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-   -   Rising PSA, need guidance on next move (http://www.healthboards.com/boards/cancer-prostate/926697-rising-psa-need-guidance-next-move.html)

Pratoman 11-08-2012 04:13 PM

Rising PSA, need guidance on next move
 
Went to Urologist today, PSA continues to rise - facts and numbers as follows:

Age - just turned 62
Father had Prostate Cancer

PSA Levels:
2009 - .7
2010 - 1.1
2011 - did not take
April 2012 - 1.7 (or 1.6, not clear)
Nov 2012 - 2.2

Got the 2.2 results today. Doc did digital rectal exam, prostate felt normal.

Gave me choice - biopsy now, or wait 3 months. Told me, while you can never be sure, he feels 3 months wait would not present any real risks. I asked what he would do if it was him - he said he would do the biopsy, and he has, in a similar situation. Said the threshold at my age is 3.5, but rising level, with family history is cause for concern.

I told the doc i would come back in three months for retake but i dont know if i am doing the right thing
I am in NY area, i hear Columbia Presbyterian has high reputation docs for this. Should i
1. do the biopsy
2. wait
3. get a second opinion immediately

Also, do any docs put you to sleep for the biopsy? I've heard it is pretty painful.
Very nervous, any guidance would be really appreciated.

Pratoman 11-08-2012 07:56 PM

Re: Rising PSA, need guidance on next move
 
Bump

I know these numbers are low, but in case anyone thinks I'm joking, and thats why i got no answers?.... I should clarify. Its not the absolute level, which i know is low, especially for my age. Its the trend, combined with my family history (and i think the velocity>) that led the doc to suggest biopsy.

I am inclined to wait three months and retake the PSA before doing a biopsy. But i would like to get some opinions from knowledgeable folks here.

User483 11-08-2012 08:16 PM

Re: Rising PSA, need guidance on next move
 
Boy, thats a low threshold for biopsy. The PSA velocity is of dubious value.
I dont see the need to rush to biopsy at all. At what age was your Dad? What grade gleason did he have?
Can you talk your doc into a PCA3?

Pratoman 11-08-2012 08:36 PM

Re: Rising PSA, need guidance on next move
 
Not sure about my dads Gleason Score, it was never relayed to me. He was in his late 60's when he was diagnosed.
Like i said, i know its a low threshold for biopsy, which is why i am considering waiting. But its the fact that i have had 4 rising numbers in a row, that is concerning to the Doc. On the other hand, i always feel, with any Doc, that i never know when they really think a test is needed or when they are either covering their butt, or looking to create revenue (hate to say that, but)

I do have another question - do any of the urologists give sedation or general anesthesia for the procedure? I know they use a local, but I've heard its not all that effective.

User483 11-09-2012 06:31 PM

Re: Rising PSA, need guidance on next move
 
American urological society info on PSA:

http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/psa09.pdf


PCA Risk Calculator:

http://deb.uthscsa.edu/URORiskCalc/Pages/uroriskcalc.jsp

Note the risk of High grade cancer in the calc.

I assume your DRE is normal.
You can always get a second opinion.

Pratoman 11-09-2012 08:19 PM

Re: Rising PSA, need guidance on next move
 
Thanks, read through relevant parts of the white paper, good info.

RBK1111 11-10-2012 09:54 AM

Re: Rising PSA, need guidance on next move
 
[QUOTE=Pratoman;5085881]Went to Urologist today, PSA continues to rise - facts and numbers as follows:

Age - just turned 62
Father had Prostate Cancer

PSA Levels:
2009 - .7
2010 - 1.1
2011 - did not take
April 2012 - 1.7 (or 1.6, not clear)
Nov 2012 - 2.2

Got the 2.2 results today. Doc did digital rectal exam, prostate felt normal.

Gave me choice - biopsy now, or wait 3 months. Told me, while you can never be sure, he feels 3 months wait would not present any real risks. I asked what he would do if it was him - he said he would do the biopsy, and he has, in a similar situation. Said the threshold at my age is 3.5, but rising level, with family history is cause for concern.

I told the doc i would come back in three months for retake but i dont know if i am doing the right thing
I am in NY area, i hear Columbia Presbyterian has high reputation docs for this. Should i
1. do the biopsy
2. wait
3. get a second opinion immediately

Also, do any docs put you to sleep for the biopsy? I've heard it is pretty painful.
Very nervous, any guidance would be really appreciated.[/QUOTE]

Yor PSA has more than doubled. The number is less important than the trajectory. When it comes to prostate cancer, it is always better to know than wonder. Get biopsies. The downside is a sligh risk of infection, minimal discomfort, and the upside is knowing. If there is a positive finding than send to a specialized laboratory like Bostwick Laboratories. After results then decide. Urologists have limited understanding of this area and if by misfortune you have PCA, you will need to read a great deal and understand there are many courses of action, including as I chose nothing ore than Watchful Waiting or Active Surveillance. Best

Pratoman 11-10-2012 10:51 AM

Re: Rising PSA, need guidance on next move
 
Update - i called the urologist back, and asked him some questions (below with his responses) . I got the questions from readin this and another forum, and he said they were great questions, all the right one's, so thank you to everyone...... i asked
1. should we do free psa, psa3, before doing a biopsy. His response was he generally does those tests when the PSA is above 4. Since my PSA is 2.2, he thinks the results wouldn't be useful
2. What about CIPRO? - His response was that he uses CIPRO alot, but its more likely to be an infection, when there is a sudden spike, as opposed to my situation which has been trending up over a few years, slowly
3. Would doing a biopsy with what might be such an apparently very early stage situation increase the chances of false negative? He said it wouldn't
4. does he use ultrasound to guide the biopsy - he said yes
5. what does he do about pain management - he said it wasn't really necessary, he just uses a little lydocaine around the prostate. I followed up with a question about gel to numb the area before the lydocaine injection, he said he doesnt use it , there is not that much pain frmo the lydocaine injection.

He said regarding the cipro, even though my situation was not typical of an infection it was worth a try (why didnt he try it before i brought it up?) So he gave me a prescription and said to retake in a month.
I said ok. Last thing i told him was that he shouldn't be surprised if i request the records because i would go for a second opinion before i do anything invasive (like a biopsy). He was totally cool with that (as he should be, it wouldn't matter to me if he wasnt)

So that leads me to my next move. I contacted a Doc who was recommended to me at Columbia Presbyterian, Dr DeCastro, for a second opinion, i am going to see him next Friday. Maybe I am wrong, but it bothers me that the doc i am seeing is a one doc practice in a small local office. He was recommended to me by my Primary Care Doc,but you know how that goes, they are all buddies. So i have no way of knowing who is good, but i figure at Columbia, they are well known in Urology, i think on a par with Hopkins, and why not consult with the best.

So we'll see. I will be pretty nervous until this is resolved one way or the other, even though i know that if it turns out to be a problem, it is in all likelyhood very early and curable. I can't even imagine having an "i have cancer" conversation with my 29 - 30 year old kids, no matter how good the prognosis. I think thats what scares me most.

RBK1111 11-10-2012 09:39 PM

Re: Rising PSA, need guidance on next move
 
First have a biopsy to determine the presence of cancer. A lump sounds like either infection or tumor. A good idea to know the difference. Secondly, PSA readings increase with prostate size (increase tissue = increase psa). Next have biopsies examined by a "specialized" laboratory such as Bostwick Laboratories. Need to determine Gleason Score, 3/3 best and if so, many options including doing little but future PSA's and Dopplars to observe. If higher, a need to "research" and get in touch with Yana and other sights with 100's of PCA people with allot of experience from genesis to treatments and afterwards. Keep in touch and I wil try to offer more.

Billy6 11-11-2012 06:54 PM

Re: Rising PSA, need guidance on next move
 
You shouldn't worry about the biopsy. I had 3 of them. I can't say it is something I would volunteer to do for no reason but it is not so bad. The doc will insert the probe, numb the area, and take the 12 samples. You will feel each of the 12 needles but they are not painful like the needle stick from a blood sample. It is more like the anticipation of those needles going in.

When it is over and you get home, you will have some discomfort ( I wouldn't call it pain). It will be non-specific and feel somewhat like an urge to go the bathroom. It will feel better to lay on your stomach for a few hours. The discomfort will go away in about 4 hours. There will be a minor amount of bleeding in the stool and that will end quickly.

chris134711 11-13-2012 02:39 PM

Re: Rising PSA, need guidance on next move
 
[QUOTE=Pratoman;5085881]Went to Urologist today, PSA continues to rise - facts and numbers as follows:

Age - just turned 62
Father had Prostate Cancer

PSA Levels:
2009 - .7
2010 - 1.1
2011 - did not take
April 2012 - 1.7 (or 1.6, not clear)
Nov 2012 - 2.2

Got the 2.2 results today. Doc did digital rectal exam, prostate felt normal.

Gave me choice - biopsy now, or wait 3 months. Told me, while you can never be sure, he feels 3 months wait would not present any real risks. I asked what he would do if it was him - he said he would do the biopsy, and he has, in a similar situation. Said the threshold at my age is 3.5, but rising level, with family history is cause for concern.

I told the doc i would come back in three months for retake but i dont know if i am doing the right thing
I am in NY area, i hear Columbia Presbyterian has high reputation docs for this. Should i
1. do the biopsy
2. wait
3. get a second opinion immediately

Also, do any docs put you to sleep for the biopsy? I've heard it is pretty painful.
Very nervous, any guidance would be really appreciated.[/QUOTE]

Absolutely do the biopsy now. Why would you wait for something with bad potential to possibly get worse, even a tiny bit. The biopsy is no sweat. I liken it to someone snapping a rubber band on your wrist, but instead it is up your a** Don't worry about a biopsy. It's just relax and it's over soon. I told my guy no Christmas card for him, though. (Joke) Columbia Presb is a GREAT hosp!! They treated my Mom for years. Cutting edge doctors.

Pratoman 11-13-2012 02:59 PM

Re: Rising PSA, need guidance on next move
 
Thanks Chris. Thats what i am thinking. Unless the doc at Columbia tells me tomorrow that there is a good reason to wait on the biopsy, i''ll just get it done. The only question will be do i do it near home at my "long time" Urologist (who does have 30 years in practice), or do i do it at Columbia. Because if it went any further, i.e. if it was positive, i would go to Columbia, or Johns Hopkins, to get the surgery done (i know, i am getting way ahead of myself, thats how i am).
So we'll see tomorrow.
I pickedup a copy of my records from my doc today to bring with me. It was like 50 pages. WTH? What could be in 50 pages when i haven't even been sick yet. I told the secretary to seal the envelope so i am not tempted to open it and read thru it.

RBK1111 11-13-2012 06:38 PM

Re: Rising PSA, need guidance on next move
 
I cannot say this strongly enough. Surgery is the LAST option that should be considered, and yes you are way ahead of science and a need to systematically make a determination. Who does your biopsies is not as important as how many and where take from, i.e. 12-14 from both capsules, and secondly, the correct "specialized" laboratory to analyze the samples. If cancer is found, then it requires an understanding of Gleason Scores, a rediological bone and lymphatic assessment. It is also important to know where the "suspicious" finding was located and then to begin the process of knowing as much as oncologists before consulting with one. Each oncologist has their personal philosophy and approach so you need to be able to discuss issues as a "colleague" not a subordinate. All treatment carry some risk of impotence and/or incontinence, and surgery in my view is the most dangerous and often unnecessary. Finally, with a Gleason of 3/3 which is often the most common, no treatment is the best course of action with careful and routine psa, dre, dopplar monitoring.
[QUOTE=Pratoman;5088369]Thanks Chris. Thats what i am thinking. Unless the doc at Columbia tells me tomorrow that there is a good reason to wait on the biopsy, i''ll just get it done. The only question will be do i do it near home at my "long time" Urologist (who does have 30 years in practice), or do i do it at Columbia. Because if it went any further, i.e. if it was positive, i would go to Columbia, or Johns Hopkins, to get the surgery done (i know, i am getting way ahead of myself, thats how i am).
So we'll see tomorrow.
I pickedup a copy of my records from my doc today to bring with me. It was like 50 pages. WTH? What could be in 50 pages when i haven't even been sick yet. I told the secretary to seal the envelope so i am not tempted to open it and read thru it.[/QUOTE]

Pratoman 11-13-2012 08:04 PM

Re: Rising PSA, need guidance on next move
 
RBK - I really appreciate your perspective.
In talking about surgery, i am waayyyy ahead of myself. I do that all the time, and i should not. My first job is to confirm if/that i need a biopsy, then after the biopsy i will have an idea of what, IF ANYTHING, i am dealing with.

As far as surgery goes, if it gets that far, i intend to educate myself as much as is humanly possible, and find the right guy, whichever treatment i would choose, that is, the right guy for me.
I think this is a very personal decision. My inclination, should i actually get diagnosed with PC, is to get it out of there and not screw around, rather than watchful waiting, active surviellance, radiation, or anything else, that leaves the cancer in there for a minute longer than it needs to be. But thats me. I understand that many cancers will never do harm, and i need to look at Gleason scores, and other facts. But like i said, i am not even close to having to make a decision just yet.
Again, i very much appreciate your perspective, as well as your and everyone elses interest in educating and helping me. This board has been invaluable to me over the last few days.
Even though its rising, my PSA being at 2.2 is not causing me to panic just yet (well, it did for a day or so, till i started reading) but it is causing me to be careful and attentive.
Tomorrow i meet with the Doc at Columbia, i am keeping my fingers crossed that he is one of those Docs who will actually give me the time to answer all my questions.
I'll update after i meet with him.

chris134711 11-14-2012 10:53 AM

Re: Rising PSA, need guidance on next move
 
I did my biopsy at the one-guy urologist office for 30 years and regret it. Columbia sounds like a good choice for biopsy. I haven't posted on this forum until 9 years post treatment Stage T2B, because for a couple of years now I've been getting angrier about my treatment choices and the poor quality of life that I have. (Also I wouldn't blame my wife one bit if she wanted to have a boyfriend, after 9 years of me in my condition). I think that I may ask my doctor for the trimix penile injection.


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