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    Old 04-20-2021, 09:28 AM   #1
    skeletor33
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    hypoechoic structure

    An ultrasound intended mostly for my kidneys, revealed a 2.8cm "hypoechoic structure" on my prostate.

    My PSA has been low/normal the last few years for my age. It was just under 1 for a couple years, then went to 1.2, and at the most recent test DROPPED to .5.

    2 questions:

    -Is the drop to .5 at all suspect? Would a retest be a good idea? I'm not looking for bad news, but was surprised by the drop. Basically, I want to know if this seems like a normal fluctuation.

    -My uro paid zero attention to the report of the hypoechoic structure. When I asked what it was, he responded "who knows" but was obviously not at all concerned. Does this seem, overall, like a reasonable thing to blow off? (He is a nationally recognized, top doc with flashy credentials FWIW.)

    Thanks so much for your consideration and response.

     
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    Old 04-20-2021, 08:25 PM   #2
    HighlanderCFH
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    Re: hypoechoic structure

    The PSA does fluxuate as time goes on, so I would not be concerned at all, especially since it's well within normal ranges. If your uro is not worried about it, I would not give it any more thought.

    Take care,
    Chuck

     
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    Old 04-21-2021, 03:57 AM   #3
    DjinTonic
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    Re: hypoechoic structure

    Ultrasound reflects off of healthy tissue less than than off of anbormal tissue, but it can't distinguish atypical but benign from malignant tissue.

    My last biopsy was prompted by a new nodule my uro felt plus a slight PSA rise. The biopsy determined that the nodule was benign (50% of nodules are); however, two cores in other prostate zones did find cancer.

    A multiparametric MRI (mpMRI) is more sophisticated than typical (low-res) ultrasound and can grade abnormally appearing tissue on a 1-5 PIRADS scale, where 1 is very likely benign and 5 is highly suspicious for cancer. If your PSA rises you can discuss MRI imaging with your doc. Keep in mind that only a biopsy can diagnoses prostate cancer.

    Hope that helps,

    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
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.023 (4 yr. 6 mo.)

     
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    Old 04-21-2021, 06:58 AM   #4
    skeletor33
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    Re: hypoechoic structure

    Thank you! I appreciate the guidance.

    Let me add one more question (which I may also add in a new thread):

    - Is it possible to suppress PSA with supplements? When my PSA went from under 1 to over, I began a regimen of the usual suspect supplements. I now am wondering if these might be "working". But is there data about whether these might be able to lower/suppress PSA in the presence of malignancy? Might they actually "work" to lower PSA, but not actually be protective?

     
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    Old 04-21-2021, 10:43 AM   #5
    Prostatefree
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    Re: hypoechoic structure

    Yes. You can manipulate your PSA with diet and supplements. Most will only have a modest effect. You can see a drop in my PSA in my signature I attribute to diet and supplements. When I stopped the supplements, the PSA retuned to the same curve line reflecting the growth of my cancer. In the end, the cancer kept on doing what it does. I used the "false" decline as confirmation my cancer was not serious leading to denial and delay. I was lucky and seemed to have survived by brush with playing chicken with cancer.

    Now, on a healthy diet, I use only two supplements; D3 and fiber.
    __________________
    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, upgraded to G3+4, Tumor vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months
    7-9-21 PSA less than 0.02; zero club 6yrs

     
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    Old 04-21-2021, 11:44 AM   #6
    DjinTonic
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    Re: hypoechoic structure

    Certain supplements (e.g. curcumin) may slightly lower PSA, but their effect will be finite if you keep taking them. A rising PSA from prostate cancer will make itself known in any case.

    Take the case of 5-alpha-reductases (taken for BPH symptoms) which will approximately halve your PSA over the course of several months. I was on finasteride, which did halve my PSA, but uro's can still monitor for a PSA rise from cancer after the finasteride has reached it's maximum effect.

    IMO any PSA-lowering effect from phytochemicals (plant-based compounds) will happen in a much shorter time frame. Just tell the doc monitoring your PSA that you are taking supplements.

    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
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.023 (4 yr. 6 mo.)

     
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    Old 04-22-2021, 10:16 AM   #7
    39cancer
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    Re: hypoechoic structure

    FWIW, my urologist found a nodule in Sept 2020, did some testing, decided it was nothing. PSA 1.5. A month later a kidney ultrasound also saw the hypoechoic nodule. The kidney doc asked about it and I said "oh yeah, the urologist looked at and decided it was nothing to worry about."

    Fast forward 4 months and I was diagnosed with Gleason 9 prostate cancer. I'm going to be a biased source here, but I'd get it checked out more thoroughly.
    __________________
    40 years old
    09/20: Nodule found but not considered a problem. PSA 1.5.
    03/21: MRI: PIRADS 5, SV+, LN1. Biopsy: Gleason 9 (5+4). PSA still 1.5.
    05/21: RP performed. Final staging pT3a, LN1, M0. Negative margins. Gleason 9 (4+5). 4 positive nodes
    06/16/21: Started ADT - first Firmagon injection
    07/21/21: PSA 0.08. 2nd Firmagon injection. Started Zytiga.
    08/25/21: PSA 0.08. 3rd Firmagon
    09/15/21: Started IMRT
    09/30/21: PSA undetectable. First Lupron injection.
    11/09/21: Finished IMRT
    12/30/21: PSA undetectable.

     
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    Old 04-22-2021, 11:32 AM   #8
    IADT3since2000
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    Re: hypoechoic structure

    Hi skeletor33,

    The post below by 39cancer is an example of a type of cancer that is uncommon but that can be quite dangerous: low PSA and therefore flying under the usual radar, but high Gleason score, so, as you no doubt know now, aggressive. These unusual cancers depend very little on testosterone produced by the testes, unlike the vast majority of prostate cancers.

    Quote:
    Originally Posted by 39cancer View Post
    FWIW, my urologist found a nodule in Sept 2020, did some testing, decided it was nothing. PSA 1.5. A month later a kidney ultrasound also saw the hypoechoic nodule. The kidney doc asked about it and I said "oh yeah, the urologist looked at and decided it was nothing to worry about."

    Fast forward 4 months and I was diagnosed with Gleason 9 prostate cancer. I'm going to be a biased source here, but I'd get it checked out more thoroughly.
    Do you mind mentioning your doctor's name? If he is a major figure involved in prostate cancer, he would be well aware of this possibility and the need to check it out if the evidence so warranted, which it may not based on the testing you said he performed. Do you mind describing what testing he did? If your doctor's "flashy credentials" are not for expertise in prostate cancer, if I were you, I would get a second opinion from someone who does specialize in prostate cancer.

    Regarding that drop in PSA after supplement use, one supplement, saw palmetto, is somewhat effective in treating benign growth (benign prostatic hypertropy, aka BPH), as it is a mild 5-alpha reductase inhibitor (5-ARI); if you were taking it, that could account for the decline in PSA due to a reduction in BPH. Unfortunately for us prostate cancer patients, it does not work against cancer. There are two drugs in the 5-ARI class, Proscar/finasteride and Avodart/dutasteride, that are much more potent and are quite effective in dealing with mild prostate cancer (GS-6 and below), but are not effective against higher-grade prostate cancer, especially GS 8-10. Essentially, these drugs work against cancer by sharply decreasing production of DHT, dihydrotestosterone, which converted from testosterone; DHT is a far more potent fuel for prostate cancer than testosterone. (I have been on one or the other continuously since 2000, including through the present as part of my shield against a recurrence.)

    Last edited by IADT3since2000; 04-22-2021 at 11:34 AM. Reason: Rearranged paragraph right after posting.

     
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    Old 04-22-2021, 12:11 PM   #9
    skeletor33
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    Re: hypoechoic structure

    Thanks to everyone for their help and experience!

    39cancer - best of luck to you on the incoming RP.

    I don't want to name the doc here and now, but he is a well-credentialed uro with a few specilties including PCa and surgery for same.

    My DRE was normal. My PSA was low. Did the kidney ultrasound because I retained urine on 1st visit after emptying bladder for urinalysis. All in US was normal but for the finding of the hypoechoic structure on my prostate.

    Have seen one study that showed a hypoechoic lesion with low PSA and no troubling DRE had a VERY low % of cancer under 1 cm. It was low, but a bit higher with larger lesions like mine.

    I pushed for, and was prescribed without hesitation, an rectal MRI.

    It is a bit of a psychological battle between relying on this well-regarded doc and not rushing to more testing vs. being as responsible as possible and getting as much data as I can and is justified by my particular situation.

    Thanks again.

     
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    Old 04-22-2021, 12:17 PM   #10
    skeletor33
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    Re: hypoechoic structure

    As to supplements, I have been taking something called Prostate Optimizer which contains what you'd expect incuding saw palmetto, phytotosterols, etc. I also have been on a horse-sized regimen of Vitamin D since that showed good protection against sever COVID. I am vaccinated now and have gone back to a more normal Vitamin D supplement.

    I am, frankly, quite unsure what to do now, whether to ween myself off the supplements which might be working to some extent to keep my prostate healthy and/or might be working to some extent to fool the PSA testing.

     
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