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    Old 01-22-2020, 08:42 AM   #1
    Pbriga41
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    Possible Prostate Cancer

    Hi..I am new on here and so frazzled as my fiance' 56 years old went to urologist for low testosterone level per his GP...he had a physical in October 2019 and psa has been 1.5 for years..had blood test last week and psa is 3.65.. Can it change that my I in 4 months? He has no signs, which I understand that isn't always the case,. The urologist wanted a repeat test in 5 weeks and then consultation.. We decided to be proactive and immediately request a biopsy. He is waiting for a call to have test. Is it more than likely cancer is brewing. He had an internal exam and Dr. Said he felt nothing suspicious.. We are worried that it is cancer .. Any thoughts or encouragement from anyone who has experienced similar situation?

     
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    Old 01-22-2020, 05:39 PM   #2
    OrygunDan
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    Re: Possible Prostate Cancer

    Take a deep breath and relax. There are many reasons the PSA number may be slightly elevated:inflammation, or riding a bicycle, motorcycle, or sex within 72 hours before the blood test. Those numbers are very low and not cause to get a biopsy and risk an infection. His doc is right, wait a while and retest, remembering to abstain from the above listed items for 3 days prior to the blood draw.

     
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    Old 01-22-2020, 07:19 PM   #3
    Insanus
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    Re: Possible Prostate Cancer

    Quote:
    Originally Posted by Pbriga41 View Post
    Hi..I am new on here and so frazzled as my fiance' 56 years old went to urologist for low testosterone level per his GP...he had a physical in October 2019 and psa has been 1.5 for years..had blood test last week and psa is 3.65.. Can it change that my I in 4 months? He has no signs, which I understand that isn't always the case,. The urologist wanted a repeat test in 5 weeks and then consultation.. We decided to be proactive and immediately request a biopsy. He is waiting for a call to have test. Is it more than likely cancer is brewing. He had an internal exam and Dr. Said he felt nothing suspicious.. We are worried that it is cancer .. Any thoughts or encouragement from anyone who has experienced similar situation?
    A negative DRE means nothing. Get the biopsy.

     
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    Old 01-22-2020, 11:52 PM   #4
    guitarhillbilly
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    Re: Possible Prostate Cancer

    The PSA number alone does not tell the whole story. PSA Velocity - Prostate Density- PSA Numbers= Total and Free- are all used to make informed decisions on whether or not to have a biopsy.
    I would never tell anyone NOT to have a biopsy but be aware of the risks involved and amount of samples taken between a transrectal or transperineal biopsy. Active Surveillance is also an option.Here is link to Johns Hopkins.
    They have very good information on prostate biopsies.

    https://www.********************/health/treatment-tests-and-therapies/prostate-biopsy

    Please note I chose to wait another 4 years to have a biopsy when my PSA jumped from 2.4 to 4.7 My PSA did the YO-YO from the initial jump.I did have a MRI after 3 years [5.3 PSA] to see if any cancer was outside the prostate. I waited another 11 months and did the biopsy when my PSA hit 6.9.
    LAB Results= T2a / Gleason Score = 8

    I just letting you know my choice and path and would Never tell anyone to choose my path but it worked for me. Waiting another 4 years from the Initial PSA Jump bought me 4 more years of no Surgery OR Hormone therapy PLUS Radiation.

     
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    Old 01-23-2020, 12:52 AM   #5
    Pbriga41
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    Re: Possible Prostate Cancer

    Quote:
    Originally Posted by guitarhillbilly View Post
    The PSA number alone does not tell the whole story. PSA Velocity - Prostate Density- PSA Numbers= Total and Free- are all used to make informed decisions on whether or not to have a biopsy.
    I would never tell anyone NOT to have a biopsy but be aware of the risks involved and amount of samples taken between a transrectal or transperineal biopsy. Active Surveillance is also an option.Here is link to Johns Hopkins.
    They have very good information on prostate biopsies.

    https://www.********************/health/treatment-tests-and-therapies/prostate-biopsy

    Please note I chose to wait another 4 years to have a biopsy when my PSA jumped from 2.4 to 4.7 My PSA did the YO-YO from the initial jump.I did have a MRI after 3 years [5.3 PSA] to see if any cancer was outside the prostate. I waited another 11 months and did the biopsy when my PSA hit 6.9.
    LAB Results= T2a / Gleason Score = 8

    I just letting you know my choice and path and would Never tell anyone to choose my path but it worked for me. Waiting another 4 years from the Initial PSA Jump bought me 4 more years of no Surgery OR Hormone therapy PLUS Radiation.
    Good Morning or Evening. I am awake at 215a.m. just a couple of questions... Your MRI indicated cancer in the prostrate?
    Obviously after much research you chose a path that did work for you. My thought on the whole prostate cancer being contained within prostate , if it is at all...a biopsy would put our mind at ease and will follow up what needs to be put in place if detected with Dr. Recommendation .. If cancer is discovered we will have a jump on our options instead of playing russian roulette on PSA levels jumping up and down.. Just our thoughts
    I am a widow ..my former husband passed from colon cancer as a late diagnosis was made , he was 45 years old,which led to stage IV and five year expectancy. Had we had been aware of warning signs...the stage would not had been a IV..and he would have had a fighting chance. I have been to Sloan Kettering meeting with the specialist regarding the colon..prognosis, surgery and chemo etc. He passed after 7 years.
    My husband is having a bacterial swap this week and we go from there for biopsy..per Dr. Recommendation...As my research indicate a max of 1 to 3 % end up with infection and or hospitalization from this biopsy ..those odds I am willing to take ..i am sure anyone who has been a cancer caregiver after a late diagnosis..would agree with a biopsy with my current husband is reassurance and proactive..taking a small chance with infection. Thank you for your advice e. I am happy your route worked for you

     
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    Old 01-23-2020, 05:01 AM   #6
    DjinTonic
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    Re: Possible Prostate Cancer

    Quote:
    Originally Posted by guitarhillbilly View Post
    The PSA number alone does not tell the whole story. PSA Velocity - Prostate Density- PSA Numbers= Total and Free- are all used to make informed decisions on whether or not to have a biopsy.
    I would never tell anyone NOT to have a biopsy but be aware of the risks involved and amount of samples taken between a transrectal or transperineal biopsy. Active Surveillance is also an option.Here is link to Johns Hopkins.
    They have very good information on prostate biopsies.

    https://www.********************/health/treatment-tests-and-therapies/prostate-biopsy

    Please note I chose to wait another 4 years to have a biopsy when my PSA jumped from 2.4 to 4.7 My PSA did the YO-YO from the initial jump.I did have a MRI after 3 years [5.3 PSA] to see if any cancer was outside the prostate. I waited another 11 months and did the biopsy when my PSA hit 6.9.
    LAB Results= T2a / Gleason Score = 8

    I just letting you know my choice and path and would Never tell anyone to choose my path but it worked for me. Waiting another 4 years from the Initial PSA Jump bought me 4 more years of no Surgery OR Hormone therapy PLUS Radiation.
    I'm not sure I'm following your active surveillance point, but unless someone has had a positive biopsy, they can't do AS.

    While we are all free to make our own decisions, I wouldn't agree with you that waiting years for a biopsy after a very large PSA jump "worked" for you because you then found out your G8 appears to be prostate-confined on MRI. MRIs do not excel at predicting extraprostatic extension, and most other adverse features, such as bladder neck invasion and, of course, positive margins can be determined definitively only by microscopic examination.

    I sincerely wish you all the very best in your treatment outcome, but if you are unlucky and encounter metastatic PCa, you will not know if it could have been prevented or mitigated by diagnosing your PCa and starting your treatment four years earlier. Early diagnosis is the biggest gun in the arsenal against serious PCa.

    In theory you could wait yet another 4 treatment-free years or even longer. The question, of course, is how many years you would be taking off your lifespan.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)…0.015 (1 yr. 6 mo.)…0.015 (2 yr. 4 mo.)

     
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    Old 01-23-2020, 05:19 AM   #7
    Pbriga41
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    Re: Possible Prostate Cancer

    Quote:
    Originally Posted by DjinTonic View Post
    I'm not sure I'm following your active surveillance point, but unless someone has had a positive biopsy, they can't do AS.

    While we are all free to make our own decisions, I wouldn't agree with you that waiting years for a biopsy after a very large PSA jump "worked" for you because you then found out your G8 appears to be prostate-confined on MRI. MRIs are weakest at predicting extraprostatic extension, and most other adverse features, such as bladder neck invasion and, of course, positive margins can be determined definitively only by microscopic examination.

    I sincerely wish you all the very best in your treatment outcome, but if you are unlucky and encounter metastatic PCa, you will not know if it could have been prevented by starting treatment four years earlier. Early diagnosis and treatment is the biggest gun in the war against serious PCa.

    Djin
    I believe somehow our lines got crossed. We got a baseline pss years ago..stayed same for years. Now went up significantly in 4 months. Dr. Requesting biopsy and we are getting one on Feb. 4 after bacterial swap today..i definately would not wait.. Maybe you were reading up a bit regarding my husband who passed from colon cancer and was not diagnosed until he was stage IV. At 45 years old...
    As I remarried and now several years later we are encountering possible prostate cancer. Can't wait after what I went through with con cancer. Prevention ...proactive is where we are now. Praying for good news
    Thank you Doin
    Pmp

     
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    Old 01-23-2020, 07:51 AM   #8
    guitarhillbilly
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    Re: Possible Prostate Cancer

    Quote:
    Originally Posted by Pbriga41 View Post
    Good Morning or Evening. I am awake at 215a.m. just a couple of questions... Your MRI indicated cancer in the prostrate?
    Obviously after much research you chose a path that did work for you. My thought on the whole prostate cancer being contained within prostate , if it is at all...a biopsy would put our mind at ease and will follow up what needs to be put in place if detected with Dr. Recommendation .. If cancer is discovered we will have a jump on our options instead of playing russian roulette on PSA levels jumping up and down.. Just our thoughts
    I am a widow ..my former husband passed from colon cancer as a late diagnosis was made , he was 45 years old,which led to stage IV and five year expectancy. Had we had been aware of warning signs...the stage would not had been a IV..and he would have had a fighting chance. I have been to Sloan Kettering meeting with the specialist regarding the colon..prognosis, surgery and chemo etc. He passed after 7 years.
    My husband is having a bacterial swap this week and we go from there for biopsy..per Dr. Recommendation...As my research indicate a max of 1 to 3 % end up with infection and or hospitalization from this biopsy ..those odds I am willing to take ..i am sure anyone who has been a cancer caregiver after a late diagnosis..would agree with a biopsy with my current husband is reassurance and proactive..taking a small chance with infection. Thank you for your advice e. I am happy your route worked for you
    The MRI was looking for Cancer OUTSIDE the prostate. It also provided my UR with information about my prostate volume.[size]

     
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    Old 01-23-2020, 08:03 AM   #9
    DjinTonic
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    Re: Possible Prostate Cancer

    Quote:
    Originally Posted by guitarhillbilly View Post
    The MRI was looking for Cancer OUTSIDE the prostate. It also provided my UR with information about my prostate volume.[size]
    Yes, of course. I got the impression you were thinking that an indication that, as far as an MRI can predict, the G8 cancer was still prostate-confined meant nothing was lost by waiting the four years for a biopsy.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)…0.015 (1 yr. 6 mo.)…0.015 (2 yr. 4 mo.)

     
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    Old 01-23-2020, 08:17 AM   #10
    guitarhillbilly
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    Re: Possible Prostate Cancer

    Quote:
    Originally Posted by DjinTonic View Post
    I'm not sure I'm following your active surveillance point, but unless someone has had a positive biopsy, they can't do AS.

    While we are all free to make our own decisions, I wouldn't agree with you that waiting years for a biopsy after a very large PSA jump "worked" for you because you then found out your G8 appears to be prostate-confined on MRI. MRIs do not excel at predicting extraprostatic extension, and most other adverse features, such as bladder neck invasion and, of course, positive margins can be determined definitively only by microscopic examination.

    I sincerely wish you all the very best in your treatment outcome, but if you are unlucky and encounter metastatic PCa, you will not know if it could have been prevented or mitigated by diagnosing your PCa and starting your treatment four years earlier. Early diagnosis is the biggest gun in the arsenal against serious PCa.

    In theory you could wait yet another 4 treatment-free years or even longer. The question, of course, is how many years you would be taking off your lifespan.

    Djin
    I did NOT write the whole book on this thread. The MRI was done before the biopsy to look for PCa outside the prostate and also gave UR Prostate Volume.

    I have already had a Nuclear Bone Scan and Pelvic CT Which came after the Biopsy and Diagnosis. Both of them were negative.

    We can all play the what if game .What if I had the biopsy and treatment 4 years ago with radiation and now had developed a secondary cancer as a result of the radiation?

    I made it perfectly clear in the above posting that I would NEVER tell anyone NOT to get a biopsy.

    In my case My UR and myself started watching my PSA closely after it jumped from 2.4 to 4.7. That is called surveillance and it did the yo yo the next 4 years.It actually dropped back to 3.5 a year after it hit 4.7 Those are not unusual numbers for someone in their 60's with inflammation in the prostate. Once again weighing the risks involved with a biopsy vs the results.

    You are correct that I could do nothing from now on and see how long it takes for the Prostate cancer to kill me.

    Prostate Cancer is ALL ABOUT risk management and the amount of risk each individual is willing to take.

    Generally speaking - PCa is slow growing so I was willing to wait and see how how my PSA trended. When it hit 6.9 I knew it was time for me to get the biopsy.
    I chose Hormone Therapy + Radiation and presently 6 weeks into my Lupron Therapy.

     
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    Old 01-23-2020, 08:19 AM   #11
    Pbriga41
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    Re: Possible Prostate Cancer

    Quote:
    Originally Posted by DjinTonic View Post
    Yes, of course. I got the impression you were thinking that an indication that, as far as an MRI can predict, the G8 cancer was still prostate-confined meant nothing was lost by waiting the four years for a biopsy.
    Oh my no...not my first rodeo with cancer, as I said, but prostrate is a new one I haven't researched but I am in the midst and questions in hand for urologist today regarding free psa ..if it's higher it is a good thing...i havejust been doing some reading. I would think with two psa rest a ..he would have free psa amount? Am I correct. Also is the swab absolutely necessary prior to biopsy?
    Pmp
    Djin

     
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    Old 01-23-2020, 08:34 AM   #12
    Steve135
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    Re: Possible Prostate Cancer

    Pbriga41, welcome sory you found yourself here. Like all the post above relax this whole deal will make you nuts, we here have all gone through our own journey. Some for 20 plus years and others still at the begining! What we all can say for sure everyone of us is different than the next guy, and therefore what treatment works for me won't work for you. What options are offered to you won't be offered to the next guy. The waiting not knowing will eat you up if you let it. I delt with my PCa dianosis by sharing it with who ever crossed my path. I deliver mail to 500 homes and every one of them knew what was up with me. It kept my spirts up...knowing I wasn't alone and quite a few other men on my route were going through or had gone through the same journey. I gained so much knowledge this way. And remember there is still old thinking out there in this field that 4.0 psa is a magic number for possible PCa. Hogwash I've seen some many posting PCa with smaller numbers than 4.0 while other have psa of 20 and No PCa!
    I noticed you posted no symptoms? I'm pretty sure evreyone gets there very own symptoms and may share others as well. Mine were as simple as low pressure urinating with a dribble, followed by a weak erection and a slight raise in psa of only 0.9 from 1.5 to 2.4. The other thing you posted was Low T. Low T is a good thing if you have PCa not the other way around. My testosterone is 7, as testosterone feeds PCa which is the last thing I want to be doing is my fertilizing cancer!
    steve d
    ________________
    Diag. 56 DOB 2/59 PSA 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI ,Multicentricity multifocal
    Margins NP lN's 5 neg pT3a,N0
    PSA 10/16 0.1 1yr 02/7/17 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm BCR rt. SVB Casodex + Trelstar
    04/17 SRT (42)
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/30 0.32 6/19 0.34 7/19 0.06 8/19 0.08 9/19 0.056
    10/190 0.08 11/19 0.07 12/19 0.07
    7/19 Trelstar, Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion

     
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    Old 01-23-2020, 08:34 AM   #13
    Prostatefree
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    Re: Possible Prostate Cancer

    To the original poster,

    You're doing fine. Don't over react and don't under react. Getting a biopsy now or waiting a few weeks and retesting to confirm with another test or wating a few months then retesting to see if it's still rising are all good pathways forward for you.

    His PSA starting to move at his young age is something to pay attention to. To our advantage, prostate cancer is slow moving.

    At this point, my choice is to following you doctor's advice. More on your doctor later.

    If using testosterone supplements or boosters I recommend he stop with the consult of his doctor. It is a current and dangerous fad to use these to counter the effects of aging. It is not good medicine, and there is a good risk it will fuel prostate cancer. If he recently began testosterone supplements his recent spike is very concerning.

    Back to the doctor, if the current urologist recommended testosterone supplements to counter the effects of aging I suggest you find another urologist. If your fiance has a serious hormone heath issue he should be seen by endrocrinologist.
    __________________
    Born 1953; family w/PCa-grandfather, 3 brothers;
    7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2;
    3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3;
    5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, G3+4, T vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months;
    12-8-19 PSA less than 0.02, zero club 3.5 yrs

     
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    Old 01-23-2020, 08:44 AM   #14
    Steve135
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    Re: Possible Prostate Cancer

    Duplicate post removed

     
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    Old 01-23-2020, 09:05 AM   #15
    DjinTonic
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    Re: Possible Prostate Cancer

    GuitarHillbilly brought up the issue of conditions other than PCa affecting PSA levels. Absolutely true. Uro's tend to push for biopsies more than we might expect or want. We may be thinking Hey, maybe my PSA rise is being caused by inflammation, or BPH, etc. But your uro knows that these conditions can and do exist alongside PCa.

    I never doubted my uro's or complained about any of my nine (!) biopsies for my slowly rising but fluctuating PSA over some 25 years of BPH. On the contrary, I wanted to know if I was harboring cancer. I never said or thought, We'll, that biopsy was unnecessary -- no cancer was found.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)…0.015 (1 yr. 6 mo.)…0.015 (2 yr. 4 mo.)

     
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