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  • Elevated PSA & Nodule found

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    Old 07-01-2019, 05:24 PM   #1
    Shellsbasketbal
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    Elevated PSA & Nodule found

    Ok.....

    43 years old male

    psa levels-
    December 2018....87
    May 15th 2019 .....74
    June 1 2019 ....60
    Now.....77

    Just had a biopsy on my prostate today....there was a nodule found on the right side of my prostate. Doctor said my prostate was very large for my age. What am I up against with this ? Can’t find much about elevated psa in someone my age.

    Symptoms- can’t pee as hard as I want or as I could in the fall of 2018. Uncomfortable feeling while peeing. Those symptoms led me to the doctor.

    Anyone seen or know someone like this?

    Last edited by Administrator; 07-05-2019 at 11:11 PM. Reason: Addition

     
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    Old 07-01-2019, 06:25 PM   #2
    Shellsbasketbal
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    Re: Elevated PSA & Nodule found

    Oh ya....yes there was a nodule found on the right side of my prostate.

     
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    Old 07-02-2019, 12:02 PM   #3
    IADT3since2000
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    Re: Elevated PSA & Nodule found

    Hi Shellsbasketbal and welcome to the Board!

    Yes, PSAs this high with a declining trend and then upward curve are quite uncommon but not unheard of, and they can represent a number of problems, ranging from a combination of problems, to just infection, to cancer, and to BPH (benign enlargement). Based on the doctors comment, you already have BPH, but even with a very large prostate that would likely account for “only” about a PSA of 10 to 15. A nodule could be due to cancer, but there are other causes as well.

    Infection could produce numbers this high, and a telltale sign of infection is a roller-coaster pattern, such as your record. Some patients have had their PSAs return to normal when the right antibiotic is found to match the bacterium that is causing the infection.

    Of course the reason you came to this board is that you are concerned about cancer, and cancer too can raise PSAs this high, though it is uncommon, and even far higher. My first ever PSA, in December 1999, was 113.6, and it was due to a fairly aggressive case of prostate cancer. Though I have done exceptionally well as I approach 20 years as a survivor, many patients with cases like mine have not been so fortunate. Whatever your situation, you should know that while prostate cancer is no cake walk and can be deadly, enormous progress in case assessment and treatments has been made in the past two decades and continues to be made. Most of us are going to have very good odds of long-term survival after treatment, and some of us are not going to even need treatment. Those of us on the Board can help more once you have your biopsy results in hand.

    Was anything done by the doctor after your earlier tests? Certain medications could also be affecting the PSA pattern and the problem(s) it indicates.

    Good luck with your biopsy results!

    Jim

     
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    Old 07-02-2019, 12:40 PM   #4
    Shellsbasketbal
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    Re: Elevated PSA & Nodule found

    Primary doctor visits :

    Went to primary doctor and complained about symptoms and she did the finger check and said my prostate felt boggy....didn’t mention any hardness or nodule. She then prescribed the following medicine and checked my psa.....results are below.

    Medicine prescribed : 12/12 tamsulosin-2 tablet PO x 1 day then take 1 tablet daily continuously.

    Psa was checked after visit and it was 80.44

    Went back on 5/22 after tamsulosin and was finger checked again and she said, “your prostate feels inflammed.” She then prescribed the medicine below and checked my psa again.

    Medicine: 5/22 doxycycline- 100 mg , 2 times a day, 21 days

    Checked Psa after visit and dropped to 74.82 ....Which i was only on tamsulosin medicine for 7 days....I ended up getting busy and just dealing with it since my primary diagnosed it as chronic Prostitis .

    So I started my doxycycline medicine prescribed on my 5/22 visit and and went back to have psa checked on 6/21 and It went down to 60.61.

    After that visit she put me on ciprofloxacin for 7 days and my psa went up to 77.8 and my free psa is 5.2 which I was told was borderline .....so here I am today.

    Did all of that make sense ?

     
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    Old 07-03-2019, 12:11 PM   #5
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    Re: Elevated PSA & Nodule found

    Hi again Shellsbasketbal,

    Yes, it makes sense. I’ll tell you what I know, what I don’t know, and what I think.

    With your pattern of PSA changes following medication, to my now savvy layman’s eyes it looks clear that you have prostatitis, in other words a prostate infection, that it is responding to medication, and it is clear that the infection accounts for some portion of your elevated PSA, with the percentage of that portion of elevation uncertain – could be a lot or even all of it, or could be just a substantial fraction. The drugs you have described would not have helped against cancer alone: your PSA would have increased steadily, but it didn't! That is powerful evidence that infection is playing a role.

    Your free PSA is really not borderline; it is in the low area of the range that suggests but does not prove that there is cancer. HOWEVER, like PSA, free PSA also is influenced by infection, which you clearly have, so it is not strong evidence of cancer in your case. Maybe that’s what your primary care doctor meant by calling it “borderline.”

    I’m wondering why your doctor did not continue either the tamsulosin or the doxycycline, as they almost surely were having a good effect. But I’m out of my area here – not so aware of the ins and outs of treating prostatitis. I’m also wondering why your primary doctor was not working with a urologist early on as your PSA was so elevated. Do you know why?

    Here is an issue for you that you can put on the back burner until you get a diagnosis: complications due to chronic prostatitis for patients who have radiation therapy. I am generally a big fan of radiation for prostate cancer patients with intermediate- and high-risk cases (and “active surveillance” for lower risk cases, even “watchful waiting” if life expectancy is short). I am convinced that properly done, modern, image-guided radation does just as good a job as surgery in wiping out cancer in the prostate, unless the prostate is so large that it decreases the effective dose (which might be the case for you), but radiation can also reach beyond the prostate to the pelvis and knock out small metastases there, which surgery cannot do. (These are key reasons why I chose radiation for myself.) However, it is known that patients with chronic prostatitis often have seriously bothersome long-term urinary problems following radiation, which contrasts sharply with other radiation patients who overwhelmingly have no urinary problems at all long-term, once the treatment is behind them. A urologist is likely to be unaware of this issue or only superficially aware. If you are diagnosed with prostate cancer and have a case that needs treatment (meaning not eligible for active surveillance), a lot of us feel it is wise to consult a “radiation oncologist” as well as a urologist about treatment options. “Medical oncologists” who treat a lot of prostate cancer patients can also advise.

    I'm hoping that someone with more knowledge of prostatitis will also respond to you.

    Again, good luck!

     
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    Old 07-03-2019, 06:40 PM   #6
    Shellsbasketbal
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    Re: Elevated PSA & Nodule found

    They asked me if my symptoms improved and I told them that it wasn’t noticeable ! All of my psa’s were taken after my rectal exams and visits. They never knew my psa until after I left the office.

     
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    Old 07-04-2019, 04:45 AM   #7
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    Re: Elevated PSA & Nodule found

    Hi again,

    It is better to get the blood test before the rectal exam as it can increase PSA somewhat, but it would not make a major difference, so it would not account for a significant portion of your very elevated PSA results.

    Again, good luck!

     
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    Old 07-09-2019, 06:22 PM   #8
    Shellsbasketbal
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    Re: Elevated PSA & Nodule found

    Well the biopsy revealed prostate cancer....Gleason 8 with 9 of 14 cores tested having tumors present

    I have a bone and CT scheduled next.

    Stinks because I couldn’t figure out why my psa fell only to rise again......scared to say the least .

     
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    Old 07-10-2019, 02:30 PM   #9
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    Re: Elevated PSA & Nodule found

    I’m so sorry you are formally joining our “club.” Joining, especially with a Gleason 8, 9 cores positive, and that elevated PSA that now is clearly mostly due to cancer, means your life is going to be different from now on, and sometimes will be burdensome and difficult. On the good side, great progress has been made in figuring out what to do for different kinds of prostate cancer cases, and there are far better resources to do it with than there were even as recently as a decade ago. When I and my wife were trying to sort out dealing with diagnosis of my own aggressive case just before Christmas in 1999, we wondered whether we would ever experience joy again in our lives. We were surprised how quickly joy rose again in at least part of our lives. I hope you experience that too.

    While bone and CT scans are not worthwhile for many patients, they are valuable for a patient with your aggressive case characteristics. The bone scan is probably the standard Tc99 (technetium 99) scan. (You can ask the doctor.) Both the CT scan and the Tc99 bone scan are capable of catching tumors of substantial size, and a lot of research that relates to picking the best treatment strategy relates to results of those scans. Other scans may also help. Be sure to get copies of your reports and file them.

    It now seems clear that your PSA is being elevated by both prostatitis and cancer; this combination explains that high but fluctuating PSA after medication for infection.

    One good thing I’ve heard about patients with high PSAs is that their cancers are often very responsive to hormonal therapy, otherwise known as androgen deprivation therapy (ADT); prostate cancers with high PSAs are often very good at using the usual cancer fuels for growth, but when those fuels are sharply reduced, the cancers are usually vulnerable. (This was my situation; ADT did not cure me – it rarely cures patients, but it set the cancer way back.) At this point there are several therapy options and combinations, including ADT, which might help you. The situation will be clearer when you get those scan results. Whatever the results, you will have options.

    Waiting for results is hard, so if it is hard for you, just know that you are not alone.

    Hoping you get those good scan results,

    Jim

     
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    Old 07-10-2019, 04:26 PM   #10
    Shellsbasketbal
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    Re: Elevated PSA & Nodule found

    Well.........

    CT scan and Bone scan came back clean and the doctor says that it all appears to be contained in the prostate. He told me an MRI is next......I want my prostate removed!!! Thoughts?

     
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    Old 07-12-2019, 04:26 AM   #11
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    Re: Elevated PSA & Nodule found

    Congratulations on those good negative results for the bone and CT scans!!! This increases your odds of success in beating this thing, and in a more subtle sense, it is very likely going to increase the time you will have after treatment for technology to improve in case there are any stealthy threats from the cancer.

    The urologist likely wants the MRI to determine whether there are any extensions of the cancer through and/or beyond the prostate capsule. MRIs are very good at that, and you don’t get that information from the DRE, the biopsy, or the other tests and scans. Surgeons want to know that because they know that surgery alone will not be able to cure cancer that extends beyond the prostate, except for the seminal vesicles and lymph nodes that can be removed (but which look clear of cancer for you per the CT scan results). Multiparametric MRI can also provide more risk information.

    If there is extension, surgeons often recommend radiation instead of surgery, which for many patients makes excellent sense to me, especially because modern image guided radiation is as good as surgery in knocking out cancer in the prostate but can also cover an area well beyond the prostate in the pelvis, which is an early stalking ground for metastases. However, because you appear to have chronic prostatitis, radiation without surgery has a good chance of creating quite irritating, burdensome urinary side effects (even though for the vast majority of patients without prostatitis radiation usually has NO long-term urinary side effects, in sharp contrast to surgery urinary side effects).

    So, surgery looks to my layman’s eyes like a good bet for you if there is no extension, but maybe it would also be a good foundational strategy even if the MRI found extensions of the cancer beyond the capsule. In the latter case surgery would be unlikely to cure you, but it would set the cancer back. At that point you could do radiation therapy to the place where the prostate had been – the “prostate bed” – as well as to the pelvis, covering the areas of extension. This would be in combination with 1 ½ years to 2 years of androgen deprivation therapy plus supportive medication. That combination of surgery plus radiation and ADT cures some patients who have extensions of cancer beyond the prostate. I’m thinking that this sequence would not trigger problems because of prostatitis, but as a layman I’m kind of uncertain about that.

    Research studies have indicated a good chance of surviving a case like yours with good treatment, with rates of survival at ten years ranging from 97% to 85%. I hope that looks good to you. It’s not at all a sure thing, but often patients think their survival will be very short, while the reality is the vast majority of patients will do much better. (My early doctors predicted I would survive for five years; while I was only 56 at the time and had thought I had decades ahead of me before the diagnosis, those estimates of five years sounded very good to me as I thought I would not last a year.) Also, this range of survival is based on history – how patients have done with what was available when they were diagnosed and afterwards, and there have been and will be many advances that will improve these numbers for men being diagnosed these days.

    Some unorthodox, emerging approaches have substantially improved success rates compared to surgery alone for patients with advanced cases. This looks important for Gleason 8 cases because the rates of the cancer coming back after treatment, “recurrence”, are fairly high for Gleason 8 to 10 cases, even when the cancer is thought to be contained in the prostate. For instance, one study involved surgery plus two years of androgen deprivation therapy ADT right after surgery. At five years, freedom from recurrence rates were quite high (92% free from recurrence and 97% survival at 5 years for 199 Gleason 8 or higher patients or stage T3b), much better than with surgery alone, in contrast to not much effect of adding ADT for less advanced patients getting surgery (who tend to do better anyway). You can check this study at: https://www.ncbi.nlm.nih.gov/pubmed/21502546. It has a lot of excellent data and references, and I can answer questions (probably) about the complete paper which is available from a link at that site. This is exciting stuff!!! When you add ADT, you need to counter side effects, and there are known ways to do that that are very to fairly to minimally effective. One exciting new approach is to use the old diabetes drug metformin to counter some of the main potential side effects of ADT and also to boost effectiveness of therapy. (For example, take a look at https://www.ncbi.nlm.nih.gov/pubmed/21933330, which suggests that metformin plus lifestyle tactics helps a lot in reducing side effects of ADT; it has a link to a free copy of the complete paper. It can help to add a medical oncologist to your treatment team to handle the drug side of your therapy.

    Again, congratulations on those good scan results.

    Take care,

    Jim

     
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