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  • New User - Active Surveillance Changes

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    Old 05-12-2022, 12:04 PM   #46
    CentralPaDude
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    Re: New User - Active Surveillance Changes

    Quote:
    Originally Posted by gabow View Post
    I was a bit surprised he suggested Flomax instead of a round of antibiotics.
    All of my biopsies and pathology reviews made mention of chronically "bothered" (my word) prostate tissue even while no signs of infection. I wonder if Flomax can't settle the tissue down a bit.

    I had a PSA of 5.76, had a urinary retention episode, was prescribed Flomax, had another PSA 2 months later, and was PSA = 5.1.

     
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    Old 05-13-2022, 04:53 AM   #47
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    Re: New User - Active Surveillance Changes

    Quote:
    Originally Posted by Prostatefree View Post
    What if the next PSA test is another rise?
    What is the plan/ next step then?
    I'm not sure, I guess time will tell.

    Quote:
    Originally Posted by Prostatefree View Post
    Statistically, how many men with PSA of around 15 or more in their practice have then subsequently been diagnosed with cancer.
    I don't know, I was a bit surprised when he said they had many patients with a PSA that high that had no cancer..

    Quote:
    Originally Posted by Prostatefree View Post
    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.
    Yes I frequently do this as well and may do that here. However, that can be equally as frustrating. The way UofM works with their portal is that I very rarely get any response from the Dr. I will always get a response, but it's usually from a nurse or admin. They generally find a creative way to answer my questions in vague ways that really don't answer anything.

    I guess this is why it's sometimes called "watchful waiting."

    Quote:
    Originally Posted by Prostatefree View Post
    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.
    Yes, a bit frustrated, but better frustrated than many other outcomes of a biopsy, so it could certainly be worse.

    Quote:
    Originally Posted by Prostatefree View Post
    But, impressed they didn't give you antibiotics. Did they do a culture?
    I have no knowledge of a culture one way or the other.

    Thanks as always for your support and suggestions, it's very helpful.
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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 05-13-2022, 04:55 AM   #48
    Prostatefree
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    Re: New User - Active Surveillance Changes

    My preference would be they find the cancer and develop a treatment plan while you are still young and it is early enough. Flomax will not shrink the prostate or effect the PSA. It's a safe drug for you to help relax the prostate for urination. It changes nothing.

    Bottom line, your prostate will continue to do what it is doing and pick up speed. You need a game changer.

    I agree with Djin. Get a genetic test of the G6. And, a second opinion on the Gleason score. The number one habit of successful people, take action. The additional testing and second opinion are safe and do not increase your risk and may provide valuable information.

    Don't get stopped by "go live your life." This is your life, not the doctor's.

     
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    Old 05-13-2022, 04:59 AM   #49
    gabow
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    Re: New User - Active Surveillance Changes

    Quote:
    Originally Posted by CentralPaDude View Post
    All of my biopsies and pathology reviews made mention of chronically "bothered" (my word) prostate tissue even while no signs of infection. I wonder if Flomax can't settle the tissue down a bit.

    I had a PSA of 5.76, had a urinary retention episode, was prescribed Flomax, had another PSA 2 months later, and was PSA = 5.1.

    I think that's a perfect term for my prostate, "chronically bothered." and keeping my fingers crossed that it's nothing more than that!

    I have wondered if I have Chronic prostatitis, which is defined as an ongoing or recurring pelvic pain and urinary tract symptoms with no evidence of infection. Basically a "chronically bothered" prostate.
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    [email protected] in 2017,PSA 5.4,MRI Pirads 2,vol 36mL,Glea6,1 core R base
    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 05-13-2022, 07:15 AM   #50
    Prostatefree
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    Re: New User - Active Surveillance Changes

    Did you have a chronically bothered prostate as a young man? No. BPH is a sign of the DNA breakdown of the prostate. Genetically, your prostate is running out of time. BPH alone does not lead to cancer, but the breakdown of the genetic health of the prostate can.

    Testing the G6 may reveal a tendency to develop G4. Good to know.

    PS: BPH is the breakdown of the prostate cell's life cycle. The cells no longer die on time, but continue to reproduce on time. Hence, an enlarging gland as the old cells live longer. Identifying prostate cancer as a genetically generated disease may lead to a genetic cure. I'm the meantime, understanding the genetic disposition of the cancer (genetic testing) can provide useful diagnostic information.

     
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    Old 05-13-2022, 07:43 AM   #51
    DjinTonic
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    Re: New User - Active Surveillance Changes

    Quote:
    Originally Posted by Prostatefree View Post
    Did you have a chronically bothered prostate as a young man? No. BPH is a sign of the DNA breakdown of the prostate. Genetically, your prostate is running out of time. BPH alone does not lead to cancer, but the breakdown of the genetic health of the prostate can.

    Testing the G6 may reveal a tendency to develop G4. Good to know.

    PS: BPH is the breakdown of the prostate cell's life cycle. The cells no longer die on time, but continue to reproduce on time. Hence, an enlarging gland as the old cells live longer. Identifying prostate cancer as a genetically generated disease may lead to a genetic cure. I'm the meantime, understanding the genetic disposition of the cancer (genetic testing) can provide useful diagnostic information.
    It was noted some time ago that prostate cancer is under-represented in men with BPH. This is not to say that that men with BPH don't get PCa--we do, and I am one of those men. But despite the fact that inflammation is thought to be a common factor in these conditions, the paradox remains. Two theories for this are (1) the increased physical pressure resulting from the greater cell density may have an inhibitory effect on cancer formation and (2) genes that may promote BPH may also have a protective effect regarding PCa.

    Any Correlation Between Prostate Volume and Incidence of Prostate Cancer: A Review of Reported Data for the Last Thirty Years (2021, review)

    https://pubmed.ncbi.nlm.nih.gov/34676178/


    "Results: Our systematic review found 41 articles reporting an inverse (negative) relationship between prostate gland volume and incidence of prostate cancer. Sample sizes ranged from 114 to 6692 patients in these single institutional and multi-institutional studies. Thirty-nine (95%) of the 41 articles showed a statistically significant inverse relationship. In our search, no study was found showing a positive correlation between BPH size and the incidence of PCa.

    Conclusion: To our knowledge, this is the first systematic review on the important clinical question of interaction between prostate size and the incidence of PCa. The results are demonstrating an inverse relationship, and therefore reveal strong evidence that large prostates may be protective of PCa when compared to smaller prostates."

    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 05-13-2022, 07:47 AM   #52
    CentralPaDude
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    Re: New User - Active Surveillance Changes

    Quote:
    Originally Posted by DjinTonic View Post
    "Conclusion: To our knowledge, this is the first systematic review on the important clinical question of interaction between prostate size and the incidence of PCa. The results are demonstrating an inverse relationship, and therefore reveal strong evidence that large prostates may be protective of PCa when compared to smaller prostates."
    Djin
    My docs cited that study indirectly. They just said big prostates usually don't have bad cancers. Good news for me.

     
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    Old 05-13-2022, 07:51 AM   #53
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    Re: New User - Active Surveillance Changes

    Quote:
    Originally Posted by CentralPaDude View Post
    My docs cited that study indirectly. They just said big prostates usually don't have bad cancers. Good news for me.
    I wouldn't go that far--I had a 90 g prostate reduced to 30 g by a TURP. Several years later I had a G 10 (5+5) biopsy. By that time my prostate had grown back to 64 g. It's true that the incidence of cancer is lower, but the increase in PSA from BPH can easily mask a PSA contribution from PCa.

    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 05-13-2022, 07:52 AM   #54
    CentralPaDude
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    Re: New User - Active Surveillance Changes

    Quote:
    Originally Posted by DjinTonic View Post
    I wouldn't go that far--I had a 90 g prostate reduced to 30 g by a TURP. Several years later I had a G 10 (5+5) biopsy. At that time my prostate had grown back to 60 g.

    Djin
    I know, it's all ultimately a roll of the dice, but the odds do vary.

     
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    Old 05-13-2022, 02:39 PM   #55
    gabow
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    Re: New User - Active Surveillance Changes

    Quote:
    Originally Posted by Prostatefree View Post
    My preference would be they find the cancer and develop a treatment plan while you are still young and it is early enough. Flomax will not shrink the prostate or effect the PSA. It's a safe drug for you to help relax the prostate for urination. It changes nothing.

    Bottom line, your prostate will continue to do what it is doing and pick up speed. You need a game changer.

    I agree with Djin. Get a genetic test of the G6. And, a second opinion on the Gleason score. The number one habit of successful people, take action. The additional testing and second opinion are safe and do not increase your risk and may provide valuable information.

    Don't get stopped by "go live your life." This is your life, not the doctor's.
    Good points and thanks. Right now I'm going to focus on my colon issue, if you recall during all this I also had a positive cologuard test. I have a colonoscopy scheduled in two weeks. That will either put that issue to rest if there is no colon cancer or create more complications that will have to be dealt with. Including whether that has anything to do with my PSA.
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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 05-13-2022, 07:48 PM   #56
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    Re: New User - Active Surveillance Changes

    I agree with DJin and ProstateFree about doing a genomics test on your positive biopsy cores, as well as a second opinion on the Gleason assessments.

    But, I have participated in many tens of thousands of threads on dozens of PCa support sites over the past twelve years. That exposure has informed me that some men do have PSA of 30, and others have MRI PIRADS lesions of 5, and multiple targeted biopsies have failed to find any cancer. Again and again.

    Itís a long shot, but possible, that you could be one more exception.

    Have the above testing, and good luck.

     
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