Hope some of you guys can help me with this. My husband has been taking Flomax for a couple of years now for BPH (BHP?) and having PSA tests every six months because of high levels. He underwent a biopsy a few years ago which was negative. His last PSA test showed levels of 15 (the previous one was 10). We are now awaiting the results of his second biopsy. So here are my questions:
1. Have any of you ever had (or heard of) PSA levels of 15 that did not turn out to be cancerous?
2. If the results do show cancer, does surgery usually follow quickly or does it depend on the grade and stage? I'm asking this because we have a trip to Las Vegas planned in about six weeks and my husband insists that he is going to put off any surgery until after that (which I think is stupid and dangerous).
3. What kind of books/websites can I read to learn what I need to in order to support him emotionally and understand what he is going through? Even if the test is negative, he is convinced that the fact his PSA levels are increasing means he will get cancer eventually. From other posts on this board, I made a note of the American Cancer Society prostate cancer support group called Man to Man and a book called "Dr. Patrick Walsh's Guide to Surviving Prostate Cancer." Would those help me understand what he is going through? (He's not likely to read the book and definitely won't go the support group route).
4. After reading some of the posts on this board, I am now concerned that maybe he actually had cancer which the first biopsy needle missed. Do you know of times that actually has happened? And if so, did it mean the treatment had to be more aggressive?
I would really appreciate any help you can throw my way. I'm trying to remain calm for his sake but am having nightmares about his dying and am freaking out about it. Thanks!

I am brand new here and not an authority but I want to tell you a bit about my situation. I am 48 and a psa of 8.5 was detected during a routine physical, I have been having minor sporadic sypmtons of bph for about a year and did not realize it until getting the results of the elevated psa, finding this site and upon adivce from this site purchased the Walsh book. You can have elevated psa without having cancer, but you do not have elevated psa unless there is some sort of disorder with the prostate. Get the book it goes into detail in an easy to read manner. A negative biopsy is not a gaurantee of no cancer, you will understand more about this from the book. There is another psa test called 'free psa' which can give an indication of cancer/no cancer. We are all different in our reaction to emotional stress you know best how to support your husband but one thing is sure you both need to be well educated about the disease. Get the book, search this forum and post questions, thats what I have been doing and I feel better about it already. Best Wishes to you both. Scott

As Scott said, a PSA can be high with no cancer, but it does indicate some sort of problem with the prostate.

As for treatment (surgery is not always the only option) the DRE, Gleason score and stage are tools you use to make that decision. If this second biopsy does not turn up anything and the PSA continues high, the "free" PSA is another test that can indicate cancer - a score under 19% would indicate further investigation. Also, there should be NO sex, bike riding, heavy physical acitivity in the prior 72 hr before the blood is drawn for the PSA and the DRE should be AFTER the blood is drawn.

Best wishes.
Major

1. PSA of 15 does not necessarily indicate PC. Other factors like inflamation, infection, and enlarged gland can affect PSA. The suggested "free PSA" test is often used. For a PSA number to be meaningful, the gland size needs to be factored in as this will be contributing at least to some extent to the high PSA.

2. As mentioned here, surgery is not the only option. The grade and stage could influence your decision and timing. Some PC's are small and slow growing, some are obviously more agressive.

3. The books by Dr Walsh and Dr Scardino are very informative. They are top surgeons. Surgeons usually lean towards surgery. Another very good comprehensive book is "Prostate Cancer Prevention and Cure" by doctor Lee Nelson who had PC himself some years ago.
Some websites are;
www.prostate-cancer.com , which has a good treatment guide
www.yananow.net , which has information and stories from lots of men who have used various treatments.
www.urology.jhu.edu/newsletter , which has interesting articles including some by Dr Walsh over the years.

4. Biopsy can miss a cancer. Some years ago, only six samples were often taken, but most now use 10 or 12 whch is over 90% accurate. A tumor can still be missed, which usually indicates that it's small. It does not necessarily mean that the tumor or treatment is more agressive.
Biopsy readings are subjective, and what looks normal to one doctor could look suspicious to another. Some people obtain a 2nd opinion from another institution, as you could be basing form of treatment on the reading.

5. CHOOSE A TOP DOCTOR, as this will have a huge influence regardless of which treatment you ultimately select.

John

Thanks for this posting John, I will be checking out the sites referenced Scott

In my case I had 3 separate biopsies which were negative, and my psa kept climbing. My urologist then recommended a "saturation biopsy" in which they put in the hospital and while under anesthesia, take many tissue samples of the prostate (I think around 50). Well, he found it then with 16 positives. During that time my psa had risen to 15.95, and I had the RP with no follow up therapy such as radiation. The prostate gland was 40% cancer with a positive margin. Wouldn't you know it....psa started slowly but consistently rising again; 0.23 last month. I went to Mayo Clinic yesterday for another opinion; they suggested radiation, and I now have an appointment with a radiation oncologist at the end of the month. One other note for anyone's future reference....it is the policy of the doctor I spoke with at Mayo to recommend radiation following RP if there are positive margins.
Gleason - 7 (3+4), T3a