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    Old 07-11-2020, 05:53 PM   #1
    Walu
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    Another Newbie - PSA issues

    Hi: I'm new to the site. My question primarily relates to the link between PSA and diet. In March 2017, my PSA was 2.5 In March 2018, the PSA was 3.2 In March 2019, the PSA was 4.4 Six months later in September 2019, the PSA was 3.4 March of 2020, PSA was 5.2 July of 2020, PSA was 5.2 So it has been going up, although it dropped to 3.4 less than a year ago. My diet was POOR (high fat, low fiber) leading up to the 4.4. The next six months I really worked at eating better (lower fat) and my PSA came down to 3.4 More recently when my PSA jumped to 5.2, my diet was terrible (in part due to the pandemic). I'm going back for a PSA in a couple months. I'm hoping that improving my diet, that will help. Any thoughts? Anyone else experience a seeming link between PSA and diet. (I'll know more when I go back at the end of August and see if the PSA comes down following a period of a couple months of much improved diet [and exercise]). One side note, about 14 months ago, I had an MRI of the prostate (to look for the spread of cancer or whether it was aggressive). It came back negative, which I'm told means either I do not have cancer, or if I do, it is early state and not aggressive.

     
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    Old 07-12-2020, 12:31 PM   #2
    guitarhillbilly
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    Re: Another Newbie - PSA issues

    Quote:
    Originally Posted by Walu View Post
    Hi: I'm new to the site. My question primarily relates to the link between PSA and diet. In March 2017, my PSA was 2.5 In March 2018, the PSA was 3.2 In March 2019, the PSA was 4.4 Six months later in September 2019, the PSA was 3.4 March of 2020, PSA was 5.2 July of 2020, PSA was 5.2 So it has been going up, although it dropped to 3.4 less than a year ago. My diet was POOR (high fat, low fiber) leading up to the 4.4. The next six months I really worked at eating better (lower fat) and my PSA came down to 3.4 More recently when my PSA jumped to 5.2, my diet was terrible (in part due to the pandemic). I'm going back for a PSA in a couple months. I'm hoping that improving my diet, that will help. Any thoughts? Anyone else experience a seeming link between PSA and diet. (I'll know more when I go back at the end of August and see if the PSA comes down following a period of a couple months of much improved diet [and exercise]). One side note, about 14 months ago, I had an MRI of the prostate (to look for the spread of cancer or whether it was aggressive). It came back negative, which I'm told means either I do not have cancer, or if I do, it is early state and not aggressive.
    Your PSA graph looks very similar to mine in about the same timeline. Don't let the YO-YO fool you into a false sense of security. I'm surprised your UR has not already requested a biopsy. My UR wanted to do a biopsy at 5.3 but I chose to wait another 11 months. Once my PSA hit 6.9 I agreed to the biopsy.You can see the summary results in my signature. Please note that my Pre-Biopsy MRI was also Negative and I still had an Aggressive Score on my Biopsy.
    DO NOT let the relative low PSA numbers fool you and your PSA Velocity is cause for concern. Your UR should be able to also calculate your PSA Density from the MRI results which is also an important factor in the decision making to investigate farther. [Biopsy] Do not play the denial game because I did and it is very easy to do that over choosing a biopsy especially when other folks are telling you what you want to hear. Only you can make the decision to Biopsy but after traveling down a very similar road I would not wait to do the biopsy.I was very fortunate with a PSA of 6.9 and an Aggressive score of 4 [1-5 scale] that my PCa had not left the prostate when I had the NBS[Nuclear Bone Scan] and Pelvic CT. It is much more treatable with surgery or Radiation +ADT when the PCa is confined to the prostate. Early Detection is the name of the game.
    You never stated your age.
    __________________
    T2a / Gleason Score 8 / PSA at Diagnosis 6.9 /
    1-5 aggressive score : 4
    12 cores= 4 positive
    NBS = Negative
    Pelvic CT= Negative
    Pelvic MRI= Negative
    Age at Diagnosis= 60-65 age group
    Completed 42 IMRT Sessions
    Lupron scheduled for 2 years [Started DEC 2019]

     
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    Old 07-12-2020, 12:51 PM   #3
    Terry G
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    Re: Another Newbie - PSA issues

    Walu, Welcome to the forum. PSA depends on many things and finding the cause for your climb is very important. I’m not aware that diet plays a large role in PSA. Age, size of your prostate, inflammation or infection, recent sexual activity, and even riding a bicycle or a digital prostate exam can effect PSA. Prostate cancer can also effect PSA. If your Dr. has not suggested you have a biopsy I would recommend changing the Dr. A biopsy is the only way to confirm prostate cancer and finding it early is very important.
    __________________
    Rising PSA:
    11/13 1.95; 9/15 3.28; 10/16 5.94
    TRUS 1/17
    Bx: Three of twelve cores adenocarcinoma Gleason 6 (3+3) all on left side, no pni.
    DOB 7/21/47; good health; age 69 @ Dx
    Treated 6/17 SBRT @ Cleveland Clinic by Dr. Tendulkar
    Reduced ejaculate only side effect; everything works
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    PSAís post.SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6

     
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    Old 07-12-2020, 01:06 PM   #4
    Walu
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    Re: Another Newbie - PSA issues

    Thanks for the info. My age is 65. Walt

     
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    Old 07-12-2020, 02:43 PM   #5
    DjinTonic
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    Re: Another Newbie - PSA issues

    Welcome Walt! A rising PSA is not necessarily prostate cancer, but it can be and merits investigation. My advice is to take the advice of a urologist who suggests a biopsy. Even though serious high-grade PCa may account for only 20-25% of cases, it can be lethal and early diagnosis is the most important weapon in its fight.

    Some researchers believe that a PSA of 3 and not 4 should be used as the upper limit of normal. You do not want to be in a position where you ignore a request for a biopsy now, have advanced, clinically significant PCa diagnosed in the future, and look back, wondering "What if?"

    An initial biopsy is a win/win proposistion: either you have the peace of mind knowing that no cancer was found, or you have the knowledge that you found your cancer as early as possible.

    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 07-12-2020, 04:26 PM   #6
    Walu
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    Re: Another Newbie - PSA issues

    Thank you. What is the biopsy like? Iím not too concerned about pain. There is no catherization up the urethra, correct? Doesnít the biopsy super aggravate the prostate, causing issues of urinary frequency urges. I already have bph so I donít relish those symptoms being worse. Walt

     
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    Old 07-12-2020, 05:52 PM   #7
    guitarhillbilly
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    Re: Another Newbie - PSA issues

    Quote:
    Originally Posted by Walu View Post
    Thank you. What is the biopsy like? Iím not too concerned about pain. There is no catherization up the urethra, correct? Doesnít the biopsy super aggravate the prostate, causing issues of urinary frequency urges. I already have bph so I donít relish those symptoms being worse. Walt

    Quote:
    "What you can expect
    Types of prostate biopsy procedures

    Prostate biopsy samples can be collected in different ways. Your prostate biopsy may involve:

    Passing the needle through the wall of the rectum (transrectal biopsy). This is the most common way of performing a prostate biopsy.

    Inserting the needle through the area of skin between the anus and scrotum (transperineal biopsy). A small cut is made in the area of skin (perineum) between the anus and the scrotum. The biopsy needle is inserted through the cut and into the prostate to draw out a sample of tissue. An MRI or CT scan is generally used to guide this procedure.

    What to expect during transrectal prostate biopsy

    You will be asked to lie on your side with your knees pulled up to your chest. You might be asked to lie on your stomach. After cleaning the area and applying gel, your doctor will gently insert a thin ultrasound probe into your rectum.

    Transrectal ultrasonography uses sound waves to create images of your prostate. Your doctor will use the images to identify the area that needs to be numbed with an injection to reduce discomfort associated with the biopsy. The ultrasound images are also used to guide the prostate biopsy needle into place.

    Once the area is numbed and the biopsy device is situated, your doctor will retrieve thin, cylindrical sections of tissue with a spring-propelled needle. The procedure typically causes a very brief uncomfortable sensation each time the spring-loaded needle takes a sample.

    Your doctor may target a suspicious area to biopsy or may take samples from several places in your prostate. Generally, 10 to 12 tissue samples are taken. The entire procedure usually takes about 10 minutes.
    After the procedure

    Your doctor will likely recommend that you do only light activities for 24 to 48 hours after your prostate biopsy.

    You'll probably need to take an antibiotic for a few days. You might also:

    Feel slight soreness and have some light bleeding from your rectum.
    Have blood in your urine or stools for a few days.
    Notice that your semen has a red or rust-colored tint caused by a small amount of blood in your semen. This can last for several weeks.

    Call your doctor if you have:

    Fever
    Difficulty urinating
    Prolonged or heavy bleeding
    Pain that gets worse

    Results

    A doctor who specializes in diagnosing cancer and other tissue abnormalities (pathologist) will evaluate the prostate biopsy samples. The pathologist can tell if the tissue removed is cancerous and, if cancer is present, estimate how aggressive it is. Your doctor will explain the pathologist's findings to you."
    -End Quote-



    My transrectal biopsy was very non-eventful. The UR gave me shots to deaden the nerves very similar to what a dentist does before working on your tooth. The UR explained the procedure very well while performing the biopsy. When the needle popped it felt like a light to moderate pinch of the skin on the arm or hand.
    I did have to have IV Anti-biotics the Day before-the Day Of- and the Day After the biopsy. This decision was made by my UR after seeing the results of my rectal swab.In my case I thought the Day before PREP and Morning of PREP was more demanding than the actual biopsy.
    If you have the transperineal biopsy it will most likely be performed under general Anesthesia in an operating room at the local hospital. This is what my UR does. This method does have less post procedure infection risks.
    __________________
    T2a / Gleason Score 8 / PSA at Diagnosis 6.9 /
    1-5 aggressive score : 4
    12 cores= 4 positive
    NBS = Negative
    Pelvic CT= Negative
    Pelvic MRI= Negative
    Age at Diagnosis= 60-65 age group
    Completed 42 IMRT Sessions
    Lupron scheduled for 2 years [Started DEC 2019]

     
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    Old 07-12-2020, 06:56 PM   #8
    Terry G
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    Re: Another Newbie - PSA issues

    Hillbilly gives an accurate and detailed explanation of the biopsy. That said I found it to be no big deal; a little uncomfortable but no real pain. The infection risk of the transrectal approach is about 1 in 20. If given a choice I would opt for transperoneal. Bottom line is the only way of catching this disease early is with a biopsy.
    __________________
    Rising PSA:
    11/13 1.95; 9/15 3.28; 10/16 5.94
    TRUS 1/17
    Bx: Three of twelve cores adenocarcinoma Gleason 6 (3+3) all on left side, no pni.
    DOB 7/21/47; good health; age 69 @ Dx
    Treated 6/17 SBRT @ Cleveland Clinic by Dr. Tendulkar
    Reduced ejaculate only side effect; everything works
    To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

    PSAís post.SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6

     
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    Old 07-13-2020, 12:05 PM   #9
    OldTiredSailor
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    Re: Another Newbie - PSA issues

    I am another, somewhat older ~73, guy who had a PSA yo-you similar to what you describe. During the 2004 - 2013 (age 57 to 66) it varied between 4.0 and 5.8 and I always found reason to ignore it. My long time GP (board certified Internist) was always willing to let me postpone a decision because I was young(ish) and otherwise very healthy. Additionally, I was a hard core bicycle rider which was usually a convenient excuse.

    My sailing and bicycle adventures from 2013 to 2018 led me to "forget" all about the PSA and none of my annual physicals questioned the absence of a PSA test.

    May 2018 arrived with a new Internist who insisted I have a PSA test... And the rest is history - RALP in August 2018 and I am now in month 24 of the "Is it recurrent Prostate Cancer and do I need Radiation Therapy?" puzzle.

    I doubt that your MRI should provide as much certainty as you ascribe to it. Mine, done by a radiologist who has worked with my urologist on thousands of PCa cases, gravely understated the tumor size, my prostate size, and the location of the cancer cells. Additionally, the radiologist was quite specific that I had no PCa escape from the capsule. The surgeon found that my PCa had, in fact, found it's way out of the capsule.

    My PIRADS-3 MRI result could have led me to believe I could delay the initial treatment. Fortunately, my urologist and members of the non-defunct Prostate Cancer Forum (many of whom are now here), convinced me to do the safe and sane thing - get a biopsy and find out what kind of PCa tissue was hiding in there and how much there might be.

    My biopsy was a non-event. My urologist does them under the blessed tranquility of Propofil. One moment I was talking the Nurse Anesthesiologist about sailing and the next moment I was in a small recovery room with my wife holding my hand. No pain, no fuss, no muss!

    Only that biopsy can give you the actual details about your prostate.

    Medicare and Plan F paid 100% of everything for me during my 3-month diagnosis and treatment planning phase. Don't delay - get that Biopsy.
    __________________
    DOB: July 1947
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported
    Decipher RP = 0.47, which is .01 above a LOW risk

    Post-RP PSA
    10/3/18 0.021 01/4/19 0.018 04/03/19 0.022 06/26/19 0.028 10/1/19 0.035 3/14/20 0.050 4/16/20 0.055 7/8/20 0.060

     
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    Old 07-13-2020, 01:49 PM   #10
    Prostatefree
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    Re: Another Newbie - PSA issues

    Early detection early treatment is the watchword for cancer. Especially treatable cancers. PCa is a very treatable cancer. Stay on top of it.

    Protocols vary slightly based on your profile, but in general, a PSA of 4 triggers a biopsy. PSA can bounce around a bit, but a trend is obvious. Yours is rising.

    I manipulated my PSA with diet and supplements for a while. See the drop in my signature. It made no difference in the progression of my cancer. The time I wasted is not something I would do again.

    There was also a lull in testing due to the scare of overtreatment. My health system went to testing PSA every three years instead of ever year. See my big jump. I have no sympathy for the prostate cancer treatment deniers. My anxiety over recurrence would be much lower had I acted sooner. I was fortunate.

    By all means, improve your diet and get your BMI into normal, but don't let that distract you from managing your healthcare, screening for cancer, and getting biopsies when appropriate.

    I continue to eat healthier and lower my weight. It makes everything better, but it will not cure cancer. There are demographics that increase your cancer risk for PCa and should not be ignored: diet, weight, visceral fat, race, family history, age. Are they the cause or just sign posts for things we don't know yet? No one knows.

    Take care of yourself and follow the standard protocols. We have been managing this disease for a long time and have a history and knowledge we know works.

    Sounds like you are a candidate for a biopsy.
    __________________
    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;
    6-30-20 PSA less than 0.02, zero club 4 yrs

     
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    Old 07-13-2020, 01:56 PM   #11
    Gary I
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    Re: Another Newbie - PSA issues

    Concur that a biopsy is a need, and relatively minor, event.

    One word of caution is to be very careful with the common use of strong (sledgehammer) antibiotics. You do not want 'black boxed' Cipro. It was used during my biopsy, and resulted in me getting C Diff.

    Caution is the word. Good luck!
    __________________
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    Second 3T MRI 1/17
    RALP 7/17, G3+4, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over next 4 months
    DCFPyl PET & ercMRI @NCI - 11/17
    One inch tumor still in prostate bed
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    Old 07-13-2020, 02:14 PM   #12
    Prostatefree
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    Re: Another Newbie - PSA issues

    Gary makes an important point. Antibiotics are often used indescrimanately by urologists to screen for PCa by prescriping anitbiotics for a rising PSA thinking the inflammation of an infection can spike PSA. This is rare. The overuse of antibiotics is a serious problem and bad medicine.

    Studies have shown the occassional drop in PSA some experience following the use of antibiotics is no different than the control group. The problem is time lost for many men thinking their PSA rise was from an infection and a biopsy is postponed or they become complacent about their annual PSA test. A diagnoses of BHP can also have a simialr outcome; my PSA rise is due to BHP and follow up becomes lax.

    If you have used antibiotics recently for this purpose, or other reasons, you may be at increased risk of complications during biopsy to drug resistant bacteria. Also, don't expect BHP to be the last answer to your PSA rise. Most of us have it in one form or another. BHP PSA bounces a lot, but usually returns to a more normal number. PSA from cancer usually never settles back done to previous levels, but continues the trend always pushing the curve up.
    __________________
    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;
    6-30-20 PSA less than 0.02, zero club 4 yrs

     
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