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My New PSA Results & Recommendation


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Old 04-14-2017, 02:57 PM   #1
Sw1218
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My New PSA Results & Recommendation

hello. below this message is my history:
my new PSA results is a 7.2, up from a 6.94 over the last six months. my uro is recommending i have an MRI. i will ask the person who's in charge will this be the 3T MRI. my question to you is it possible for a man to go all of his life with an elevated PSA without being diagnosed with prostate cancer? do you know if prostatitis will eventually lead to PC, because of the continuous inflammation?


12.18.2013 | Turned 40 yrs. old
07.09.2014 | Annual physical
07.11.2014 | P.S.A. 5.5 Referred to Urologist
07.29.2014 | Urologist performed DRE found nothing.
08.19.2014 | Biopsy performed
08.25.2014 | Diagnosed with Asymptomatic Inflammatory Prostatitis & BPH
==================
07.29.2015 | PSA is 5.9
01.14.2016 | PSA is 7.6
03.09.2016 | PSA is 6.2
07.08.2016 | PSA is 6.92
10.17.2016 | PSA is 6.94
04.14.2017 | PSA is 7.2 ][ DRE was performed and everything felt fine. MRI is recommended
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07.08.2016 | PSA is 6.92
10.17.2016 | PSA is 6.94
04.14.2017 | PSA is 7.2 ][ DRE was performed and everything felt fine. MRI is recommended

 
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Old 04-14-2017, 06:56 PM   #2
RunnerPig
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Re: My New PSA Results & Recommendation

Why an MRI and not a biopsy?
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Prostate Cancer 9/23/16, Prostatectomy on 11/8/16, Bone & CT Scan negative. 8 Lymph Nodes all negative. Extraprostatic extension and invasion of both seminal vesicles - pT3bN0MX. Gleason: 4+3.

 
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Old 04-14-2017, 07:16 PM   #3
Sw1218
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Re: My New PSA Results & Recommendation

Quote:
Originally Posted by RunnerPig View Post
Why an MRI and not a biopsy?
Here are my biopsy results.
08.19.2014 | Biopsy performed
08.25.2014 | Diagnosed with Asymptomatic Inflammatory Prostatitis & BPH. No cancer seen.
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07.08.2016 | PSA is 6.92
10.17.2016 | PSA is 6.94
04.14.2017 | PSA is 7.2 ][ DRE was performed and everything felt fine. MRI is recommended

 
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Old 04-14-2017, 07:30 PM   #4
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Re: My New PSA Results & Recommendation

Hi Sw1218,

I have had no enrolled medical training, and your uro is, of course, a doctor, and has examined you and apparently followed your situation for some time, and he does not appear to be rushing you toward a biopsy and treatment. Therefore his recommendation of an MRI has a lot of credibility. My layman's understanding is that the ideal MRI for your situation is a multiparametric MRI (mpMRI) with a 3T magnetic field, and that is probably what your doctor has in mind. These days, especially when a patient has had a previous negative biopsy and with increased confidence in 3T (great image resolution) mpMRIs, a rising proportion of doctors are using MRIs instead of another biopsy as the next step.

Here are considerations on the other side of the scale, on the side of just continuing to observe with PSA tests.

- Your last three values, spread over 9 months, are virtually stable - a really long PSA doubling time (PSADT), though significantly higher than the 5.9 and 6.2 values, with the spike to 7.6 an anomaly. As prostate cancer involves cell division over a fairly constant period of time, the pattern of increase is an exponential rise. In other words, 1 million cells become 2 million, 2 million become 4 million, 4 million become 8 million, etc. That does not match the pattern of your PSA results, though the difference does not rule out cancer.

- Benign growth, known as BPH - which you have, results in a fairly steady growth of the prostate, and that is not associated with an exponential rise. It could account for the gradually increasing PSA results that you are seeing. Usually BPH is not significant until men are older than you are, but some men get the growth earlier, and the biopsy proved it. The rule of thumb is that you get about 1 unit of PSA for every 10 cc of healthy (meaning here non-cancerous) prostate tissue, so a prostate of 70 cc would probably account for your PSA. But you could have BPH accounting for some of the rise in PSA and infection/inflammation accounting for the rest, or perhaps a small amount of cancer also involved.

- Inflammatory prostatitis, which you had and maybe still have, often causes scary abrupt rises in PSA followed by reassuring declines. That looks suspiciously like the pattern you saw from the summer of 2015 through the spring of 2016.

So I'm thinking your doctor probably thinks it's very likely you do not have prostate cancer but wants the additional assurance of that MRI. That's reasonable and understandable to me.

Because of BPH and prostatitis, it is quite possible for a man to go through all of his life without having prostate cancer. I suspect that happens rather often.

The research on prostatits and prostate cancer mainly indicates they are not connected, but there is some uncertainty.

Good luck!

Last edited by IADT3since2000; 04-14-2017 at 07:33 PM. Reason: Brief addition.

 
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Old 04-14-2017, 08:10 PM   #5
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Re: My New PSA Results & Recommendation

IADT3since2000, for you to have no enrolled medical training, one sure would never know it. WOW!! i had to get out the dictionary at least twice. thank you so much, for this information. i have a worry wart type personality and have always been afraid of the big C. i hope it all works out in my favor with no PC diagnosis.
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07.08.2016 | PSA is 6.92
10.17.2016 | PSA is 6.94
04.14.2017 | PSA is 7.2 ][ DRE was performed and everything felt fine. MRI is recommended

 
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Old 04-15-2017, 04:37 AM   #6
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Re: My New PSA Results & Recommendation

Good morning Sw1218,

My wife is a bit of a worry wart type, and as you know that can be a good thing in motivating you to prepare. The downside, of course, is unnecessary worry that preoccupies and disturbs you. Maybe your uro wants the mpMRI in part at least to reassure you.


Here is a key perspective for you to bear in mind: prostate cancer is no longer "the Big C." Rather, it is a range of Cs: c c c c c c c C C C. IF you should be diagnosed in the near future, which I think is unlikely, your case is probably like one of the small "c"s based on the test and exam results you have had. For such cases, which are described as "low-risk" with other characteristics that amplify the low degree of risk, research has now proven that "active surveillance" rather than treatment right away is the best way to go. We did not know that about a decade ago, and a greater proportion of low-risk patients has been choosing active surveillance every recent year. Active surveillance for most patients choosing it means they can defer treatment for at least a few years, with most not needing treatment for the rest of their lives: the disease just not affect their length of life or have much effect on their quality of life.

The odds of surviving cancer at 5, 10 and 15 years are really good for the average patient, and the odds are improving for those who start out with distant metastatic disease (meaning away from the prostate) - think of them as the C type cases, though they are the ones mainly responsible for pulling the overall survival odds down from 100%; their odds of making it to 5 years are still well below 50%, but, with the prevalence of PSA testing in the US, there are not very many of them these days so they don't have much weight on the scale of survival odds. According to the American Cancer Society, as last updated in 2016, survival of all patients at 5 years for prostate cancer is nearly 100% as compared to their age mates without prostate cancer. At 10 years survival is 98%, and at 15 years survival is 95%! Moreover, great progress is being made, and these figures will improve further as years go by.


You probably cannot stop worrying, but maybe this information will enable you to worry about something else.

Last edited by IADT3since2000; 04-15-2017 at 04:40 AM. Reason: Added detail about added surveillance just after posting.

 
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Old 04-15-2017, 11:49 AM   #7
Sw1218
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Re: My New PSA Results & Recommendation

Thank you again.
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07.08.2016 | PSA is 6.92
10.17.2016 | PSA is 6.94
04.14.2017 | PSA is 7.2 ][ DRE was performed and everything felt fine. MRI is recommended

Last edited by moderator2; 04-15-2017 at 01:20 PM.

 
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Old 06-28-2017, 09:55 PM   #8
Max1822
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Re: My New PSA Results & Recommendation

An T3 mpMri helps rule out any significant cancer and can highlight insignificant ones. If a suspicious lesion is found, a biopsy can be targeted as opposed to having a blind random sampling. Makes a lot more sense to me. I've gone through your worrying myself and have posted my experiences here on this board. I have a larger prostate 96cc and BHP and a very high PSA number. The insights and help offered by many people on this board (such as IADT3) has made my personal journey less worrisome. Best of Luck. Regards Max

 
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Old 06-29-2017, 08:37 PM   #9
Sw1218
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Re: My New PSA Results & Recommendation

Quote:
Originally Posted by Max1822 View Post
Best of Luck. Regards Max
thank you, max. i had the MRI, and everything turned out fine.
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07.08.2016 | PSA is 6.92
10.17.2016 | PSA is 6.94
04.14.2017 | PSA is 7.2 ][ DRE was performed and everything felt fine. MRI is recommended

 
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Old 07-01-2017, 06:26 AM   #10
Max1822
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Re: My New PSA Results & Recommendation

Thats great news. Cheers!

 
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