PSA 35

Hi. I'm 55 and in October I went to see a doc for a weak urine stream and the feeling of my bladder not entirely emptying. My prostate was slightly enlarged and she put me on a round of cipro for prostatitis. Still having weak stream so I went to urologist Thursday. My prostate is still enlarged, but had no lumps, bumps or hard places. However, my PSA came back at 35. Does this high level indicate an aggressive cancer and does it also indicate that the cancer has probably spread? My biopsy is scheduled on 1/12/17. I'm worried sick and my family is devastated.

[Dr_WHO]

Hello. The PSA test can be very misleading. My brother was measured at 21 but biopsy showed it was not cancer. Mine was 4.7 but I have Stage 4D1 Cancer. There are other men here with advanced cancer where their PSA was less than three.

There is every reason to think yours is not cancer. But even it it is, if you catch it early enough the chances of you getting cured is almost 100%. Trust me, I would give a lot to be able to say that.

It will be hard to do, but be thankful that they are taking action now, when if you have cancer (and that is a big if) it should be curable. In some ways that is the best gift possible.

Stay strong and prayers going out to you.

[Hidden in reply to Dr_WHO]

Thank you. I wish you the best too.

[dockam]

Until a biopsy is completed you won't know for sure. It may be benign prostatic hypertrophy (BPH). My urologist placed me on Flomax with Cipro at the start. Flomax helps with the urine flow.

My PSA was 840 and the cancer had only gone to the lymph node chain around the left side ureter - this drains the bladder. I had a huge tumor on the front side and the urologist was not able to palpate it.

If there are abnormalities in the biopsy, a scan will be done and that will determine the extent of any metastases.

Any prostate/breast cancer in your family? What is your overall health like? How is your fitness level?

Check to see if they are going to do an MRI guided biopsy - this is more accurate than the old school blind biopsy - which is what I had.

harvardprostateknowledge.or...

Since my diag in 01/2015 I've gone whole grain, fruits/veggies(esp like broccoli), no red meat, lean protein, fish twice/week, stayed as fit as I can. Eating healthier/exercising will benefit your heart and prostate - if you do have cancer, this may help you deal with any upcoming treatments. I had testosterone deprivation therapy for 30 months and had 15 chemos in 2015 - my MedOnc and I feel that i tolerated it well because of my overall health.

This is a great site for info and encouragement, but most of us aren't MDs and we just report our treatments and results. As the ads say" individual results may vary"

Please keep us posted. Assume that it is cancer and be proactive in making changes prior to the biopsy. With either a positive or negative results you will be better off healthwise.

Please feel free to message me or look up my previous posts

Fight On - Randy

Btw - my PSA is at 0.2

[Hidden in reply to dockam]

My grandpa had prostate cancer, but he died at 91 from a heart attack. I am in good health. I'm not obese and I'm very active. I'll read those links. Thank you very much and I hope you continue to do well.

[drsridhar53 in reply to Hidden]

That is it Dale 339. I am sure you will beat your granddad and live at least up to 92!! About Heart attack, I am not sure anyone could be so positive!!

[Hidden]

Read carefully what Dr_WHO said in his reply to you. He nailed it. I also wish that I was in your shoes. You sir, are one lucky man. Now quit worrying so much and tell your family that they will have to put up with you for a long, long time. In other words, chill. You are not chained to a railroad track with a locomotive bearing down on you. Finally don't freak out and start Googling life expectancy charts. They are obsolete the minute they are published.

If I were you I would be far more concerned about a drunk driver hitting your vehicle broadside. Cheer up and hope the neighbors dog doesn't bite you in the rear.

[Hidden in reply to Hidden]

Thanks for the encouragement.

[AlanMeyer]

I think it's possible that you don't have cancer but it's also quite possible that you do. If you do, you'll have many decisions to make about treatment.

If there is no evidence of metastasis (spread of the cancer outside the prostate), there is a decent chance of curing the cancer with surgery or radiation, or even a combination of the two.

In my personal opinion, the best thing you can do either to cure the cancer or to at least manage it well, is to get the very best doctor available to treat it. Your insurance company or primary care physician might have sent you to a urologist to evaluate you and do a biopsy, but he or she might not be the best person to perform a radical prostatectomy. If you do have cancer and it does look like surgery is a good option for you, you want a specialist in prostate surgery - not a general urologist who does a half dozen prostate surgeries a year, but a person who does 50 or 100 a year and really knows what he's doing. The same is true for a radiation oncologist. He or she should be someone who does a lot of prostate radiation and is up to date and experienced.

You've got a biopsy scheduled in January. You might want to spend some time between now and then investigating surgery and radiation and finding top doctors in your area. Given that appointments always take time to set up, you might want to go ahead and get an appointment. You can always cancer it if the biopsy is negative. Here's a list of top hospitals for cancer treatment from the U.S. National Cancer Institute: cancer.gov/research/nci-rol... . People in this forum may also be able to recommend doctors if you say where you live or where you're willing to travel to.

I'm hoping that you don't have cancer, if you do, I'm hoping that it can be cured with treatment, or if not, I'm hoping that you'll be able to control it well. I know men who have lived two decades with prostate cancer and are living very normal lives with no symptoms. Their cancer is held down to a tiny number of tiny tumors in just a few spots. The number of men who can do that is increasing all the time as more new treatments keep being developed.

It's pretty hard to tell someone who might have cancer not to worry. How can you help but be worried? But I think you should decide that you are going to apply yourself to learning how to take care of yourself. Your goal is to master this problem. One way or another, I think there's an excellent chance that you'll succeed.

Best of luck.

Alan

[Hidden in reply to AlanMeyer]

Thank you, Alan.

[drsridhar53]

I completely agree with Dr. Who. I am sure you either do not have malignancy, or even if that is not correct you can be treated with great effect. Time is not yet to worry.

[jronne]

Move up your biopsy date asap. This is the best first move. Get your free psa blood test level done as this helps determine risk. Regardless of the biopsy outcome your should get psa (free and total) levels tested 2 or 3 times a year going forward as rises are bad.

[ewhite999]

You should insist on an MRI too. My first biopsy was a false negative. The MRI was more telling which prompted a second biopsy which came back positive. A high PSA alone does not mean you have aggressive prostate cancer so don’t jump to conclusions. You’ll drive yourself nuts. I agree with the other responder who suggested that you move up your test. There’s no reason to wait until mid-January. You may want to consider another urologist if this one has you waiting this long.

[Hidden]

I've called the cancer center of America and they assured me that was not too long to wait. I don't know what to do. I have a family member who is chiropractor and he did X-rays to see if it was anywhere in my bones. He could not detect any, but I don't know how good X-rays are for detecting early spread. My prostate appears to be only slightly enlarged and I've had two DREs, one in Oct and one in Dec. Neither exam revealed lumps, bumps or hard places, just an enlarged prostate. The PSA level (35.8 to be exact) scares the heck out of me. I have not been able to eat since I received the news. I'm a wreck.

[bigbassman]

Hi. I and others here empathize with your worries. I think it's normal to be worried about health concerns for which you have little or no information. I think it's commonly accepted among patients and docs that elevated PSA is not a reliable indicator of prostate cancer (PCa). There are 2 other PSA related factors which urologists and other docs use as indicators of concern for PCa. PSA velocity refers to how quickly PSA rises over time. If this was your first PSA test result, that information is not available until you do several more PSA tests. Your value of 35 is the "total PSA" figure. The other PSA related indicator is the ratio of "free to total PSA." If this is less than around 0.12 (12%) urologists will tend to want to refer you for biopsy, because lower ratio values raise concerns of higher risk PCa, more aggressive and higher tendency to spread.

I had more concern and outright fear of the biopsy procedure than of the possible result, (not a constructive thing) and after intense and stressful research, I learned that the standard trans-rectal ultrasound guided (TRUS) biopsy has accuracy around 65%. I figured, "why put so many men through an invasive procedure if it's that inaccurate? After a man in my informal support network told me he had had 3 negative TRUS biopsies before having his PCa confirmed by an MRI-fusion biopsy, (which is far more accurate, but is not done routinely since it is not the "standard of care", a phrase I hope you will not come to resent) I was able to negotiate a TRUS biopsy using MRI data to focus the biopsy sites. I was told this was about as accurate as the fusion-MRI type, and in my case, 9 of the 10 core samples were cancer. (70% average per sample) I was only able to convince the hospital take me on, and also to do the biopsy this way after I paid elsewhere for the first MRI, which clearly showed adenocarcinoma with 95% confidence.

I also had an enlarged prostate, (BHP), "unremarkable" prostate ultrasound results, "unremarkable" rectal prostate exam results, urinary issues and recurrent infections several years before my PSA results alerted my urologist to my PCa situation. I'm sharing this because I wish I had known then that BHP mimics many symptoms of PCa, because none of the docs who had been aware of my BHP and elevated PSA looked into it any further than to prescribe Cipro for the UTIs, which never ever produced any positive urine culture lab results, or to dismiss "unremarkable" US results. I paid for an expensive DNA based test which indicated that the UTI problems were caused by ureaplasma, which is not often tested for, even if you request it. ( I and many others believe the repeated long courses of Cipro and similar drugs were unnecessary, misguided, and have resulted in our peripheral neuropathy.) My relationships with the guys in my support network have provided invaluable information and links to important connections with experienced PCa professionals.

I won't apologize for possibly raising your concerns with what I've shared. The bottom line for me is that I wish I had insisted at the earliest sign of issues to have accurate diagnostics done ASAP, not accepting being put off because I had no "significant" symptoms until the urologist picked up on my PSA indicators much later. I might not be at stage 4 now, if I had done this then. Knowledge is king in this territory. You have to be your own best advocate, and be prepared to do as much research as you feel you need. Every case is different, as is every man's experience with the response of the health care system. Hopefully, your diagnostics will be fine, and you and your family can stop worrying. In my case,. from the beginning I was hoping for the best, but prepared for the worst. That helped to shape my ongoing mantra: "I am not going to worry unless or until I have something to worry about."

Best of luck.

[Hidden in reply to bigbassman]

Thank you. Everything I've read online indicates PCA greater than 30 is almost 100% guarantee of PCa and often times the first and even second biopsies do not find it. My biopsy is scheduled 1/12. I get results on 1/19. The anxiety of waiting is killing me. Best of luck to you as well.

[bigbassman in reply to Hidden]

Are you having the standard TRUS biopsy or one guided by MRI etc? An MRI guided biopsy will almost certainly determine the situation in one procedure. The problem with TRUS biopsies is that they are guided to areas of the prostate, but there is no imaging of potential tumours. The other drawback is that their access point, into the rectum area allows access to the rear parts of the prostate, but not very well to the upper or frontal areas, so that is mainly why TRUS misses some cancers. I imagine you've been informed of the relatively small risk of infection. The most precise biopsy is conducted through the perineum, which bypasses the rectum and most of the risk of e-coli infection, and allows greater access to the prostate. If you are going ahead with a TRUS biopsy and the result is negative, you might consider getting an MRI, either doc ordered, or self pay if you're not convinced you are in the clear. Good luck. I'm hoping for the best for you.

[Hidden in reply to bigbassman]

The urologist did not want to wait for an MRI. Apparently those are scheduled further out. How accurate are X-rays for spotting cancer that has spread to the bones? A family member X-rayed me from my head to my knees and said my bones looked great. He's trying to get me a PET scan this week. I've read a LOT of stories where cancers were not detected until the second or third biopsy. I don't want to let it go that long. My prostate is slightly enlarged with no lumps, bumps or hard places, but I cannot get away from that PSA level of 35.8. That number is what sucks all the hope from me and my family. We've all read the information available online. It doesn't offer a lot of hope for a "cure" for numbers over 30. Even the 5 year survival rate is low (28%). It's hard not to dispare.

[bigbassman in reply to Hidden]

Borrow my mantra: try not to worry unless or until you have something concrete to worry about. You need to keep your wits about you and your energy up right now. And it is true that a PSA value at your level may not be related to PCa. You just won't know for sure until the biopsy. Your family will fare better if they see you less worried. My understanding is that X-Rays are good at checking bones, but not good at soft tissue. If you're worried about metastasis to your bones, that's possible, but from what I've seen, serious PCa bone invasions become painful, which is too often the first indication of PCa, if a man has never had his PSA checked. Even then, such men have often been successfully treated and have survived long term. I think MRI or PET is the way to go if you want some info before biopsy. I'll be honest with you: I postponed the TRUS biopsy my urologist booked for me, partly out of fear, but mostly to buy time so I could get an MRI done and look for resources to get the better biopsy done. And, I just needed to know before doing anything invasive. I am absolutely not suggesting that you do this. I took a calculated risk that the extra few months waiting (as the disease, if it existed, progressed) would be offset by avoiding the hassles and wasted time of a potential false negative biopsy, and by having a pretty good answer of whether or not I had PCa, so that going into a biopsy would be more a confirmation of how worrisome it might be. And as it turned out, I would likely have gotten diagnosis and treatment a couple of months earlier if I'd done the initial TRUS biopsy, due to the very large tumour size. I won't offer an opinion on whether or not you should have a biopsy if you do get a negative scan result. If that is the case, you should discuss that with a urologist and/or oncologist.

As I said previously, I had no way of knowing how either of these choices would have worked out. I have no regrets doing it the way I did. I was able to get an MRI within a week, and the radiologist gave me his opinion that same day, with a written report and copies of the scan on disk within a few days. If you do decide to get a PET or MRI, you may have to travel and pay around $500 US (unless you have coverage) if you want it in a fast time frame. One thing I've learned is that there are no absolutes with this disease and every decision you make about its diagnosis and treatment has consequences. It's a crap shoot; no guarantees.

[chasd]

Hello Dale

The first way to help yourself and the family is not to worry yourself to death.

Cancer sounds dreadful, cancer is bad, but most PCa can be controlled for years, it is not necessarily an immediate death sentence.

Now: you may not have the PCa.

Do the exams, tests, maybe biopsy and consultations.

You will either 1) find you have no problem or 2) you will map a strategy forward.

With 1) just don't play in traffic, with 2) you may well be able to have a long, happy and productive life, as long as you still don't play in traffic.

This may be the end of tranquility but not the end of your life.

I am 82 and still buy green bananas.

Live your life, enjoy the journey, don't be distracted by fear and life will be much more fruitful.

Best of luck, maintain your fortitude and pray every now and then. Works for me.

[Hidden in reply to chasd]

Thanks.

[j-o-h-n]

To dale339

Wanna die early?... then worry......

Wanna live long?....then don't worry....

Good Luck and Good Health.

j-o-h-n Sunday 12/17/2017 10:35 PM EST

[Hidden in reply to j-o-h-n]

Thanks.

[Hidden]

You've probably been told this already, but avoid anything resembling a 'blood thinner' for the week prior to your biopsy -- aspirin, other nsaids, vit E, fish oil, etc. I wonder if you got the DRE test -- that's what got me sent to a urologist; my PSA was a low 2.7. DRE sensed the tumor. Be glad that you are being treated after only the minor symptom of impaired urination. Others here weren't treated until they felt symptoms of advanced disease -- like bone pain. The conventional treatments for prostate cancer are RP (radical prostatectomy, or removal) and radiation. There is a third option -- High Intensity Focused Ultrasound. That is the option I chose. Insurance won't cover it. Research it. Good luck with your biopsy. If it is positive, it is a good thing that it is found now and not later when it is more advanced.

[Hidden in reply to Hidden]

Thank you!

[Larkinsammy]

How did your biopsy turn out, my brother is going through same thing

[Sxrxrnr1]

To have to wait for a biopsy until middle of January is outrageously excessive. Certainly in the USA anyhow. However if you cannot schedule earlier, this book is an extremely interesting book on the value or better said little value of relying upon merely PSA to diagnose PCa. Highly recommended.

amazon.com/Great-Prostate-H...

[Sxrxrnr1 in reply to Sxrxrnr1]

Oops just noted that this is an old thread, have no idea why website just presented it to me now. Likely you know by now if biopsy was positive for PCa. Sorry