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    Old 02-25-2021, 09:53 AM   #1
    Liliac96
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    Elevated PSA/Urologist Felt Small Bump

    Hi Folks,
    First thanks for this board. I've read it a lot over the last few weeks.

    During a routine physical my husband's PSA came up elevated at 4.8. A retest showed it remained elevated at 5.2 with a free psa of 11%. During his physical, the doctor said his prostate felt normal.

    Today he saw a urologist PA. During the exam, she said she felt a very small bump on his prostate and thought the prostate might be slightly enlarged but could not say for certain. I thought I read that for low-grade prostate cancers, the digital exam is normal. So the fact she could feel a small bump is sending me into a total panic.

    A 3T MRI is scheduled and a biopsy after that.

    Is it possible that she could feel a small bump and still have cancer contained to the prostate?

    (I realize that no one can say for certain and that we won't know for sure until the MRI and biopsy are completed. I'm just so overwhelmed by this news. And I wasn't able to be with him during the appointment because of COVID rules.)

     
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    Old 02-25-2021, 10:13 AM   #2
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    Re: Elevated PSA/Urologist Felt Small Bump

    MRIs and biopsies will not be certain unless they hit the cancer. Trust the PSA test. If steadily rising you have to stay on the hunt until you find it. Multiple biopsies may be needed.

    Early detection early treatment is the mantra for treatable cancers.

     
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    Old 02-25-2021, 10:18 AM   #3
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    Re: Elevated PSA/Urologist Felt Small Bump

    Hi Liliac and welcome to the Board! You wrote:

    Quote:
    Originally Posted by Liliac96 View Post
    Hi Folks,
    ... I thought I read that for low-grade prostate cancers, the digital exam is normal. So the fact she could feel a small bump is sending me into a total panic. ... Is it possible that she could feel a small bump and still have cancer contained to the prostate? ...
    I have never heard that the DRE will be normal for low-grade prostate cancers. It's quite possible, even likely, that there could be a small tumor that could be felt while the cancer is still contained in the prostate. Total panic is a pretty common reaction. You will probably calm down with more information, support, good medical guidance, and time.

    Quote:
    Originally Posted by Liliac96 View Post
    A 3T MRI is scheduled and a biopsy after that.
    That is an excellent approach!

    Good luck!

    .Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. 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 and stable at <0.01; apparently cured (Current PSA as of 12/2/2020). (Current T 93 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 02-25-2021, 10:22 AM   #4
    Liliac96
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    Re: Elevated PSA/Urologist Felt Small Bump

    [QUOTE=IADT3since2000;5509107]Hi Liliac and welcome to the Board! You wrote:



    I have never heard that the DRE will be normal for low-grade prostate cancers. It's quite possible, even likely, that there could be a small tumor that could be felt while the cancer is still contained in the prostate. Total panic is a pretty common reaction. You will probably calm down with more information, support, good medical guidance, and time.



    That is an excellent approach!

    Good luck!

    .Jim

    Thank you. For some reason, I thought I'd read that.

    They are doing a transrectal, not a transperineal biopsy. I saw this is somewhat outdated. Should I be concerned or is a transrectal biopsy still acceptable?

    (And your signature really made me feel hopeful too)

     
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    Old 02-25-2021, 11:36 AM   #5
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    Re: Elevated PSA/Urologist Felt Small Bump

    About half of nodules felt on DRE are benign. My last biopsy was triggered by a new nodule felt on DRE (as well as a slightly elevated PSA). The nodule turned out to be benign; however, the same biopsy found two positive cores out of 14, a G10 and a G9, in two other prostate zones.

    Djin
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    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
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    Old 02-25-2021, 12:57 PM   #6
    guitarhunter
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    Re: Elevated PSA/Urologist Felt Small Bump

    I lost track of how many DRE's I had and not a single one felt anything unusual. My PSA went over 20 and they finally found cancer with the 4th biopsy. That one found a G7 cancer area which had also been identified as suspicious on my 3 MRI's.

     
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    Old 02-25-2021, 02:09 PM   #7
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    Re: Elevated PSA/Urologist Felt Small Bump

    During a DRE, the entire prostate cannot be examined. The doc is only feeling on side.

     
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    Old 02-25-2021, 02:45 PM   #8
    Liliac96
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    Re: Elevated PSA/Urologist Felt Small Bump

    Thank you all so much. It means so much that you've taken the time to reply.

    I'm still very worried but I feel better than I did this morning, thanks to you all.

     
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    Old 02-25-2021, 04:52 PM   #9
    IADT3since2000
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    Re: Elevated PSA/Urologist Felt Small Bump

    Hi again Liliac. You wrote:

    Quote:
    Originally Posted by Liliac96 View Post
    ... They are doing a transrectal, not a transperineal biopsy. I saw this is somewhat outdated. Should I be concerned or is a transrectal biopsy still acceptable?

    (And your signature really made me feel hopeful too)
    You're welcome. I'm glad to be able to help.

    Transperineal biopsies have been gaining in popularity, but my impression as an interested layman is that transrectal biopsies are still done frequently. The main issue is the low but increasing risk of some specific bacteria that can be released into the body by a transrectal biopsy. There are ways of estimating the risk, a test for individual patients before a biopsy, and ways of reducing the risk through use of antibiotics to which the bacteria are not resistant.

    Here is a link to a recent medical paper that is in line with my impression:

    https://pubmed.ncbi.nlm.nih.gov/33457275/

    .Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. 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 and stable at <0.01; apparently cured (Current PSA as of 12/2/2020). (Current T 93 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 02-26-2021, 12:30 PM   #10
    IADT3since2000
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    Re: Elevated PSA/Urologist Felt Small Bump

    Hi again Liliac,

    After posting earlier, I realized there is some very thoroughly researched evidence supporting what I posted that should put your mind at rest. It's not just me as a single layman telling you something. The research is summarized in a usable form in what are known as "The Partin Tables," which have been updated over the years by an expert team from Johns Hopkins University, which is famous for its expertise in surgery for prostate cancer, including critical pioneering advances by Dr. Patrick Walsh, MD. The main purpose of the tables was/is to estimate the percentage likelihood that the patient's prostate cancer is OC (organ confined), ECE (extra capsular extension, meaning breaking through the prostate cancer, SV+ (seminal vesicle positive), and LN+ (lymph node positive). Your concern was whether it could still be contained in the prostate, or high odds of OC, organ confined, in the Partin Tables.

    To recap your concern, you wrote in part:

    Quote:
    Originally Posted by Liliac96 View Post
    Today he saw a urologist PA. During the exam, she said she felt a very small bump on his prostate and thought the prostate might be slightly enlarged but could not say for certain. I thought I read that for low-grade prostate cancers, the digital exam is normal. So the fact she could feel a small bump is sending me into a total panic.... Is it possible that she could feel a small bump and still have cancer contained to the prostate? ...
    A very small bump would qualify as "Stage 2a". In the Partin Tables, you would go to the area for Stage 2a and a PSA in the range from 4.0 to 6.0. You don't know your husband's Gleason score yet as that is determined by the pathologist from the samples taken during the biopsy. Therefore, let's look at the possible odds, in percentages, for each of the Gleason score groupings in the tables. The number is the Gleason score; in recent years, a simpler, easier to understand grouping system has been used, known as Gleason Grade (GG), and that is also shown:

    Gleason score ...... 6 GG1 ..... 3+4=7 GG2 .....4+3=7 or 8 GG3-4 .....9-10 GG5

    OC odds ................ 87% .......... 66% .................. 55% ................. 38%

    While you do not know the Gleason score yet, few patients fall into the GG5 group at diagnosis; odds are strong that your husband would fall into GG1 or GG2, with high odds that the cancer is still contained in the prostate. By the way, even if it is not contained, modern radiation is very good at curing such cancers.

    You can look at the tables yourself by doing a search for "Partin Tables". These days, my impression, not really sure, is that the Partin Tables are not used as much as they were a decade ago because there are other tools, such as "multiparametric MRI" imaging and various "biomarker" and genetic tests that can provide pretty reliable estimates for each individual patient.

    .Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. 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 and stable at <0.01; apparently cured (Current PSA as of 12/2/2020). (Current T 93 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 02-26-2021, 03:21 PM   #11
    Liliac96
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    Re: Elevated PSA/Urologist Felt Small Bump

    Jim--
    WOW! Thank you so much. This really, really helps!

    Today we made the decision to go to NYC to a large cancer center (Not sure if I can name it on the forum).

    They are able to see my husband on Wednesday.

    Between the info you shared and the new appointment, I'm feeling so much better than I did last night.

    I really can't thank you enough.

    Lili

     
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    Old 02-27-2021, 05:33 AM   #12
    IADT3since2000
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    Re: Elevated PSA/Urologist Felt Small Bump

    NYC has several outstanding centers, including one, Memorial Sloan Kettering Cancer Center, that is known around the world for its excellence in treatment and pioneering work in prostate cancer (and other cancers).

    Good luck!

    Jim

     
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    Old 02-27-2021, 07:20 AM   #13
    Liliac96
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    Re: Elevated PSA/Urologist Felt Small Bump

    Quote:
    Originally Posted by IADT3since2000 View Post
    NYC has several outstanding centers, including one, Memorial Sloan Kettering Cancer Center, that is known around the world for its excellence in treatment and pioneering work in prostate cancer (and other cancers).

    Good luck!

    Jim
    That's the place we picked!

    I'm reminding myself today that we won't know more until the tests are run.

     
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    Old 03-05-2021, 11:36 AM   #14
    Michael F
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    Re: Elevated PSA/Urologist Felt Small Bump

    Quote:
    Originally Posted by IADT3since2000 View Post
    A very small bump would qualify as "Stage 2a". In the Partin Tables,....
    [/SIZE]
    Hi Jim! Excellent information and effort as always. However, in Ms Liliac96' husband's case, he has yet to have an MRI or biopsy. "Stage 2a" will apply IF & Only IF this bump/nodule is in fact PCa. As Dj points out: "About half of nodules felt on DRE are benign."

    Collectively we can be of better service to Ms Liliac96 by providing a list of questions and issues to discuss with their expert URO MD as opposed to speculative Partin Table predictions.

    MF
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    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free =13%)
    Jan '12: Biopsy: 1/12 = G7 (3+4) & 5/12 = G6
    March '12: Robotic RP: Left: PM + EPE => Surgeon went back and excised additional adjacent tissues on Left side down to (-) Margins
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    uPSA Range: 0.017 - 0.039 at 105 Months Post Op: Mean = 0.023 (n = 25)
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    Old 03-05-2021, 12:00 PM   #15
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    Re: Elevated PSA/Urologist Felt Small Bump

    The average risk for prostate cancer is 13 in 100. A positive DRE then takes that to 50%, if I understand Djin's statistic.
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