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Old 03-25-2011, 01:58 PM   #1
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Real or False

New to the boards, I hope I do not have to hang around this particular board but If I do there seems to be quite a few that I will be able to relate to and visa versa.....

I am a 57 y.o. white male in pretty good shape and am active as well. Had my annual physical 2 weeks ago. Everything was fine with the exception of the PSA test. Came back at 5.2. One year ago it was 1.2....Primary doctor suggested I visit a Urologist which we have set up an appointment for 4-4-11. I have no problems or symptoms that I have read about on line. From time to time I do have a slow urine stream but no waking at night to go. No pains in belly or area. No problem with intercourse as well. I am anxious to see what the Urologist has to say. Hopefully we will have another PSA blood test before a biopsy..as that sounds really bad......One thing my wife reminded me or is that we did have sex 10 hours before the blood work. While I have read that that sometimes may cause a jump I do not see as to where it could jump that high, but then again as I have read stories of a test being in double digits.... Figured my wife told me that so I would not worry, let's hope she is right.........look forward to your comments. Hope to report back with the next appointment in a couple weeks....

 
Old 03-25-2011, 03:02 PM   #2
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Re: Real or False

Hi OldSalt and welcome to the Board! Hopefully you will be just a temporary participant. I'll put some comments in green in an excerpt of your post #1.

Quote:
Originally Posted by OldSalt53 View Post
... Had my annual physical 2 weeks ago. Everything was fine with the exception of the PSA test. Came back at 5.2. One year ago it was 1.2
....Primary doctor suggested I visit a Urologist which we have set up an appointment for 4-4-11.
That's a sound call by your primary doctor. The most common cause of an elevated PSA is infection or inflammation of the prostate, and that can cause the PSA to jump a lot, with 50 not being rare, and even much higher in a few patients. Usually cancer would not cause such a jump in one year, but it is possible. Benign enlargement can also cause an increase, though again the increase is usually quite gradual and not an increase of 4.0. Of course, you could have a combination of any or all of the three major causes of PSA elevation.

Quote:
I have no problems or symptoms that I have read about on line. From time to time I do have a slow urine stream but no waking at night to go. No pains in belly or area. No problem with intercourse as well.
Prostate cancer usually sneaks up on us with no or minimal symptoms. That slow stream could be the result of some benign enlargement, or possibly also of a waxing and waning infection. Of course, cancer is also a possibility, but not a real high likelihood.

Quote:
I am anxious to see what the Urologist has to say. Hopefully we will have another PSA blood test before a biopsy..as that sounds really bad......
Yes, another PSA and some other tests as a workup for possible infection would be wise before a biopsy. But no, for the vast majority of us, a properly done biopsy, including numbing agents and infection prevention pills (often Cipro), is not really bad.

Quote:
One thing my wife reminded me or is that we did have sex 10 hours before the blood work. While I have read that that sometimes may cause a jump I do not see as to where it could jump that high, but then again as I have read stories of a test being in double digits.... Figured my wife told me that so I would not worry, let's hope she is right.........look forward to your comments....
The sex might have influenced the PSA a little bit, but hardly enough to explain most of that rise of 4.0.

Chances are you will have a decent urologist who will reassure you and not try to spook you into a hasty biopsy at this point. If you want to get an advance look at the territory, there is a great new book for orienting and empowering potential and actual prostate cancer patients that was published last August: "Invasion of the Prostate Snatchers", by Ralph Blum and Mark Scholz, MD.

Take care and good luck,

Jim

 
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Old 03-25-2011, 07:57 PM   #3
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Re: Real or False

Jim.........i've read some of your post, you are so knowledgeable it is amazing...........thanks for your thoughts and I will be in touch.......Good luck to you and your health
Tom

 
Old 03-25-2011, 08:38 PM   #4
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Re: Real or False

OldSalt53
You want to abstain from sex for 3 to 4 days before your test and avoid riding on vibrating equipment so that you can get "normal'' test as a baseline to compare future "normal" tests to. I also abstained from any coffee, tea, or other drinks which might irritate the area. I did this by trial and error and always tested higher if I didn't abstain from my usual behaviour. If you have sex shortly before testing or go dirt biking your test may give skewed results.

Research the different therapies available at leading treatment centres and don't just settle on the first treatment proposed. It is of utmost importance who is performing the treatment. Avoid surgeons who only do three or four a month, robotic surgeons who haven't done 700 by one article I read and 1600 in another, and find out their relevant statistics. Find out the side effect statistics and success rates of the differing radiation options available. You are on the young side and I would suggest you seek a cure.
Bob

 
Old 03-25-2011, 08:41 PM   #5
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Re: Real or False

harpman.......thanks for your thoughts...........I remember like yesterday telling my bride if we had sex it would make me relaxed the next day for my physical......i hope that is what has caused this reading ..... either way, we are not going to jump into a treatment before studying the deal............

 
Old 03-25-2011, 09:01 PM   #6
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Re: Real or False

OldSalt53
I see that you are in Atlanta. I had a very good consultion with Dr. Critz in Decatur in 2004 and was finally treated in 2009 for my recurrent prostate cancer after a failed radical prostatectomy with Proton Beam Therapy at Loma Linda.
Bob

 
Old 03-25-2011, 09:03 PM   #7
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Re: Real or False

i'm going to Dr. Futrual in Conyers, he has been around awhile, I will let you know

 
Old 04-04-2011, 08:20 AM   #8
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Re: Real or False

Had my appointment this morning, which was mostly informative, but here's the scoop......My initial thoughts on the Doc were positive, he sat down and we had a good talk and answered all my questions. He suggested doing another PSA test along with a DRE and then come back in a week for results. Of course he mentioned if still elevated he would probably suggest a Biopsy......He did a very thorough DRE, said he felt no "hard" spots but did notice the right side was a little larger than the left side. He said this could just be a characteristic of my Prostate. So there you have it....hurry up and wait for another week. We will be in touch with results then...Good luck to All

 
Old 04-08-2011, 07:05 AM   #9
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Re: Real or False

I remembered that back in November I applied for a new life insurance policy and had the results of my blood work, looked at it last night and the PSA count was 1.18 opposed to 1.08 the previous March during my physical. So the big jump came between November and March of this year....Our follow up is at 10:30 Monday, will let you guys know then....

 
Old 04-11-2011, 10:34 AM   #10
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Re: Real or False

Back from the visit to my Urologist....The PSA was 2.8..his suggestions were: come back in 6 months for another DRE and Blood Test or / and have a biopsy. He really had no sense of urgency with the Biopsy. He said we could schedule next week, next month or in several months. He did mention that something caused the spike which of course is not normal, he also reminded me during the DRE all he can feel is the back side and even though it was smooth something could be happening somewhere else. he suggest to take my time and decide what course I wanted to do...He did mention again that as we age the gland does enlarge....I had my wife with me so I would not forget to hear something....Given the short time it has been since the visit, I may very well go with the biopsy in 2 or 3 months as I have always been about "Preventative Maintenance". Would love to hear some thoughts from you guys, thanks for listening and your responses!!!

 
Old 04-11-2011, 12:15 PM   #11
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Re: Real or False

OldSalt53
I'm not a doctor but I wouldn't wait 6 months or more to find out what is going on. If you have to be treated you want to catch it as early as possible for the best chance of a cure with the fewest side effects. Get the biopsy immediately and I would find another doctor as he in not taking it seriously enough in my opinion. Time may be critical as that is a serious rise in a short time. I am trying to scare you.
Bob

 
Old 04-11-2011, 01:16 PM   #12
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Re: Real or False

Hi again OldSalt53,

First, thanks for your kind words back in post #3. I've read through Harpman's post #6. Just to make things more challenging for you, I'll offer a much different view, in green below.


Quote:
Originally Posted by OldSalt53 View Post
Back from the visit to my Urologist....The PSA was 2.8..
Congratulations on that nice plunge in PSA, from 5.2 a few weeks earlier! I would say that deserves a celebration! My bottom line is that I like what your doctor is telling you as well as his poise, but that is because there is some solid logic behind this view.

In essence, your PSA was more or less stable around 1.08 to 1.8 last year, but then you had a result of 5.2 a few weeks ago. Normally, as mentioned before, cancer is not going to cause such an extreme jump, though it is possible; in contrast, an infection or inflammation of the prostate can easily cause such a jump (and a lot more). Moreover, and more to the point, cancer causes a steady increase in PSA in an exponential pattern (a thousand cells split into two thousand, two become four, four become eight, etc.), each split taking about the same length of time), though that trend can be clouded by combined involvement with infection and/or benign enlargement. What prostate cancer does not do is rise and then drop! But that's exactly the pattern you have. That's an excellent but perhaps not absolute indicator that some infection or inflammation is playing the key role in that spike to 5.2 and then the drop. I suspect inflammation or infection may also have played a role in the earlier rise from 1.08 to 1.18. It could well happen that your PSA would be back to the range it was in last year if you were to measure it on the right day.


Quote:
his suggestions were: come back in 6 months for another DRE and Blood Test or / and have a biopsy. He really had no sense of urgency with the Biopsy. He said we could schedule next week, next month or in several months. He did mention that something caused the spike which of course is not normal, he also reminded me during the DRE all he can feel is the back side and even though it was smooth something could be happening somewhere else. he suggest to take my time and decide what course I wanted to do...
I like his style and cool. Too many of us do not get that from our doctors. He probably is not too concerned about the infection as your symptom is mild (the occasional slow urination), but you might want to work with him to see if you can pin down the cause and eliminate it. Sometimes it is hard, even impossible, to accurately determine such infections, but often the cause can be pinned down and eliminated.

Quote:
He did mention again that as we age the gland does enlarge....I had my wife with me so I would not forget to hear something....Given the short time it has been since the visit, I may very well go with the biopsy in 2 or 3 months as I have always been about "Preventative Maintenance". Would love to hear some thoughts from you guys, thanks for listening and your responses!!!
I'm all for biopsies when the basis is sound. After all, I had to persuade a doctor to prescribe my first ever PSA, and it turned out to be 113.6, launching me on this course. However, overtreatment is a tremendous problem in prostate cancer today, and we now have tools that can vastly reduce overtreatment. Overtreatment extends to excessive biopsies. Chances are very strong that, based on your PSA without the infection, and the negative "thorough DRE", you do not have prostate cancer. Even if you do, it is quite likely that it is so small that a biopsy would miss it. The Prostate Cancer Research Institute, a non-profit organization known as PCRI, recently published its March 2011 edition of it free newsletter PCRI Insights. The lead article is entitled "Eleven Decisions Before Prostate Biopsy," and Table 2 covers "Current Clinical Practice and Proportion of Men with Cancer Based on PSA and DRE Results." It shows that for a man with a PSA between 0-2 and a normal DRE, the chance of cancer is about 1%. For a man with a PSA between 2 and 4 and a normal DRE, the chane is about 15% - about 1 chance in 7. However, in your case, we are already virtually sure that some infection or inflammation is involved, so that 15% is almost certainly on the high side.

One thing you could do, now or in a few months, is to get a PCA3Plus test. It's a urine based exam with the sample taken after an "attentive" DRE by the doctor - essentially a brief massage of about a minute. The PCA3Plus is strong where PSA is weak, and vice versa; it takes more cancer to set off the PCA3Plus than it does to signal possible cancer with PSA (PCA3Plus is not as "sensitive"), but PCA3Plus is not fooled by other conditions (it has a high degree of specificity for prostate cancer). The "free PSA" test is probably not worth doing as it is fooled by infection, which you very likely have, even if it is now in the waning phase; both prostate cancer and infection often lead to low free PSA percentages.

I'll close by recommending again the book "Invasion of the Prostate Snatchers." The full title is: "Invasion of the Prostate Snatchers -- No More Unnecessary Biopsies, Radical Treatment, or Loss of Sexual Potency."

Take care,

Jim

 
Old 04-13-2011, 02:33 PM   #13
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Re: Real or False

Bob, I'm too old to get scared, I roll with the flow but thanks for your thoughts and good luck

 
Old 04-13-2011, 02:36 PM   #14
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Re: Real or False

What prostate cancer does not do is rise and then drop! But that's exactly the pattern you have.

Jim, yes this was great news and we did celebrate.....We will remain optimistic and remain hanging out on the board here, at least until the second test in 6 months....

Thanks for your words and thoughts !!!!!!!!!!

Tom

 
Old 09-16-2011, 12:43 PM   #15
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Re: Real or False

As promised 6 months ago I said I would return after my follow up. Had the PSA checked this week and came back at 1.2 Doc said I probably had an infection. Will check in March at my annual physical....Good luck to all

 
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