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    Old 05-06-2022, 10:08 AM   #31
    Prostatefree
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    Re: New User - Active Surveillance Changes

    Quote:
    Originally Posted by gabow View Post
    Now we just need to discuss why my PSA is 15.1 and I have constant pain urinating.
    Agreed. A PSA rising steadily from 5 to 15 over 5 years without explanation is a serious concern. PSA screening has been our most reliable indicator of PC. I'll be interested in the medical explanation. A PSA <10 is a standard guideline for AS.

    Your AS may be Active Search.

     
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    Old 05-07-2022, 11:24 AM   #32
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    Re: New User - Active Surveillance Changes

    Quote:
    Originally Posted by Prostatefree View Post
    Agreed. A PSA rising steadily from 5 to 15 over 5 years without explanation is a serious concern. PSA screening has been our most reliable indicator of PC. I'll be interested in the medical explanation. A PSA <10 is a standard guideline for AS.

    Your AS may be Active Search.
    Indeed it may be Active Search, the roller coaster of health... A day after getting my very favorable biopsy report, I get a call from my GP Dr. He was calling to let me know that the Cologuard test from my regular yearly check up, returned a "positive." Just like regular PSA tests, I have been doing regular Cologuard tests, with my last one in 2019 being negative. So if there is anything there, I've caught it early just like you try to do for everything.

    So next week I will follow up to get an appointment for a Colonoscopy to see what's going on with that. However, in a quick google search, I see where there can be a correlation between PSA and colon cancer!

    https://pubmed.ncbi.nlm.nih.gov/9241551/


    I will bring that up with my Uro next week in my review of the biopsy. Hoping to dodge another bullet and it's just polyps for the colon issues, and maybe inflammation for the PSA rise. The plot thickens!
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    2020 PSA ~8,MRI Pirads 2,Trans/Median Nodules, Vol 36mL
    2022 PSA 12.8,15,MRI Pirads 2,Trans/Median Nodules,Peri zone abnormalities,Geographic inflammation right peri zone, Vol 36mL

     
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    Old 05-07-2022, 02:41 PM   #33
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    Re: New User - Active Surveillance Changes

    Quote:
    Originally Posted by gabow View Post
    However, in a quick google search, I see where there can be a correlation between PSA and colon cancer!

    https://pubmed.ncbi.nlm.nih.gov/9241551/
    I had never heard of a connection of colon cancer and PSA in following the disease for 22 years and was interested in what this case report would show. While the authors classed this with "rare instances", they found convincing evidence that it does occasionally happen: no prostate cancer but a high PSA that returned to normal after the colon cancer was removed. This just goes to show how highly individualized circumstances can sometimes affect our trusted diagnostic indicators. Thanks for posting this!


    [QUOTE=gabow;5516649I will bring that up with my Uro next week in my review of the biopsy. Hoping to dodge another bullet and it's just polyps for the colon issues, and maybe inflammation for the PSA rise. The plot thickens![/QUOTE]

    That inflammation noted in the report could easily account for some or most of that PSA elevation. Good luck!

    Jim

     
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    Old 05-07-2022, 05:10 PM   #34
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    Re: New User - Active Surveillance Changes

    Quote:
    Originally Posted by IADT3since2000 View Post
    I had never heard of a connection of colon cancer and PSA in following the disease for 22 years and was interested in what this case report would show. While the authors classed this with "rare instances", they found convincing evidence that it does occasionally happen: no prostate cancer but a high PSA that returned to normal after the colon cancer was removed. This just goes to show how highly individualized circumstances can sometimes affect our trusted diagnostic indicators. Thanks for posting this!


    That inflammation noted in the report could easily account for some or most of that PSA elevation. Good luck!

    Jim

    I don't even know why I did a search on it, as I've never heard of anything like that either.

    Yes, I am certainly going with the idea that inflammation is the cause, at least until proven otherwise! And I think it's the more likely scenario, Cologuard is known to have a fairly high rate of false positives. So, as always, take the right path and do the things you have to, but keep a good positive attitude that it's all going to be just fine.

    Thanks for your support Jim.

    Gary
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    Old 05-09-2022, 04:37 AM   #35
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    Re: New User - Active Surveillance Changes

    My understanding is PSA movement from inflammation is typically erratic. And, you have a very normal size prostate with only mild signs of inflammation.

    Stick to the science and protocols. The steadily rising PSA now over 15 is your best friend. Keep doing what you're doing.

    I'm sorry this is such a challenge, but there is not shortcut. The most biopsies I seen from our regulars is 9 to reveal a small but aggressive cancer.

     
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    Old 05-09-2022, 06:38 AM   #36
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    Re: New User - Active Surveillance Changes

    Quote:
    Originally Posted by Prostatefree View Post
    ...
    I'm sorry this is such a challenge, but there is not shortcut. The most biopsies I seen from our regulars is 9 to reveal a small but aggressive cancer.

    I assume Prostatefree is referring to me. Although I did have 9 TRUS biopsies plus a 10th--since the tissue removed at my TRUS (for BPH) was examined--it is wrong to think that "it took 10 biopsies to find my cancer". It is very unlikely that my cancer had been there and was missed for more than one or two preceding biopsies and my first biopsy was about 25 years earlier. In fact, although my cancer was bilateral and accounted for just 5% of my prostate tissue, my uro captured lesions in 2 of the 14 cores. And since a few of these were aimed at one new nodule at the other end of the prostate (which turned out to be benign), it is more accurate to say 2 of 11 or 12 cores.

    And while my cancer was indeed high-grade--G9 (4+5)--I don't think it's accurate to call it "aggressive", since a Decipher test showed my cancer was low-risk for metastases and (even though I am confident it hadn't been there that long) a 5% tumor burden is low.

    Djin
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    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 05-09-2022, 07:02 AM   #37
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    Re: New User - Active Surveillance Changes

    Thxs for the correction from aggresive to high-grade and from small to 5% of your prostate.

    The statistic that two biopsies will catch the largest percentage of cancers has it's nuances and does not convince me cancer detected later must be new.

    What confounds me here is the persistent PSA of 15. It is very difficult to dismiss casually as inflammation.
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    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
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    Old 05-09-2022, 07:24 PM   #38
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    Re: New User - Active Surveillance Changes

    Assuming a "random" 12-core biopsy misses existing cancer approx. 1/3 of the time, there is roughly a 3.5% chance that existing cancer will be missed by three consecutive biopsies and a roughly 1% chance of it evading 4 biopsies. The advent of MRIs and targeted + systematic biopsies improves the odds of cancer detection, as does increasing the number of cores taken.

    Granted, a single microscopic lesion could evade any number of biopsies, but prostate cancer doesn't behave like that; instead, lesions become larger and, usually, more numerous over time.

    As I've posted many times, "random" cores are not always random. When I asked my uro for an estimate, he said he sees suspicious spots to target somewhere in the prostate in about 50% of the (non-targeted) biopsies he does. Of course, not all of these suspicious (darker) areas are cancer, but such targets work in favor of existing cancer being captured in cores.

    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 05-10-2022, 05:54 AM   #39
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    Re: New User - Active Surveillance Changes

    There is another user here, @guitarhunter who also had quite a few biopsies before they found his as well.

    However, in all the cases I've read about on here, granted only a handful, it seems that all those people had some significant "thing" that pointed in a direction to take more biopsies. @guitarhunter had a pirads 5 score from an MRI and it looks like Djin also had significant issues as well.

    In my case, I've had 3 MRIs, one at a different hospital with a different machine, all pirads 2 and all very consistent with each other in every aspect of the report. I've also had 3 biopsies, the first was a TRUS biopsy, the 2nd was an MRI guided transrectal at a different place by a different Dr., the 3rd was a Transperineal by a 3rd Dr at a 3rd different place. All those biopsies were extremely consistent, two cores of gleason 6 and I have very mild BPH and a couple of nodules.

    In general I'm doing much better than most (and I'm so very thankful for that!), but there still seems to be something we're missing. Either that or my problems ARE caused by the nodules and inflammation I have.

    In my review with my Uro on Thu, my strategy for my conversation is two fold. First part of the strategy is to explore the question of "are we sure this PSA rise is NOT due to cancer?" If we aren't sure, then how can we find out?

    If we are sure, then what is it from and can we do anything about that?

    My expectation is that those two things are tied together and we may do something that might address the 2nd question and see if that decreases my PSA. Which would in turn give a clearer picture of the first question.

    To date, my PSA has not been very erratic and has not really decreased. Although there was one time when it went from 8 back down to 7.1 for one test. The recent skyrocket is yet to be determined. My PSA went from relatively steady around 8 for about 3 years, then recently jumped to 12, then to 15. Which prompted us to do the latest round of MRIs and Biopsies. So we really haven't seen yet if that's going to go back down or be erratic.

    By coming here and talking to all you guys, I've learned so much more. I now realize that even my PSA of 8 for a number of years, with only a pirads 2, a couple of nodules, and 2 cores of gleason 6 was a bit unusual.

    Something is causing my PSA to be too high and to date it's a bit of a mystery. I'm now on a bit more of a mission to push my Dr's to get to the bottom of this.
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    2019,PSA8.2,MRI Pirads 2,Trans/Median nodules,vol 36mL,Glea6,2 cores
    2020 PSA ~8,MRI Pirads 2,Trans/Median Nodules, Vol 36mL
    2022 PSA 12.8,15,MRI Pirads 2,Trans/Median Nodules,Peri zone abnormalities,Geographic inflammation right peri zone, Vol 36mL

     
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    Old 05-10-2022, 08:24 AM   #40
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    Re: New User - Active Surveillance Changes

    Thank you for the summary! Keep doing what you are doing.

    Is it time for full body scans? PSA <20 predictively excludes metastisis in 98% of cases, but it leaves 2% still at risk.
    __________________
    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 05-10-2022, 12:04 PM   #41
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    Re: New User - Active Surveillance Changes

    That would be the concern for me. The PSA is coming from somewhere. If repeated exams of the prostate don’t show it as an obvious source in the jump, then that “somewhere” is somewhere other than the prostate.

     
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    Old 05-10-2022, 12:38 PM   #42
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    Re: New User - Active Surveillance Changes

    As I mentioned, a genomics test can give you more information. If it comes back high-risk for mets, it means your G6 has to be watched/investigated even more closely for progression and the formation of higher-grade lesions. On the other hand, a low-risk result can give you some breathing room.

    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 05-11-2022, 02:40 AM   #43
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    Re: New User - Active Surveillance Changes

    Can you explain that further, i.e. can G6 be predicted to develop higher grades; what breathing room is available with a PSA of 15?

    A PSA >20 begins being statistically predictive of metastasis.

    I chose to treat my G6 based on a high volume. I'm glad I did. Turned out to be a high volume of G 3+4. A second opinion on the grading may have caught it. Or not.

     
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    Old 05-12-2022, 06:39 AM   #44
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    Re: New User - Active Surveillance Changes

    I had my meeting with the Uro this morning. His prognosis, "you have nothing to worry about, go live your life!"

    Of course that's great news, but it still leaves unanswered questions in my mind. I asked was he certain that my rise in PSA was not due to cancer, his answer was "yes." I asked about 2nd opinions, genomic tests, etc. He said there was certainly no harm in doing those, but in his mind it was not necessary. In his words, "there is nothing, among numerous tests from multiple sources, that would indicate anything of any concern, just continue on AS."

    So I moved on to the questions of my PSA rise. His answers were that simply the PSA is an imperfect test and they have many patients with PSA as high as mine, and higher, that have no cancer. That it was not something to be concerned about.

    I asked about my symptoms and the possibility of inflammation. He asked if I was taking any medication, and I am not. So he suggested a round of Flomax to see if that helped my symptoms. But also said that my symptoms were very mild and inform them of any changes. I asked about my colonoscopy, in terms of when I could do that after my biopsy, he said any time after two weeks. In terms of could that have anything to do with my PSA rise, his answers were that it was very unlikely, but to make sure I had the colonoscopy to identify any issues and we'll go from there.

    Of course all of this is great news, and the unanswered questions will be resolved over time and we have time. So it's all good.

    - We'll see if Flomax does anything for my symptoms. I've also ordered a few of the supplements, Saw Palmetto/Beta Sitosterol/Pygeum/Nettle to see if any of that does anything. If I could get rid of the constant feeling of having to pee along with burning/pain (which is pretty constant and not just when I pee), then I would be good.

    - We'll also see if my recent spike in PSA is a temporary thing, possibly caused by Inflammation. If that starts to go back down or is more erratic, it will give us more information.

    - I was a bit surprised he suggested Flomax instead of a round of antibiotics. I don't really have too much problem with BPH. That may be due to the push to not use antibiotics these days.
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    2019,PSA8.2,MRI Pirads 2,Trans/Median nodules,vol 36mL,Glea6,2 cores
    2020 PSA ~8,MRI Pirads 2,Trans/Median Nodules, Vol 36mL
    2022 PSA 12.8,15,MRI Pirads 2,Trans/Median Nodules,Peri zone abnormalities,Geographic inflammation right peri zone, Vol 36mL

     
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    Old 05-12-2022, 11:30 AM   #45
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    Re: New User - Active Surveillance Changes

    What if the next PSA test is another rise?
    What is the plan/ next step then?

    Statistically, how many men with PSA of around 15 or more in their practice have then subsequently been diagnosed with cancer?

    I've learned something from my partner. They email the doctor after the session with any new questions that occur from considering/ thinking on the visit.

    If you look through the new guidelines you will see PSA testing to be the most respected tool we have for assessing the cancer. I'd be frustrated.

    But, impressed they didn't give you antibiotics. Did they do a culture?

     
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