Surely these (like the PSA) are just informative data to formulate a judgment (for instance, when the PSA is high, there is no hyperplasia and the 12-plated biopsy is negative). However, in the end one needs to confirm the judgment via a stained piece of the prostate tissue and analyze it under the microscope.

You need to find a doctor you trust. You can also use a medical oncologist to oversee your process in the diagnosis, or consult another urologist friendlier to your wishes.

Here is a link about the relationship between total and free PSA;

https://www.verywellhealth.com/percent-free-psa-2782266

Best,

VG

Georges Calvez
Posts: 229
Joined: Sep 2018

It would be great if we could find a single strong factor apart from the genetic ones of family relationships and race and age that would cut the incidence of prostate cancer by a big percentage, but we have not.
Every adult male would take a diet supplement every day like folic acid or avoid doing something and bang, down by thirty per cent but it does not exist.
Drinking, smoking, diet, etc seem to have no effect or an effect that could be no more than statistical noise.
The best we have is testing to catch it and treat it early but there is the bugbear of over treating where patients that could have been safely left have painful and unneeded treatments.

Clevelandguy
Posts: 427
Joined: Jun 2015

Hi,

Only a biopsy will tell you if you have PCa, You will need a biopsy to confirm if you have cancer.  Throw your family history, what you eat or don't eat, ect. out the window as a predictor.  An MRI will tell the doctor where to take the biopsy samples at.

Dave 3+4

lighterwood67's picture
lighterwood67
Posts: 185
Joined: Feb 2018

In my opinion, no decision on treatment is a decision in itself.  Coming to terms with what to do about this cancer is a process in itself, but one that must be done.  To ask us if you have prostate enlargement or prostate cancer is a question your doctors should be answering.  We are not doctors.  At this time we are survivors, that can give you our first hand experiences when dealing with this cancer.  This is one of the best sources of information that you will find.  Above Max says you had a positive biopsy.  So you need to move on, curative, pallative, or wait and see what happens.  I will be 68 this month.  Gleason 4+3= 7.  Radical prostatectomy 3/20/2018.  I am still here.  You can look up my surgical procedure and post op pathology on this site.  Good luck on your journey.

BLUEBIRD3291
Posts: 9
Joined: Sep 2018

How many days you make your decision on Radical prostatectomy from first date you find your prostate cancer? There are a lot side effective on Radical prostatectomy. There is a statistics on internet to indicate percentage of side effective on Radical prostatectomy from major prostate surgery centers in United States. Some are high and a few are low. The more educated people the more suspicious and they are not totally trust their doctors. I am one of them because I earned my master science degree from one of New York universities long time ago. The academic training make me much suspicious and I do not fully trust what my doctor told me.

lighterwood67's picture
lighterwood67
Posts: 185
Joined: Feb 2018

My wife and I researched and studied case studies for around 6 months.  We got opinions from Surgeons and Radiology onocologists. Actually, talked to RP and non- RP folks.  In my case, common side effects:  incontinence; erectile dysfunction.  Fact:  surgery is permanent.  My choice was based on what the doctors told us.  Results:  At this time, my PSA is undetectable; the incontinence is 99% gone away; I am intimate with my wife.  Basically, Gleason 4 + 3= 7 means to me, tumor is more likely to grow and spread than a 3+4=7 tumor, yet not as likely as a Gleason score 8 tumor.  If you read a good bit on this site, you will see some folks that analyze until they are paralyzed (unable to make a decision).  The best thing to do is study this cancer.  Find doctors that you trust; make a decison.  To me, the most helpful research was actually talking to the folks who have been treated surgically and then people who have been treated hormonally; radiation; and and chemo. There are many options.  This decision is yours.  Looks like you are studying your issue.  Good luck on your journey.

Georges Calvez
Posts: 229
Joined: Sep 2018

So now we cut to the chase.
How many positive cores did you have, have you had any other scans to find out haw extensive the tumour is and its location.
Glaeason 4 + 3 is very treatable, it is possible that you could have a robotic prostatectomy with nerve sparing, few months and you will be almost as good as new; erections, orgasms without the nuisance of shooting semen everywhere! :-)
Certainly better off than a lot of others on these boards

BLUEBIRD3291
Posts: 9
Joined: Sep 2018

Get cancer treatment at these cancer treatment cancers.
The Nobel committee awarded American doctor James Allison and Japan doctor Tasuku Honjo with the 2018 Nobel Prize in Medicine. In its announcement, the Nobel committee pointed to the wide-spread effects of cancer and lauded the two doctors for their “discovery of cancer therapy by inhibition of negative immune regulation.” Allison, the committee said, studied a protein at MD Anderson Cancer Center that functions as a brake on the immune system and developed the concept into an approach for fighting cancer. Honjo, a professor at Kyoto University, also discovered an immune cell protein that acts in a similar braking manner, although with a different action.

“By stimulating the inherent ability of our immune system to attack tumor cells this year’s Nobel Laureates have established an entirely new principle for cancer therapy,” the committee said in a statement.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3256
Joined: May 2012

Bluebird,

As with the two Nobel winners you mentioned, advances against cancer are happening all the time. Unfortunately, the trickel-down from discovery to implimentation for usage as an FDA-approved therapy is long and slow.  People in need of a new option think that the FDA should move really fast, but people who have used a new, maybe experimental option and who got serious side-effects, or even died, think that the FDA should have moved much slower. And this latter group has a million lawyers calling them on the telephone, wanting them to sue. So it is a dilemma, always moving back and forth.

I heard a doctor say once on TV that the reason cancer has not been cured yet is that cancer is not one disease, it is thousands of diseases.  Just in Lymphoma, there are over 60 variants of the disease recognized by the World Health Organization (WHO). Drugs that will kill one verison are worthless against the others.  We all long for the "Next Big Thing," but most advances are not what drug company marketing departments, and research university press releases, claim.

There are around 250 FDA approved chemotherapy agents today-- same thing.  Most of these, when new, where the next big thing.  What will cure one disease, has no effect on most others.  New discoveries, and what they will or will not do, takes years, and in some cases even decades, to sort out.  New massive computer software is shortening this wait time, but it is still not something that happens overnight.   Patience is what is most necessary in this game,

max

Georges Calvez
Posts: 229
Joined: Sep 2018

This is interesting and may form the basis of future therapies but it is not as far as I know relevant to current frontline therapies for prostate cancer.

 

Old Salt
Posts: 720
Joined: Aug 2014

Allison's research has led to the drug Yervoy (ipilimumab) which is used against (metastatic) melanoma

and Honjo's research has led to both Keytruda and Opdivo.

When these cancer drugs work, the results can be amazing. Unfortunately, they don't work for many patients. The reason(s) are being investigated, obviously.

To my limited knowledge, these drugs haven't been successful to fight prostate cancer, but I am by no means sure about that.

I am reasonably sure that other drugs based on the same concepts are being developed.

 

BLUEBIRD3291
Posts: 9
Joined: Sep 2018

Your MRI exam may possibly involve the use of an endorectal coil, a thin wire covered with a latex balloon, placed inside the tail end of the large bowel, called the rectum. The rectum is located inside the pelvis immediately behind and up against the prostate gland. New 3T MRI does not require an endorectal coil which is too big to have great chance to damage the patient's rectum. Usually, MRI center may have old MRI and new 3T MRI. You may be referred to old MRI or 3T MRI depending on your health insurance and your urologist's referral.

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