Low PSA and positive biopsy

[Charlean]

I have a close friend who has lost about 20 pounds in the past year and I was worried about him and suggested he get to his urologist. So he recently went to his urologist for his colonoscopy and a PSA test. The PSA hadn't changed. It was 1.1, last year was 1.12, the previous year, 1.1 but the colonoscopy showed a polyp. The Dr said because of its location, he wanted to do a biopsy of the prostate where he found three positive samples. He said no treatment, lets just watch and wait. I am concerned because of the weight loss, even though the PSA would never had given him an indication that anything was wrong. Any thoughts? I am trying to get him to go for a second opinion here.

[DFZ4835]

He needs to find a good oncologist and talk to him about prostate cancer. With the oncologist they need to make a plan on what to do and when. Cancer is a beast that can attack at any time. It sounds like he has caught it early enough to kill the beast. Tell him to see an Oncologist.

[Charlean in reply to DFZ4835]

That's what I am trying to get him to do, and not our local one! He failed us miserably. I suggested UCSF.

[CERICWIN]

Hi Charlean,

There can be many reasons for weight loss besides prostate cancer, but he needs to have additional testing to rule out other causes. Even a low PSA prostate cancer can metastasize.

My own PSA test in August was the lowest it had been in about two years, but there were new lesions in several areas, including the bladder and new lymph gland metastases. I had increased uptake in all of my skeletal system, from shoulders to feet. But the PSA was only 2.72.

It's possible to have a lot of metastases with a low PSA and also possible to have a very high PSA with no metastases at all. As you know, Charlean, dear friend, the cancers differ wildly from individual to individual.

My warmest regards and love and peace,

Eric

[Charlean in reply to CERICWIN]

Thanks Eric, and yes I do know how different it can be. Glad to see you are still answering posts. Hope you are feeling better. I pray for you all nightly!

[Dr_WHO]

Please know that some forms of prostate cancer, such as small cell and Ductal, may not raise your PSA at all. Even worce, they can be hard to pick up with a digital exam. The good news are these forms are very rare. The fact that "only" three samples were positive may not tell the whole story. You need to find the Gleason score for those three samples. They should also be able to determine is it is small cell or Ductal. That was how they found mine. I had only four positive samples out of 14, but it was determined that it was Ductal, Gleason 8 (4+4). A follow up CT scan determined it had spread to the pelvic lymph nodes. (On the positive, the bone scan was negative). A large part of my prostate (75 grams vs ~25 for a normal one) was cancerous. It just ended up that most of the samples from by biopsy targeted clean areas.

I hope that his weight loss is from benign source and that he can rule out some of the alternatives. Even it if is not cancer, a CT, bone and/or MRI may be in order. In addition to an oncologist you may consider an urologist that specializes in prostate cancer surgery.

[Charlean in reply to Dr_WHO]

Thank you so much for the information. I will pass this on to him. The more information he can get, the more informed he can be when he speaks to the next doctor. I am concerned that there is more to this than just a slow growing cancer. I don't think they said anything about the gleason score, at least he didn't to me, so I will ask him. I hope yours is under control.

[JoelT]

We are missing too much information about your friend. As mentioned we need his Gleason score, also a genetic test to measure the aggressiveness as well as an understanding of what type of prostate cancer your friend has developed. Also, how old is he, what are his other medical issues, if any, etc.

Joel

[ffiore]

Have him take a T3 MRI with coil of the prostate. It is found that it is as good if not better than random biopsies of the prostate. If something is found after the scan. They can go back in with the T3 MRI and take biopsies of the suspicious areas. That's what I did.

[Charlean in reply to ffiore]

I will share this with him.

[Hidden]

The medical people are talking about replacing the biopsy with good imaging, since the biopsy misses half the prostate to start with, and can miss the most dangerous areas in any case. So I also like imaging the prostate, to figure out what's up.

Your main worrisome symptom is weight loss, and cachexia is certainly a dismal and ominous symptom. Not sure that this qualifies as that though. Curious what others think...

[Charlean in reply to Hidden]

That makes good sense. Part of the reason my husband took so long to get to his urologist the second time was because he had the biopsy and it was very painful...so he delayed his next visit for two years instead of the year they told him. He later found out that he could pay money to have something so that he didn't have to have that pain but he didn't know it the first time. I agree, the weight loss is concerning to me. That was the first sign I had of my husbands cancer and why I sent him to the Dr when I did.

[Hidden]

I am surprised that a polyp in the intestine made the doctor want to do a biopsy of the prostate. You can't argue with success, but did he say what made him suspicious?

[Charlean in reply to Hidden]

The doctor said that the location of the polyp was close to the prostate on the other side. However, the biopsy showed nothing where he expected it but instead it was in another location. It was more or less luck that this guy decided to follow his instincts here.