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Old 11-14-2012, 11:06 AM   #16
Pratoman Pratoman is offline
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Join Date: Oct 2012
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Re: Rising PSA, need guidance on next move

pdate -
I had my appointment with Dr Spencer today at Columbia University Allen Hospital. Basically what i expected and same as what my original urologist told me, but a bit more upbeat.
Said that based on the rising PSA and family history, i should do the biopsy. I scheduled it for November 28th.
But he also said, that while he can't guarantee or say anything is for sure, he would be surprised if the biopsy would find any cancer. But better to do it. They will do a 12 point biopsy. He said that even if they do find cancer, he would expect it would be a very "small amount". I asked him how many he has done, he said probably over 1000. He spent part of his career at Memorial Sloan Kettering prior to Columbia, and he is a Urologic Oncologist, which i guess is more specialized than a Urologist.
Also said that when someone in their 50's tests for a PSA of .7, which i did about 5 years ago, (have my dates a little mixed up) it has been shown in large studies that there is a much lower chance of finding a cancer in the future.
I felt very very comfortable with him, he had a personality and was very patient, he answered all my questions and spent about 40 minutes with me one on one. Combined wtih the fact that he is part of a well known Urology Dept, i am going to change to him as my urologist, at least for this issue, so he will do the biopsy. When asked if there is a difference, between doing it with him and locally, on Long Island, he said the biggest difference is the Path lab that they have at Columbia.
Last thing, he did mention if something was found, they would discuss options, and mentioned that they have been doing a lot more watchful waiting / active survellliance these days. (and he does surgery for a living). Which surprised me.

Only thing that bothered me - he did a retake of the PSA, with an understainding that the lab is different so the result might be different. Said that if it were to drop to say, 1.5 or some similar significant drop, which he doubts will happen, then he would advise me to wait on the biopsy. But he doesnt expect that to happen, after two weeks. He did say he has seen fluctuations all over the place though so anything can happen and he wanted to be thorough. But the only thing that bothered me is that a i realized after i got home, that the PSA bloodwork was taken ABOUT 20 MINUTES AFTER he did a DRE.
btw also told me that after the DRE that my prostate was relatively small for my age and he felt no abnormalities.
I'll get the PSA results tomorrow (another thing i like about having them with in house lab.

So now i have to just wait two weeks (assuming PSA is not down) to get the biopsy over with. I could have had it done next week, but i would rather wait until after Thanksgiving.
Thats where I'm at.