There seems to be quite a wealth of information on this board. I was hoping some of you could share some knowledge in regard to my case.
I am a 44-year-old white male with no history of prostate cancer in my immediate family. I have no symptoms of any kind, and the five DREs I've had during the past two years have revealed nothing suspicious.
Biopsy date and results:
5/09 - negative
12/09 - negative, but area of PIN revealed
4/10 - negative
My urologist has suggested, at this point, that I don't have another PSA reading for another six months and consider Proscar or Avodart as medications.
I've decided to get opinions from a medical oncologist and another urologist within the next month after my records are sent to them, respectively.
Please do share comments or recommendations. The insight and courage displayed in some of the posts on this board are quite inspiring -- Thanks!
Welcome. Sorry to hear that you are having concerns which led you to this site. I’ll hope to provide some comments/answers that may be helpful. I’ve dealt with prostate cancer (PC) and have both read and experienced a bit about it along the way, and so I hope that my learnings might be helpful to you or others…but keep in mind that I’m no doctor.
The good news is that your doctor has not found PC in the several biopsy samplings that have been taken, plus you have no family history; the bad news is that there is a substantial percentage of men in the age group you are entering that do eventually get diagnosed with PC, and the PIN (Prostatic Intraepithelial Neoplasia) which was found (in only one of three biopsies, however) is often seen as a precursor of PC. So, you’ve got some possible very, very early signs that you might have to deal with the most common, and some say the most treatable, form of cancer found in men. It’s never too early to start learning about it, because an informed, empowered PC patient will make the best possible treatment decisions for himself when the time comes for decisions to be made. Not saying it’s a sure thing, but I’m only sayin’…
First, a comment on your PSA test results. Cancerous prostate cells produce PSA at 20X normal prostate cells…which is the basis of using PSA testing as a possible indicator of PC (but they say that PSA testing is not very “specific” for PC). Your results showed some “up and down” which means that something else (besides, or—I hate to say it—but possibly in addition to unfound/unsampled PC) is contributing to the elevated value. PC by itself won’t cause PSA go up and down in the pattern you’ve seen. A likely explanation could be prostatitis (prostate infection), which is treatable by antibiotics; usually a urologist will prescribe antibiotics to eliminate possible prostatitis contribution (has yours suggested this?). A couple other possible contributors worth quick mention: bicycle or motorcycle riding (something which “massages” the prostate) in the few days before a PSA test will cause a temporary rise, as will sexual activity in the preceding few days.
I might suggest that you look into having a “free PSA test” along with your next standard PSA test. PSA exists in the blood in two fractions, one bound to proteins (complexed) and the other in a free state. Benign prostate tissue contains more free PSA than prostate cancer tissue. Patients with prostate cancer tend to have lower free/total ratios, whereas men with benign disease have higher free/total ratios, except in the case of prostatitis. The American Urological Association suggests the “free PSA test” as a means for reducing the number of biopsies in men with PSA between 4 and 10 ng/mL. The percentage of “free PSA” above 20% or 25% is a pretty clear indicator of no PC, whereas below 7% or 10% usually indicates PC; in between those values has not been demonstrated to be so clear an indicator.
Online information is good, but I would also recommend investing $25 in a book (available at online booksellers) which is considered by many to be the “bible” on prostate cancer and it’s treatment. I recommend Dr Patrick Walsh’s “Guide to Surviving Prostate Cancer.” It’s never too early to start learning about something which is showing signs of being in your future.
I hope this helps...
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Adding this note later, as I realize I didn't address all your questions.
I've read that between 40% and 60% of men with PIN will be found to have PC on subsequent biopsy. Studies suggest that most patients with high and medium grade PIN will develop prostate cancer within 10 years (what "grade" was yours?). Therefore, the 6-month follow-up is typical.
Regarding "chemoprevention" using Avodart or Proscar, I have less reading experience and no direct experience, but my understanding is that there are clinical trials looking into whether PIN can be decreased, thereby preventing PC. Sorry, don't know much more about this.
kcon -- Thank you very much for your comprehensive reply.
I've scheduled appointments with a medical oncologist and another urologist, respectively, to get other perspectives. My urologist told me that my prostate size is 29. Unfortunately, I do have high-grade PIN. My urologist did not prescribe any anti-biotic treatment. Before my last PSA test, I did engage in sexual activity about 60 hours before the blood sample was taken.
My last biopsy was less than two weeks ago, so I'll have to wait a few months before I get another PSA reading, but I will have my free PSA measured along with the standard PSA.
I'm guessing that if my PSA doesn't significantly drop, then a "saturation" biopsy will be next, correct?
Last edited by Hope4Happines; 04-27-2010 at 04:58 PM.
Hope,
Your sitituation somewhat mirrors my own. My PSA started to rise 15 years ago and my 1st biopsy was done when it reached 4. I had a total of 12 negative biopies over 10 years as my psa consistantly rose to 40. A biopsy in Nov 2008 found a small core G6, 5%. I went to a prostate oncologist for a 2nd opinion, Dr Scholz, After reviewing my history he said that the cancer found on my biopsy was clinically insignificant and most certaintly wasn't the cause of my high psa. He said that I had significant PC that was possibly already in matastasis and most likely I had a large tumor that had yet to be uncovered. He ran a few tests and picked up something suspicious on a color doppler and referred me to Dr Duke Bahn for a color doppler ultrasound biopsy. Dr Bahn found a 16mm X 18mm G7 tumor in the transition that 12 biopsies and an MRIS had missed. The tumor was confirmed by a Combidex MRI which also showed that my lymphnodes were clear.
If psa keeps a steady rise and biopsies are negative and free psa is low then there is a high probability of PC. The place to look is in the transition zone or anterior, This area is very difficult to biopsy and when done is rarely done correctly unless it is done through the perienum. A good color doppler guy like Dr Bahn or Fred Lee have the skill to properly sample this area. Hope this helps.
According to Dr Strum, in his 40 years of treating PC, he has never seen a psa doubling time less than 12 years that was not eventually DXed as PC.
JohnT
A biopsy only three weeks ago will affect psa readings; not sure about free psa. Did he suggest a PCA3 test. I would make no decisions based on this psa; Is the oncologist a specialist in prostate Ca or just a medical oncologist?
*It's been six weeks since my last negative biopsy and two months since a PSA reading of 5.0.
*I just finished a three-week prescription of Cipro.
*I went for a PSA reading yesterday and the result was 3.6 (I’m still waiting for the free PSA percentage as this will take a few days).
*This PSA reading is a 1.4 drop from my last reading of 5.0.
I know a 3.6 PSA is still high, but does this significant drop indicate that the Cipro had an effect on some type of infection at play?
I'm coming late to your thread but thought you might want a response as your latest post has gone unanswered. I've read all the posts to date. I'll put some comments in green.
Quote:
Originally Posted by Hope4Happines
Quick update:
*It's been six weeks since my last negative biopsy and two months since a PSA reading of 5.0.
*I just finished a three-week prescription of Cipro.
*I went for a PSA reading yesterday and the result was 3.6 (I’m still waiting for the free PSA percentage as this will take a few days).
*This PSA reading is a 1.4 drop from my last reading of 5.0.
First of all, congratulations on that very nice drop in PSA!
I know a 3.6 PSA is still high, but does this significant drop indicate that the Cipro had an effect on some type of infection at play?
That could very well be the case. On the other hand, there is a possibility that the infection was unaffected by the Cipro and simply waned on its own. You have an up and down pattern for your PSAs, and that is typical of chronic prostate infections, as I understand it as a layman.
It could well be that you need more follow-up to totally defeat the infection. It could also be that you and your doctors will never pin down and totally eliminate the infection as they are known to be tricky.
Infections can also cause free PSA results to be low.
Any insight is always greatly appreciated.
While it seems likely there is some infection involved, there is a possibility that cancer is lurking there too. It's probably a small possibility in view of all your results, but it is worth remembering.
I like the suggestion of finasteride or Avodart by your urologist. Either drug will shrink the prostate somewhat, usually driving out the growth due to BPH. Gold standard type clinical trials, one for each drug, have demonstrated that these drugs have an impact against prostate cancer. Initial trial results indicated 23% prevention of PC for Avodart and 25% for finasteride, but the latter figure appears to have risen to about 30% based on longer follow-up and further analysis. I think it's likely the percentage for Avodart will also increase, for the same reasons.
Nutrition and other lifestyle tactics could also help you prevent or minimize prostate cancer.
Take care, and good luck with your next PSA. Hope that free PSA actually turned out to be high despite the apparent infection.
On the other hand, there is a possibility that the infection was unaffected by the Cipro and simply waned on its own. You have an up and down pattern for your PSAs, and that is typical of chronic prostate infections, as I understand it as a layman. 
