Nervous

[Ginny56]

Hi All! DH has had a slowly rising PSA (3.2 at the end of 2017, 4.4 now/ it was pretty steady from 2014-2017). He had a MpMRI and it was clear six months ago since then his PSA has went from 4.0 to 4.4. He will be getting a biopsy on Friday, his doctor did not want to continue to wait. He has a 59cc prostate, so largish but he also have a dad who died of prostate cancer and two brothers who have been diagnosed. I am so scared for him but hoping for the best. He is 56, so we have a young teenager.

[baw1955]

It is a very scary time, be assured that diagnosis of prostate cancer at this stage can have a very positive outcome. Your description of DH's history is exactly that of mine (except my age was 62). I elected to have radical robotic prostatectomy (Oct 2018) based on my biopsy results. My PSA is now undetectable. Good luck and prayers for you.

[AlanMeyer Moderator]

With DH's family history, he is doing the right thing by keeping on top of this issue. If no cancer is found on the biopsy it will still be necessary to keep on regularly testing PSA and possibly get more scans or biopsies in the future. There are also new kinds of blood tests like "free PSA" (free as in unattached to other molecules, not free as in free beer) and "PCA3" that are not so invasive as a biopsy and may be worth adding to the panel of tests that DH gets in the future if the biopsy is negative.

If the biopsy is positive for cancer, don't rush into the first treatment offered. You'll want the best treatment you can get from the best doctor, one who keeps up with the latest research, builds up his or her skills, takes his or her patients' health very seriously, and specializes in prostate cancer treatment - not just any urological disease or any kind of cancer. You'll want to speak to at least one surgeon and one radiation oncologist since surgery and radiation are both effective but have different characteristics and side effects. Personally, I would prefer a good surgeon to a mediocre radiation oncologist or a good rad onc over a mediocre surgeon. I think the quality of the doctor makes a big difference in the outcome.

I always recommend checking the National Cancer Institute's list of "Designated Cancer Centers" ( cancer.gov/research/nci-rol... ), as well as asking people you know for recommendations. If you post information about the area where you live, someone on this list may also have recommendations.

I know this is all very scary but both diagnosis and treatment have gotten better and better over the years. There is an excellent chance for a complete cure, and with steady and continuing advances in drug therapies, even men who fail initial treatments are living significantly longer than before.

Best of luck.

Alan

[Tall_Allen]

His PSA density is only 0.075, which is half the average. This, and his negative mpMRI, predicts a biopsy negative for significant prostate cancer. The rise in his PSA can be explained by BPH. It sounds like he is committed to having a biopsy anyway, so some tips:

• if he has taken fluoroquinolone antibiotics (like Cipro) before, it is a good idea to get a rectal culture so that he can avoid taking an antibiotic he is resistant to. If he starts having a fever, go to the ER.

• make sure he will be getting a periprostatic nerve block or a pelvic plexus nerve block. This involves finding key nerves on the ultrasound and injecting lidocaine directly into them. Not all urologists are skilled at this.

• expect some bleeding in the urine and from the rectum for a few days, and blood in semen for several weeks. Some guys have temporarily impaired erectile function.

For future monitoring, ask his urologist for a Prostate Health Index (PHI) test. It includes PSA, free PSA, and another kind of PSA that makes it more sensitive for prostate cancer.

[Ginny56]

Thanks for all of the replies. DH biopsy was fine. He said it was not as bad as he had expected, although it was not the most comfortable thing that he has done either. He got the results today, which were benign. The left lateral base and left lateral mid both came back at Fibromuscular tissue only? Does that mean that there was just not enough tissue to evaluate (it was a 12 core biopsy)? His urologist is at mayo and I feel like he has been fantastic! DH free PSA was 0.11 and he has three first degree relatives with prostate cancer, and he has a rising PSA, hence the biopsy. His last MRI was clear and his PSA density was not high, but his urologist felt like reasons to biopsy and reasons to not were about 50/50 and he did not want to be the guy to not do the biopsy given family history (especially two brothers). He is supposed to go back in 6 months for another PSA test. If it goes up again, another MpMRI. Is this typically the way monitoring goes? It feels like we are in this for the long haul.