It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Cancer: Prostate Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 03-20-2011, 08:37 AM   #1
Newbie
(male)
 
Join Date: Mar 2011
Location: OKC
Posts: 9
mark500 HB User
PSA anxiety

I do not have known prostate cancer. For this, I apologize for posting on this board to all that do.
Age 53.
My PSA has gone from 2.1 on 12/2008, to 2.8 on 11/2009. Now it is 3.5. Normal DRE.
I am going to repeat it in 3 months and if high, will see urologist for biopsy. It's difficult to stop the train once you start down this path.
I have read tons of material and know the problems with PSA and the risk of sitting on a high grade cancer.
What is frustrating is that autopsy studies have shown about 30-40% of men in their 50's that die from other causes will have prostate cancer in their prostate. Yet 40% of men do not die of prostate cancer.
Thus, if one has a low/int risk cancer, no one can determine if this cancer will kill you before you die of something else. Is it better to risk ED/incontinence for 30 years from therapy, or risk the fate of Dan Fogleberg?

 
Old 03-20-2011, 04:51 PM   #2
Senior Veteran
(male)
 
Join Date: Nov 2007
Location: Annandale, VA, USA
Posts: 1,730
Blog Entries: 3
IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
Re: PSA anxiety

Hi Mark,

Welcome to the Board, and no need to apologize! I'll insert comments in green in excerpts from your post #1.


Quote:
Originally Posted by mark500 View Post
I do not have known prostate cancer...
Age 53.
My PSA has gone from 2.1 on 12/2008, to 2.8 on 11/2009. Now it is 3.5. Normal DRE.
I am going to repeat it in 3 months and if high, will see urologist for biopsy. It's difficult to stop the train once you start down this path.
That pattern of increase is enough to warrant suspicion, but it could well be due to something other than cancer, such as benign growth, infection (perhaps waxing and waning), both, or both with a little cancer mixed in too.

Right off you can take some reassurance in the fact that you have two characteristics that suggest, if you do have prostate cancer, that your case is probably the lower-risk type. The first fact is that your PSA is well under 10. The second is that you are not seeing a rise of more than 2.0 in a year.


Quote:
I have read tons of material and know the problems with PSA and the risk of sitting on a high grade cancer.
You are not doing that. Rather, you are carefully and thoughtfully gathering key evidence and paying attention. That's exactly what you should be doing. Have you realized yet that prostate cancer is the slowest growing of the major cancers? Are you aware that virtually 100% of low- and intermediate-risk prostate cancer patients are alive in the US at the ten year point, and that 95% of even high risk patients are alive at that point? It's good that you plan to be tested again in three months, but you are on a sound course, not a rash one. Unless you are among an extremely small percentage of patients with deceptively mild-looking yet very aggressive cases - less than 1% of all cases, you have time.

Quote:
What is frustrating is that autopsy studies have shown about 30-40% of men in their 50's that die from other causes will have prostate cancer in their prostate. Yet 40% of men do not die of prostate cancer.
Actually the percentage found at autopsy quite closely lines up with your age. However, your figure of 40% is far too high. The vast majority of prostate cancer patients do not die of prostate cancer!

Quote:
Thus, if one has a low/int risk cancer, no one can determine if this cancer will kill you before you die of something else.
Fortunately, while true in the strictest sense that no one has a 100% clear crystal ball, the statement is misleading because we now have the technology to give a high odds forecast of how patients will do. We now know that "Active Surveillance" (AS) is very effective in allowing men to be treatment-free for a period, most likely for the rest of their lives, while catching cancer that is or becomes more aggressive in a timely enough fashion to allow an excellent chance for cure. We have also learned a lot about the factors that influence how a patient will do. (When I say "we", I mean the medical community, but I have no enrolled medical education myself.) I highly recommend the new book (August 2010) "Invasion of the Prostate Snatchers," by Ralph Blum and Mark Scholz, MD. Much of it is directed to men like you who are concerned and thinking about biopsies and possible treatment downstream.

Quote:
Is it better to risk ED/incontinence for 30 years from therapy, or risk the fate of Dan Fogleberg?
The great good news is that we now have a much better handle on whether that risk is worth taking for a particular patient. In the near future, I foresee that many thousands of newly diagnosed men will successfully pursue AS, while others, whose cases have been determined with high confidence to be more aggressive, will feel well justified in their decisions to have treatment rather than wondering if they could have done well without treatment. That should make whatever side effects occur more bearable.

Take care,

Jim

 
Sponsors Lightbulb
   
Old 08-18-2011, 02:12 PM   #3
Newbie
(male)
 
Join Date: Mar 2011
Location: OKC
Posts: 9
mark500 HB User
Re: PSA anxiety

Update:

PSA Value Lab Normal Range of Lab

12/04/2008 2.1 Lab A 0-3.5
11/18/2009 2.8 Lab A 0-3.5
03/04/2011 3.5 Lab B 0-3.1
05/23/2011 3.4 (.147 free) Lab A 0-3.5
06/15/2011 2.7 Lab C

PCA3
08/11/2011 20

PCA3 score ok, but data only evokes moderate confidence. Biopsy or not?

 
Old 08-18-2011, 09:10 PM   #4
Junior Member
(male)
 
Join Date: Jun 2010
Posts: 18
Mr.M HB User
Re: PSA anxiety

I am only a couple of years younger than you and my PSA numbers were in a similar range. I did not want to have a biopsy and was well versed in the same statistics that you are. I even looked at the various predictive tables and concluded that the odds against me having prostate cancer very favorable. After one Uroligist recommended a biopsy, I found another Urologist hoping to get a different opinion. Both told me that I should do the biopsy.

Ultimately I was diagnosed with Gleason 6 cancer that was upgraded to 3+4=7 with a tertiary 5 pattern. The interesting
piece of information I took away from all this is that my PSA of 2.9, although relatively low in risk allocation terms, was signifacantly higher than a normal 50 year old's PSA.

It's more likely than not that if you get a biopsy you will not be diagnosed with Prostate Cancer because at your age, with your PSA scores the odds are overwhelmingly in your favor. And, even if you were to be diagnosed, odds are that it would be a slow growing cancer that may not require treatment.

I went through this analysis before I underwent the biopsy. And further, I gave some consideration to the thought that even if I had cancer, since it was likely that it wouldn't affect me at all for at least 10 years, did I really need or want to know?

It's a dilemma that anyone in their younger years with a low but not normal PSA faces. I think the answer depends on how comfortable you are with uncertainty. I wish you the best with your decision. It's difficult because there's no "right" answer.

Last edited by Mr.M; 08-18-2011 at 09:15 PM.

 
The Following User Says Thank You to Mr.M For This Useful Post:
Baptista (08-19-2011)
Old 09-13-2011, 08:00 AM   #5
Junior Member
(male)
 
Join Date: Sep 2009
Location: Chicago
Posts: 47
mrmike2009 HB User
Re: PSA anxiety

Best of luck when you go for your PSA in September. I am 58 and about 6 years ago my PSA went from 3.something to low 5.something. At that time my internist told me to see a urologist which I did. He took another PSA and it had dropped to 4.something. After much consultation and thought I decided to watch my PSA every 6 months. After watching for 2 years I began to see a steady slow rise. After an 18 month period (3 PSA tests) and a continued slow rise (never above 4.x) I decided on the biopsy.

The results of the biopsy were negative for CA but positive for High Grade PIN. Unfortunately, like the PSA results, HG-PIN is only an indicator for CA and not a definitive result. They recommeded a second biopsy 3 months later. That one was positive for CA (10% of 1 of 12 cores 3+3 score). I made the decision to have robotic surgery and that was 2 years ago.

As was said above - every case is different and you need to weigh the pros and cons of your stress levels with the test results. My brother's PSA jumped up and he decided to have a test right away - negative.

I think you are doing the right thing - you are reading and learning and weighing your options. In addition, good doctors should give you both sides and then you can make up your own mind. The literature on PSA and Biopsy have been all over the place and so there is no right or wrong. Keep a close eye on it and come back to this board.

On a personal note, I came to this board after my surgery and was surprised by the openess and how helpful everyone was. Most of the people here are not "giving back" but are "giving forward" and sharing their experiences and knowledge. In additional, I found that there was very little in the way of "bad mouthing" people input. 99% of the responses I read provided helpful information and alternatives.

Best of luck and come back if you need more help.

 
Old 10-03-2011, 04:24 PM   #6
Newbie
(male)
 
Join Date: Mar 2011
Location: OKC
Posts: 9
mark500 HB User
Re: PSA anxiety

Latest PSA was 3.2. DRE remains non-suspicious. Urologist offered a biopsy or follow up in 6 months. I elected for a 6 month follow-up.

 
Old 10-03-2011, 05:13 PM   #7
Junior Member
(male)
 
Join Date: Sep 2009
Location: Chicago
Posts: 47
mrmike2009 HB User
Re: PSA anxiety

Sounds like a plan. One thing I noticed from your results. It looks like you are changing Labs where the PSA is done. One of the things my Urologist said was that he did not care if I got it done with him or with my Intern, the important thing was consistency and have it done by the same lab each time. Most likely changing labs will have a very minor impact, and often you can not help it, but at least with the same lab you rule out some of the variables. With me, my Internist changed lab a couple of years into my watching - so even with my vigilance, my lab was changed!

One other thing to watch with your results. One of my doctors (in Chicago - and one of the doctors that came up with the PSA results!) told me that he was concerned with the highs, but he was more concerned when the lows "march up". Keep an eye on things and keep getting tested each 6 months.

Before I forget - one of the factors of elevated PSA is sexual activitiy ... so just watch your activity a day or two before your test. Also, make sure they draw your blodd before the DRE as the DRE will stimulate the prostate and that can also cause an increase.

Keep in touch - Mr. Mike

 
Old 10-03-2011, 06:14 PM   #8
Newbie
(male)
 
Join Date: Mar 2011
Location: OKC
Posts: 9
mark500 HB User
Re: PSA anxiety

Thanks for the info. I did already check with the labs that I ran the PSAs. They use the WHO standardization, as opposed to the Hybritech standardization. (There can be a 10-20% difference between the WHO versus Hybritech assay.)
Interestingly, a degree of variation can occur between a single PSA serum sample depending on the brand of machine that it is run on. I am not sure what that percentage variation is, however. So I am using the same laboratory, However, I called the lab and found that they bought a new assay machine, the Siemens "Immulite 2000". Lol. The more you dig, the more complicated it gets.

http://www.mayomedicallaboratories.com/articles/hottopics/transcripts/2009/2009-10b-psa/10b-19.html

 
Old 10-08-2011, 10:06 AM   #9
Junior Member
(male)
 
Join Date: Jul 2010
Posts: 39
RBK1111 HB User
Re: PSA anxiety

All of us with Prostate Cancer live with an "uninvited guest". It gets your attention, trust me.

When diagnosed I became an "expert" finding most oncologists to be "selling" their preferred method of intervention. It was necessary to become educated in self defense. As a result, I elected AS over any invasive method.

How did I get here.

Short version. From around 1990 I included a PSA whenver completing blood work. Average PSA was 2.4. It rose to around 3.0 for the first time around 2000. I immediately had biopsies performed - all negative (good to know). All remained the same until around May last year when I recoirded my first 4.0. Again, back for biopsies, and this time a Gleason 6. Noteworthy and ironically, I did not see another 3 let alone a 4 since then and before beginning Avodart (which I elected to begin this year) which lowered my PSA to 1.8

My message - when in doubt go find out!!!!!


Best

Last edited by RBK1111; 10-08-2011 at 10:16 AM.

 
Old 04-05-2012, 06:16 PM   #10
Inactive
(male)
 
Join Date: Aug 2010
Posts: 689
Tall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB User
Re: PSA anxiety

You should understand that PSA fluctuates. The reading you just had is really no higher than the reading you had a year ago. Considering your low PCA3 score, you more likely have BPH going on. Have you had your prostate size checked with ultrasound?

Getting on finasteride has several benefits:
  • It shrinks your prostate and fixes any urinary symptoms you may be experiencing
  • It lowers any PSA that is due to BPH, so that future PSA increases are more specific to cancer
  • It prevents low grade prostate cancer
  • If you have prostate cancer, it makes it easier to detect
Since you seem to be very anxious about prostate cancer, it might be a good preventative measure for you.

- Allen

 
Old 04-06-2012, 08:48 AM   #11
Junior Member
(male)
 
Join Date: Sep 2009
Location: Chicago
Posts: 47
mrmike2009 HB User
Re: PSA anxiety

PSA as was mentioned before and I am sure you know is a stange beast. Clearly you are closely watching yours and if I remember you also changed labs. My PSA used to bounce around in the high 2's and then it junmped to the low 5's for 1 reading. My internist suggested I see a urologist which I did and they redid the PSA and it was in the mid 3's. He wanted to do a biopsy and we decided to watch it every 6 months (as it seems you are doing). It continued to bounce around in the 3's and it was not until it went up 3 successive testings in a row (18 month period) that I decided to get the biopsy. You can read back more about the issues with the biopsy (I posted on this thread before) and HI-GRADE PIN.

I also found out from one of the pioneers of the PSA tests - a doctor in Chicago - that he worries most - not about the peaks but when the valleys (when PSA is plotted) go up slowly. From what I see in your tests you have peaks and valleys and they both seem to be going up - but very very slowly.

To be honest I am not sure what I would do in your case - but I would clearly keep on a system of testing every 6 months and if the PSA goes up the next time or two then I think that would be my trigger for the biopsy. There maybe other tests you can have done (I have been out of the loop for a couple of years) before you jump to the biopsy.

In any case - stay in touch with the board as we all want to be there to support you. Good luck.

Mr. Mike

 
Closed Thread

Similar Threads
Thread Thread Starter Board Replies Last Post
What is the best I can expect rebelone Cancer: Prostate 76 12-05-2010 04:39 PM
PSA Re-Test Anxiety Howie63 Cancer: Prostate 10 08-15-2010 08:08 AM
Hormonal therapy side effects: likelihood, seriousness, countermeasures IADT3since2000 Cancer: Prostate 6 03-10-2010 04:57 PM
False alarms with ultrasensitive PSA test? laughagain Cancer: Prostate 4 10-16-2009 02:19 PM
Waiting For An Appointment Part 3 Howie63 Cancer: Prostate 2 08-28-2009 12:14 PM




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Join Our Newsletter

Stay healthy through tips curated by our health experts.

Whoops,

There was a problem adding your email Try again

Thank You

Your email has been added




Top 10 Drugs Discussed on this Board.
(Go to DrugTalk.com for complete list)
Casodex
Cialis
Cipro
Flomax
Levaquin
  Levitra
Morphine
Proscar
Tylenol
Viagra




TOP THANKED CONTRIBUTORS



Tall Allen (174), IADT3since2000 (148), Baptista (97), Gleason9 (28), harpman (27), Johnt1 (22), honda50 (9), tumbleweed (6), flyfisher37 (6), kcon (5)

Site Wide Totals

teteri66 (1180), MSJayhawk (1006), Apollo123 (906), Titchou (852), janewhite1 (823), Gabriel (759), ladybud (755), midwest1 (669), sammy64 (668), BlueSkies14 (607)



All times are GMT -7. The time now is 01:10 PM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!