Low PSA

[Inwood]

My PSA has always been <1. Five years ago I had a spike to 1.7. It was due to a testosterone supplement. I had a biopsy , the first of three, and they found cancer with a Gleason score of 6.

After my last biopsy the doctor said I was cancer free. My current PSA,s are still <1.

I know I’m fortunate but I can’t help feel that I still have a small amount of cancer. Has anyone experienced similar findings. Two of the urologists were eager to do surgery at the beginning I just wasn’t going for it. Thanks

[baw1955]

Sit tight. Maintain your surveillance program. No surgery at this time!

[Magnus1964]

Pca appears in most men over 75 and never have it treated. They die "with" Pca not from it. You didn't mention your age so but you could be one of the lucky ones who may never have to be treated.

[Inwood in reply to Magnus1964]

Sorry, I am 66 years young 😎

[Tall_Allen]

No, you are not cancer free just because they couldn't find any on the two subsequent biopsies. It just means that whatever prostate cancer you have is too insignificant to be worth doing anything about. This is common.

Spend $275 for a second opinion on your first biopsy from Epstein's lab at Johns Hopkins. Just call your urologist, and have him send the slides to Epstein. His opinion is the gold standard.

pathology.jhu.edu/departmen...

[Inwood in reply to Tall_Allen]

Thanks

[Don_1213 in reply to Tall_Allen]

Allen - I agree on a 2nd opinion (I even had a 3rd) by Epstein. Just a note on the cost. Medicare DOES cover this. No out of pocket for the patient once you've met your annual deductable. I had sent my request along with a check that they cashed. After some time they realized they had also submitted it to Medicare. They contacted me and sent back a check for the full amount I'd paid.

Just a heads up!

[AlanMeyer Moderator]

I agree with Tall_Allen. Cancer does not normally just go away. It's likely there somewhere, it just so happens that the urologist did not succeed in sticking a needle in the right place to find it, or he did but the pathologist didn't see it in his microscope. I also agree that you should continue active surveillance. I would think that PSA tests alone are enough. Unless and until the PSA goes significantly up I don't know what good another biopsy would do. Finally, sending the biopsy slides to John Hopkins involves no new needles but gives you a second opinion from a set of recognized experts. I expect it will confirm that you don't need treatment at this time.

Best of luck.

Alan

[curtisbirch in reply to AlanMeyer]

I can attest to the importance of getting a second opinion. I sent my slides to Johns Hopkins and they found small percentages of grade 4 in my biopsy when previously I was diagnosed at 3+3. This changed my approach and I opted for treatment. While it felt like bad news at the time, now I’m grateful that I had the extra information to help me more confidently choose my path.

[dac500]

Low grade prostate cancer usually progresses very slowly. But how can you be absolutely sure that you have only low grade cancer. Biopsies are notorious for missing prostate cancer. Even MRI cannot detect small volume of cancer. Being vigilant is the best thing to do.

In 2011, I was diagnosed with Gleason 3 + 3, low volume cancer (only 2 of 12 core cancerous only with 10% involvement). I had brachytherapy. Two years later, my radiation oncologist told me that I was cancer free. I protested and said: "Do you mean in remission?"

In 2016, my cancer came back with a large extra capsular cancerous mass (confirmed by biopsy and MRI). I had cyber knife with 9 months of ADT.

Then in 2018, my cancer came back again, this time quite aggressively. My PSA went from Undetectable in January to 4.48 in November, with a PSADT less than two months. PET-CT scan found metastatic cancer in many pelvic and abdominal lymph nodes. Biopsy of on of the lymph nodes confirmed that. Since November 2018 I am on Lupron and Bicalutamide. My PSA in June was 0.10. I go for another blood test and Lupron shot in early September. Being unlucky twice, I am jittery before every PSA test, wondering when my metastatic cancer is going become castrate resistant.