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Cancer: Prostate Message Board
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Old 10-20-2012, 07:36 PM   #1
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Pratoman HB User
Needless worry?

New here, an a little concerned.....
I am scheduled to see my urologist in two weeks and will go to the lab for my PSA prior, so that he has it for our visit.
I am about to turn 62. History of my father having had PC, diagnosed at around 67-68. He had a lot of other problems and was in a nursing home, so it was a little confusing, but i believe he died from it. He had been treated with meds, no surgery, due to his other issues, including dementia.

Anyway, because of his history, i have seen a urologist yearly.
My last three PSA readings were: (MONTHS ARE APPROX)

January 2010 - .7
January 2011 - 1.1
April 2012 - 1.7.
My April 2012 DRE was normal - he said a bit enlarged but no hard spots, very soft.
After the last rise, the Urologist told me to retake in 6 months. And so i have this appointment coming up.
I'm sort of convinced that if it is up again, he will want to biopsy.
My questions are....
1. is my assumption probably correct?
2. are these numbbers (the trend/velocity) something to be concerned about?
3. would he be right to want to biopsy if the number went up to say, low to mid 2's?
4. if he suggests biopsy should i get a second opinion?
5. are there Docs that do general anesthesia for prostate biopsy? I've heard it can be very painful
Thanks in advance, I've always been one to anticipate the worst, and worry about things that haven't happened yet, especially when it comes to health.

Last edited by Pratoman; 10-20-2012 at 07:38 PM. Reason: Forgot one point

 
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Old 10-21-2012, 11:08 AM   #2
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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: Needless worry?

Hi Pratoman,

Given your family history, I can see why you are concerned. Although it would not be a concern for most men with those numbers, especially with a negative DRE and some evidence of BPH.

Quote:
1. is my assumption probably correct?
It depends how much it goes up by. If it were me, I would have taken Proscar or Avodart for 6 months to eliminate BPH as the cause of the rise and establish a new, more accurate baseline PSA. You can also ask for a % free PSA test, but I don't know what its diagnostic accuracy is with PSA levels as low as yours. Hopefully, in another 6 months, the newly approved PHI test will be available too.

Quote:
2. are these numbbers (the trend/velocity) something to be concerned about?
Your doubling time is just under 2 years which is faster than normal but could be attributable to BPH - the enlargement- your doctor noted. It's certainly not very high or increasing at an alarming rate. That said, some (rare) kinds of PC never show a lot of PSA.

Quote:
3. would he be right to want to biopsy if the number went up to say, low to mid 2's?
Some doctors use a cutoff of 4.0, some go as low as 2.5. It varies with age and size of the prostate naturally.

Quote:
4. if he suggests biopsy should i get a second opinion?
It's your decision whether to get biopsied or wait. I would suggest, however, that you have a thorough discussion of the "what ifs" before the biopsy, including the arguments for Active Surveillance. It's a lot easier to be reasonable before "cancer panic" sets in. Biopsies are often a first step towards overdiagnosis and overtreatment.

Quote:
5. are there Docs that do general anesthesia for prostate biopsy? I've heard it can be very painful
There are different reactions. I found my first biopsy to be very painful -- he had to stop it. I had general anesthesia on my second, which was OK, except I was kind of groggy for a day or two. On my third, they gave me a prostatic nerve block after a little local lidocaine/prilocaine. That was the best. No pain, no grogginess. I was able to go back to work right afterwards.

- Allen

 
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