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Old 01-24-2009, 03:24 PM   #1
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New Member: Worried and Confused!

Hi ! Thanks for being here...I need some advice ! I'm 59 and was healthy (!) until the digital exam, when my Doc told me I have a "pea sized lump" on my prostate. My PSA was negligable and has been for years. I've had mild, typical symptoms ( slow pee, hard to start, night pees etc) for a few years but no indications during yearly check ups. I'm waiting for an appointment with a Urologist, but have a lot of questions, as I'm sure all of you have experienced. What I really wonder is, if the "pea" isn't cancerous, what is it ? I understand benign lumps occur, but am I deluding myself, hoping for this ? If my PSA shows nothing, does that count ? If a noticeable lump has developed over a year, is this a fast growing tumour ?
I must admit to being surprised at my situation and of having thoughts of my early demise. My Mum died of breast cancer complications and I've always feared some type of cancer would get me, too.
With thanks, Scub

 
Old 01-24-2009, 08:09 PM   #2
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daff HB User
Re: New Member:Worried and Confused !

Quote:
Originally Posted by Scub View Post
...my Doc told me I have a "pea sized lump" on my prostate. My PSA was negligable and has been for years. What I really wonder is, if the "pea" isn't cancerous, what is it ? I understand benign lumps occur, but am I deluding myself, hoping for this ?
...
While it's difficult not to be concerned, the best thing you can do is visit a urologist to see what he says-- from what I've read, such lumps are just normal tissue greater than half the time. The doctor may want to do a biopsy there just to be sure. Since you've been getting routine exams and your PSA has not been increasing, that points to your getting good news. I don't know if you're on medications such as Flomax, but this, and others, can help relieve the other symptoms you've mentioned, so that's something else you can discuss with the urologist.

 
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Old 01-24-2009, 11:34 PM   #3
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Re: New Member:Worried and Confused !

Hi, Scub,
I have checked this log often during the past four months. I have found the experience and knowledge of men like Daff helps with research from books and inquiries with doctors. I have read the PSA occasionally gives false positives (resulting in unnecessary biopsies) and false negatives (resulting in false reassurance and delayed diagnosis and treatment). Although the bean counters in the US worry about the expense of unnecessary biopsies, the PSA has helped substantially with improved diagnosis in the past twenty years. So it is important, but imperfect. Some improved tests are still on the drawing board, the doctor needs to get all the help he can from the PSA--including consideration for level relative to patient's age, the velocity of any rise (looking at least three tests over two years) and density (considering relative size of prostate). I read they were considering lowering the level cut off number from 4 to 2.5 because the PSA was missing giving early detection in some cases. I read one article that reported anything above 1 indicated a possible problem. Norman Schwarzkof (our retired general) was your age (as I recall) when diagnosed with prostate cancer. His PSA was 1.9. His doctor was suspicious of the lump discovered on the digital exam. The biopsy confirmed the cancer. I read someplace that the PSA level is a good predictor for the prognosis. I guess some super sensitive PSA exams exist, but are not routinely given. The PSA-free test is more commonly done. A percentage above 25% is encouraging (suggesting the urniary problems are more likely due to benign cell growth); a percentage below 10%.The prognosis is, also, probably better when men pursue the information and help that you are seeking. So I have learned to have resprect for the PSA--a "low" score and a slow pace of increase might still be related to cancer in the early stage (the stage when the treatments have super high rates of being effective).
Benign cell growth can cause those urination problems as the cells grow inward constricting the urethra. Medication, as Daff suggests, can help with this.
If the urologist looks at the PSA tests and the DRE findings, he may suggest a biopsy. Even if that reveals cancer, you are getting answers and help early. The doctor will be able to give you information regarding treatment options and prognosis that reduce those fears of an "early demise." I have a family history of cancer (not prostate cancer, but I have alerted my son that he is in a higher risk category now that I have prostate cancer). I had a low PSA and a peanut sized lump on the prostate. I am not expecting an early demise. I have too many unfinished projects. Your being in good health and seeking help with this suggests any fears (although natural) will be relieved as you work with your doctors.
Dale2035

 
Old 01-25-2009, 08:40 AM   #4
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Re: New Member:Worried and Confused !

Thanks for posting replies. I really appreciate your time and your thoughts help a lot. I'm still confused about this PSA thing but realize it's only a part of the process. If the Urologist confirms there is a lump, I'll be a little uneasy if it isn't sent for a biopsy...I'd like to be sure ! It's been a week since I had the digital exam and it was only last night that it all really sunk in. I'd spent quite a while reading info and found all the percentages of survivability etc. were making me feel rather low. I'm glad you confirm I'm on the right track and will try to be optimistic. I expect the way I feel is pretty typical. Things like this have always happened to someone alse and it's rather surprising to find yourself at the forefront !
I have a new prescription for Flomax, but as an afterthought, wondered if I should hold off starting until I see the Urologist. I doubt that Flomax would mask the lump in any way, but don't really want to complicate matters. I've had major low back surgery and long term complications and always thought my pee symptoms were related to my back. I'm on a chronic pain "patch" (Fentanyl) and thought all the odd sensations etc were from nerves being numbed (?) and so I was quite surprised to find the truth.

With Thanks, Steve

 
Old 01-25-2009, 09:23 AM   #5
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Re: New Member:Worried and Confused !

Quote:
Originally Posted by Scub View Post
... I'd spent quite a while reading info and found all the percentages of survivability etc. were making me feel rather low. ...
I have a new prescription for Flomax, but as an afterthought, wondered if I should hold off starting until I see the Urologist. I doubt that Flomax would mask the lump in any way, but don't really want to complicate matters.
...
Steve- I'd like to address a couple of your comments. Since your doctor prescribed Flomax, why not give it a try. It often takes up to a week before it kicks in to help. It would be good to know if that does (or does not) help, so you can get further advice from the urologist. I know that right now you're feeling pessimistic about things-- but you've got a lot going for you. The main thing is the early detection, so if it is a problem, you've caught it early. It's way too soon for you to try to second guess what this lump is, but as I said before, having a little lump doesn't mean that it's cancerous. If it is though, you've got lots of choices that you can use to successfully treat it.

 
Old 01-25-2009, 12:16 PM   #6
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Re: New Member:Worried and Confused !

Thanks, Daff. Your comments make me feel a lot better. I'll start the Flomax tonight. I'm concerned, though, as my prescription has the dose at twice daily, while the info enclosed with the pills states the dosage at one a day. Maybe if I take the two, I'll "Flow" like a horse ! I guess that would beat standing like a statue, listening to the clock tick and hearing my wife calling "WHAT are you doing in there" while I try to mentally trick things into emptying ! And you are right, it will let me see if some of my symptoms are BPH, rather than my "pea" lump.

Again, Thanks ! Steve

 
Old 01-25-2009, 01:18 PM   #7
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Re: New Member:Worried and Confused !

Quote:
Originally Posted by Scub View Post
...I'll start the Flomax tonight. I'm concerned, though, as my prescription has the dose at twice daily, while the info enclosed with the pills states the dosage at one a day.
...
About two weeks into my two month course of proton radiation treatment (a targeted form of external beam radiation) I developed a need for Flomax-- and started at one per day but quickly went to two per day. Once my treatments were complete, I was able to go off the medication entirely (about 2-3 weeks after treatment was finished). If you have concerns about the twice per day use, you could either start with one or just follow what the doctor prescribed. Maybe you want to call the doctor's office and check to make sure that's what he/she wanted you to take (it's not always easy getting through to doctors directly, but you can usually leave a message and speak with a nurse or assistant if need be).

 
Old 01-25-2009, 02:51 PM   #8
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Re: New Member: Worried and Confused!

Hi Scub,

You've had some really fine replies from daff and Dale, so I'll just address a few points in green that you raised and that haven't been specifically covered yet, using an extract of your first post. Jim


Quote:
Originally Posted by Scub View Post
... I'm 59 and was healthy (!) until the digital exam, when my Doc told me I have a "pea sized lump" on my prostate. My PSA was negligable and has been for years.

A low and stable PSA is a good thing, of course! As Dale mentioned, it's nice to have a PSA of around 1 at your age as a suggestion that problems with BPH, prostate cancer or infection/inflammation are not present. Based on research involving Dr. William Catalona, MD, one of the foremost prostate cancer surgeons and researchers in the US, PSAs of .9 for men in their fifties and 1.4 for men in their sixties are the median (average) PSAs of men with no evidence of prostate cancer. (I assume that's based on biopsies and other evidence.) For men with PSAs for their age group at or below those values, the risk of prostate cancer is "very low." For you at age 59, I suppose the key value would probably be around the 1.0 to 1.1 range. For those men with PSAs above the median for each age, risk of prostate cancer is somewhat above average, though, if your PSA is close to the median, the risk, while above average for similar men, is still pretty low.

I've read some of the research advocating that a PSA of 2.5 is a better threshold of concern than the old 4.0. Dr. Catalona is the chief advocate of that viewpoint, and because he is so highly regarded (a regular featured speaker at urology conventions), his view has been influential. Personally, as a layman but a savvy layman, it looks to me as if lowering the threshold will pick up approximately another 2 1/2% or so of prostate cancer - significant, but not game changing in my view.


I've had mild, typical symptoms ( slow pee, hard to start, night pees etc) for a few years but no indications during yearly check ups.

While it's possible that cancer can cause those symptoms, by expanding and pressing on the urethra, it's a lot more likely they are due to BPH - benign enlargement.

...
What I really wonder is, if the "pea" isn't cancerous, what is it ? I understand benign lumps occur, but am I deluding myself, hoping for this ?

I see the likelihood as daff sees it. As to what the pea could be, there are a number of causes, such as benign calcium stones in the prostate.

If my PSA shows nothing, does that count ?

Yes, that is a good negative clue, but it is not the whole story. Much of the time a low PSA suggests the absence of cancer, or at least the presence of only a mild case of prostate cancer, caught early. Very rarely, less than 1% of the time as I understand it, there will be a strange type of prostate cancer that gives off very little PSA yet is very aggressive. It's hard not to think we are at ground zero when we have nightmares about the possibilities, but the odds are extremely high against such a scenario. Quite aggressive, more normal prostate cancers can also often give below average levels of PSA, but they still produce some and are not likely to fly below the radar.

If a noticeable lump has developed over a year, is this a fast growing tumour ?

While that's possible, it's far more likely that you are like the vast majority of men whose doctors find lumps where there were none the year before: something benign as described above, or a detectable but mild case of prostate cancer caught early.

I must admit to being surprised at my situation and of having thoughts of my early demise. My Mum died of breast cancer complications and I've always feared some type of cancer would get me, too.
...
Your reaction sure sound normal and typical! Fortunately, prostate cancer is one of the slowest growing cancers, and we have an abundance of ways of controling or curing it for almost all of us. Our situation is quite a bit better than that of breast cancer patients, in my opinion. Only about 3% of prostate cancer patients will die of the disease, and that figure is very likely somewhat high as it is based on history - it has a certain lag behind current understanding of the disease and tactics. Maybe some other type of cancer will get you, but it's unlikely to be prostate cancer. By the way, two respected urologists at major cancer-treating institutions told me in early 2000 that, because I had a challenging case (at the time looked like an extraordinarily challenging case), I would probably die in five years, after three good years and two declining years with the disease. (They sugar coated it some, but that was the bottom line.) Yet it's now 2009, and I'm going strong with the cancer under reasonably good control. (The doctors weren't negligent, but they were just not aware of certain new tactics, and to their surprise I turned out not to have widespread metastases (or any that were detectable). And, there have been substantial advances in knowledge of prostate cancer since then! )

Sometimes a little knowledge can really ease our anxieties. When I was in grade school, probably around age 10 or 11, I learned about appendicitis and I worried whether certain pains I felt might be it. Well, when I found out that the appendix was on the right side, I not only stopped worrying about supposed discomfort on my left side, but about all the discomfort. In fact, most of the discomfort vanished!

We may yet admit you to our exclusive club (prostate cancer survivors), but at the moment you just don't have the credentials!

Good luck, take care, and keep your cool,

Jim

 
Old 01-27-2009, 09:03 AM   #9
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Scub HB User
Re: New Member: Worried and Confused!

Thanks for your comments, Jim and Daff. You've helped me understand things a bit better. And you are right...this is a club that nobody wants to be a member of. But it's nice of you to share your experience and I bet there are other people reading all the posts.
I lost a whole day yesterday. I took my first Flomax before bed and awoke to a terrible gum, tooth and head ache, combined with nausea. I spent the day planted in an armchair, unable to do anything much. I feel a bit better today, although I still have a wee headache and a slight feeling, like flu, of nausea. I guess Flomax is not going to work for me..good thing I have a hundred bucks worth of pills now, apparently wasted! I don't know if those symptoms would decrease after a day or so, but I felt close enough to fainting to not want to continue.
On the brighter side, I have an appointment with a Urologist on this Thursday. I'm quite surprised to get in so soon as we have government health care and you hear so many tales of long waits. I live in a rural location, but have a decent sized hospital about 40 minutes away and a great local heath team. The Urologist moved a "less urgent" appointment to allow me in earlier. It's nice to know the suspense won't go on much longer. I feel fairly calm now I'm armed with your information and from what I've read elsewhere. But I still feel rather shocked to be facing this, my welcome to the real world, perhaps ?
Thanks again, Steve

 
Old 01-27-2009, 11:08 AM   #10
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shs50 HB User
Re: New Member: Worried and Confused!

Hi Scub:
Hope you're not overwhelmed by all the good info but thought I could add two thoughts: First when I was interviewing prominent prostate surgeons after my biopsy and diagnosis ( obviously I'd decided surgery was the treatment for me after my urologist pushed radiation with seeds) the first surgeon said he felt a hardness on the left side of my prostate so he would not attempt to spare the nerve on that side. The next 3 surgeons who gave me a digital rectal exam felt nothing and when it was all over, my surgery that is, there was no extra-capsular penetration, the cancer was organ confined and I'm fine 8 years later. The moral is that the first opinion or exam is simply that---the first opinion. When you see a urologist or prostate surgeon the exam will be given by a much more experienced finger and may not necessarily agree with the first. If something is detected then a biopsy would certainly be appropriate regardless of your PSA.
My second thought agrees with Daff. I'd be very cautious about using Flomax without a definitive diagnosis of BPH (Benign Prostate Hyperplasia). Flomax has 2 significant drawbacks: 1 By shrinking the prostate and suppressing PSA it can mask Prostate Cancer. 2. Most of my friends who took Flomax stopped it because it made their breasts swell and caused irritation.
If there is a suspicion of possible prostate cancer it should be ruled out before treating urinary symptoms with Flomax or anything else.
Keep in mind that prostate cancer rarely if ever presents with urinary symptoms and is usually first suspected by PSA changes or a digital rectal exam and then detected or ruled out by a biopsy. While biopsies are not always conclusive due to false negatives, they are the only means of detecting prostate cancer conclusively when positive.

 
Old 01-27-2009, 02:37 PM   #11
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Re: New Member: Worried and Confused!

Thanks, SHS50. A very informative note ! I'm happy to know you're going strong after 8 years. My first thought after finding I had a lump was "how long do I have". I realize that sounds silly and uninformed now, and that's exactly what it was..uninformed. I was a bit confused after leaving the Doctor about the lump and Flomax at the same time. My apparent intolerance to Flomax has stopped that experiment and I certainly don't want big breasts ! I'll talk to the Urologist about my pee situation, which is mildly annoying, but not as worrying as the lump. I'm surprised at the choices you've had to make but perhaps that is something I'll be finding out about soon. I'm still hoping that this is something benign, but if there is a lump, I sure hope I get a biopsy! I don't want to be wondering about this indefinitley.
Thanks for your thoughts, I appreciate your time.

Steve

 
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