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    Old 01-26-2020, 05:58 AM   #16
    Pbriga41
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    Re: Psa prostrate Levels

    Quote:
    Originally Posted by IADT3since2000 View Post
    Hi Pam,

    I'm sure Djin will reply, but I had no symptoms prior to my first ever PSA came back 113.6 (soon confirmed, December 1999), with the DRE revealing a rock-hard prostate. Unfortunately, the vast majority of us do not have symptoms that sound an alarm for this disease; that is why screening with the PSA test is so important to signal that something (usually BPH, infection, or cancer) is going wrong in the prostate. I was diagnosed with life-threatening prostate cancer. I have worked hard against the cancer and have been lucky, now likely cured.

    You have had a lot of good replies. Obviously your husband needs medical attention, and we are not doctors here, but I suspect he probably has a short-term prostate infection that is driving his PSA up and not cancer.

    Good luck.

    Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.
    Thank you so much in helping me understand and feel more hopeful that is is something as little as an infection or something we will conquer. I see you were diagnosed at his age and have succeeded with treatment and conqured. I think I am anxiety ridden due to my past experience and feel I need to be maybe a bit over the edge proactive. After reading your diagnosis and treatment and prognosis, you are an inspiration to all of us. God Bless
    Pam

     
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    Old 01-26-2020, 07:51 AM   #17
    DjinTonic
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    Re: Psa prostrate Levels

    I would not be surprised if the PSA rise isn't from cancer. And if it is, I think the odds are excellent that you have caught it very early. As we know, PSA goes up with conditions other than cancer. The mind gloms onto the worst scenarios -- we've all been there. Take heart that these are temporary storms.

    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, negative 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-specific mortality: 3.3%
    uPSA: 0.010 (3 mo.)...0.013 (2 yr. 10 mo.)

     
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    Old 01-26-2020, 10:20 AM   #18
    Pbriga41
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    Re: Psa prostrate Levels

    Quote:
    Originally Posted by DjinTonic View Post
    I would not be surprised if the PSA rise isn't from cancer. And if it is, I think the odds are excellent that you have caught it very early. As we know, PSA goes up with conditions other than cancer. The mind gloms onto the worst scenarios -- we've all been there. Take heart that these are temporary storms.

    Djin
    Thank you , again, Djin...everyone has so many positive and reassuring advice on prostate cancer. One more question, probably ridiculous, when Dr. Is performing biopsy will be be able to see anything that would indicate or tissue that is questionable or it is all based on pathology result?

     
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    Old 01-26-2020, 11:45 AM   #19
    Southsider170
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    Re: Psa prostrate Levels

    Quote:
    Originally Posted by Pbriga41 View Post
    Thank you , again, Djin...everyone has so many positive and reassuring advice on prostate cancer. One more question, probably ridiculous, when Dr. Is performing biopsy will be be able to see anything that would indicate or tissue that is questionable or it is all based on pathology result?

    TRUS stands for "Trans Rectal Ultra Sound", so the doctor uses the ultrasound picture to focus in on areas that he sees as suspicious or questionable. Sometimes men get an MRI before hand to help steer the biopsy in the direction of trouble.

    But when the samples come out, the doctor really has no way of knowing what any of them is, until they get to pathology. If he goes to a doctor that has the path lab in the same building, he'll have the results quicker than if they have to ship them to a lab, but even then, he should know the results within a couple of weeks.

     
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    Old 01-26-2020, 12:07 PM   #20
    Pbriga41
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    Re: Psa prostrate Levels

    Quote:
    Originally Posted by Southsider170 View Post
    TRUS stands for "Trans Rectal Ultra Sound", so the doctor uses the ultrasound picture to focus in on areas that he sees as suspicious or questionable. Sometimes men get an MRI before hand to help steer the biopsy in the direction of trouble.

    But when the samples come out, the doctor really has no way of knowing what any of them is, until they get to pathology. If he goes to a doctor that has the path lab in the same building, he'll have the results quicker than if they have to ship them to a lab, but even then, he should know the results within a couple of weeks.
    Thank you..resilts will be in 7-10 days and thank you for exposing the procedure

     
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    Old 01-26-2020, 12:24 PM   #21
    DjinTonic
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    Re: Psa prostrate Levels

    As southsider posted, your uro uses the ultrasound screen to aim at any suspicious-looking areas in each prostate zone. The problem is akin to that with PSA: a lack if specificity. All sorts of conditions, including, but not exclusive to, cancer cause a change in the density of tissue that makes ultrasound reflect back differently (apearing darker on the screen, I believe) than healthy tissue. But the nature of the lesion -- cancer, chronic or acute inflammation, infection, etc. -- is known only when the sample is examined microscopically in the lab.

    BTW, the equipment does have built-in functionality that gives a good estimate of prostate size.

    Djin

     
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    Old 01-28-2020, 09:56 AM   #22
    Gary I
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    Re: Psa prostrate Levels

    Confusing the issue, for me at least, were varying estimates of physical prostate size (volume) vs. estimates of prostate weight. Until they took it out, of course.
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    Old 01-28-2020, 10:07 AM   #23
    DjinTonic
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    Re: Psa prostrate Levels

    Quote:
    Originally Posted by Gary I View Post
    Confusing the issue, for me at least, were varying estimates of physical prostate size (volume) vs. estimates of prostate weight. Until they took it out, of course.

    I can understand estimates that don't jive, but I'm not clear on why there would be any confusion between weight and volume. Because the specific gravity of prostate tissue is almost exactly 1, it means weight and volume are interchangeable: a 30 g prostate is 30 cc. My post-op path report gave my prostate size in grams (64), but I know some pathologists report cc.

    Djin

     
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    Old 01-28-2020, 12:52 PM   #24
    IADT3since2000
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    Re: Psa prostrate Levels

    Hi Gary (and thanks to Djin),

    Quote:
    Originally Posted by Gary I View Post
    Confusing the issue, for me at least, were varying estimates of physical prostate size (volume) vs. estimates of prostate weight. Until they took it out, of course.
    The usual ways of measuring size are by DRE, by Trans Rectal Ultrasound (TRUS), by multiparametric MRI (mpMRI), or by some other scan and of course by a prostatectomy specimen and a scale.

    DRE is known to be only a rough approximation, with the expertise of the urologist (or PCP) doing the exam being very important. It seems logical that a urologist who does many DREs followed by prostatectomies where he or she can compare the original estimate with truth would be a lot better at this than a PCP or inexperienced urologist.

    However, an ultrasound is quite accurate, and not dependent on the operator in contrast to DRE estimation, with an mpMRI adding some additional accuracy over TRUS. In his 2016 answers to the moderator at the 2016 conference, Dr. Mark Emberton, a UK expert urologist, said that TRUS somewhat underestimates the size because you have to press the prostate with the ultrasound device to get a good image. He added that the mpMRI volume was always greater than the TRUS volume by approximately 20%. (Discussion between Drs. Emberton and Moyad, DVD set Disc 1, 1:50:04 and following)

    Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.

     
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    Old 01-28-2020, 01:19 PM   #25
    DjinTonic
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    Re: Psa prostrate Levels

    After the initial workup, changes in prostate size are important. If you have BPH, increases in size are not of great concern, as long as flow is OK and there are no other trouboesome urinary symptoms (my prostate grew to 90 g before I called it a day and decided on a procedure for reduced flowrate).

    A uro could adjust any TRUS size estimate upward to align with more accurate MRI figures; however, I doubt they do. I imagine they just record the numbers each time your prostate is measured and track your trend.

    The challenge for a uro is ensuring that PSA rises are commensurate with increases in prostate size. Otherwise, as I well know, it was biopsy time.

    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, negative 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-specific mortality: 3.3%
    uPSA: 0.010 (3 mo.)...0.013 (2 yr. 10 mo.)

     
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