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Posted 5/14/2010 2:30 PM (GMT -5)

Let me start by giving you a little background.

I am 44 years old. White with no history of PCa in my family. At the age of 40 in 2006 I had my first PSA done which came back at 1.0. There was no concern as I was well below the "normal" range. In April 2009 my PSA was checked again during my routine physical. This time the result was 2.9. Again my PHP was not concerned. In April this year another routine test was done, resulting in a reading of 4.6. A repeat test came back 4.4. (different lab) I am otherwise in excellent health.

My PHP referred me to a Urologist.  I was examined by my Urologist who informed me that my DRE was normal. The Prostate was not enlarged and he felt nothing abnormal. I also have no symptoms of any kind. Urologist ordered a FPSA test. Those results were 4.7 and 6%. I have done enough research on my own to know those numbers are not good. On Tuesday 5/11 I had a TRUS biopsy. Nothing abnormal was observed. The only thing notable was some calcification in the gland.

 Now as I wait for the biopsy results my mind begins to wander. Urologist stated that if it is in fact PCa it would be in very early stages, which helps put my mind at ease. However I am a bit concerned with the velocity although I have not discussed this with my urologist.

 I have mixed emotions on the potential results. While I do not wish for a positive biopsy I think it would be easier than repeat Biopsy and testing. Any suggestions or words of encouragement out there?

Posted 5/14/2010 2:47 PM (GMT -5)
Welcome Greg,

Obviously something is going on and lets hope it is minor and if indeed it is Pca, perhaps it has been caught early. It's difficult to keep the mind from racing until you know the results however. Keep us posted and lets hope for the best.

Michael

Posted 5/14/2010 4:01 PM (GMT -5)

We have all been there.

When are you expecting the biopsy results?

Mel

Posted 5/14/2010 4:01 PM (GMT -5)
Greg,
Welcome, sorry you have to be here. I was 45 when my numbers started rising...and finally diagnosed a couple years later.
Sounds as if it has been caught early. Yes, there is always the chance that it's nothing, but your research is right - I did the same research. As a younger guy, the good news is that recovery from the surgery is usually really good and your side effects are usually less.
Email me if you'd like to talk.
Paul
Posted 5/14/2010 5:01 PM (GMT -5)
Greg,

Good luck with the biopsy results. If I had to live my journey over again, I would try to do a better job not worrying about things that have not, or never will, take place. Even though my outcome was as successful as could possibly be (so far), I cannot get back those many hours of worry and anxiety that cancer took from me. As others have said, you can take comfort in the likelihood that you caught it early IF the test does come back positive.

CaPCa
Posted 5/14/2010 5:19 PM (GMT -5)
Hi Greg, and welcome.

Please be aware that an elevated PSA and a correspondingly low Free PSA percentage can be caused by a prostate infection (prostatitis), which is a benign rather than a malignant condition.  In other words, Free PSA alone had no diagnostic power in distinguishing prostate cancer (PC) from prostatitis.

The American Urological Association's PSA "Best Practices" document (2009 Update) advises doctors that consideration should be given to confirming an abnormal PSA before proceeding to biopsy.  The majority of biopsy proceedures do NOT find PC, and the AUA feels that doctors should do more "due diligence" to eliminate prostatitis, infection or non-cancerous BPH before moving to a biopsy.  Anyhow, sounds like your urologist jumped right to a biopsy (which is not uncommon)...or did he do a urine/culture test to determine infection (something you didn't mention)?

The more common (and AUA recommended) approach would have been to test for infection first...I would say especially with the fairly rapid rise you experienced in PSA, which is very unlike the typical PC but is like infection symptoms.  If prostatitis symptoms are noted, four to six weeks of Cipro or similar antibiotic should be prescribed prior to recommending a biopsy.  At the end of the Cipro therapy, a repeat PSA determination should be made. If there is significant lowering of the PSA, an element of prostatitis is likely to be present. Because it is also possible to have both prostatitis and PC, the PSA value after antibiotic therapy will more aptly reflect the status of the patient in the situation where a diagnosis of PCis subsequently established.

Wanna do a little light reading on PSA?  Go to this AUA site:  http://www.auanet.org/content/media/psa09.pdf?CFid=2648028&CFTOKEN=35046693&jsessionid=84307f42d7f956aedb10451065747970f241

Hoping for good results for you.  If no PC is found, ask your doctor about eliminating non-cancerous causes of PSA elevation...like prostatitis.

best wishes...

Posted 5/14/2010 6:28 PM (GMT -5)
Thanks Guys. I appreciate the support!
Casey59, I did ask for my urine specimen to be checked for infection, though the Uro had not requested it. I know the nurse would have followed through but I was never given any results. I have no symptoms of infection. Is it possible I could harbor an infection or prostatitis over several years without symptoms?

I expect my Biopsy results next week.

Paul1959- Dr. Samadi? Looking to go the same route if needed. Will send you PM.

Thanks again guys!
Posted 5/14/2010 7:29 PM (GMT -5)
Greg, welcome here to our corner of the world.

You have already been given some pretty good advice.

Keep in mind, that there are many of us with PC, that never had a positive DRE, or any symptons of prostate problems, some with real low PSA numbers, etc.

As far as biopsies go, the waiting game is always rough. Some men get by with just one, others more. I had 3 within 18 months before a positive dx of PC. I believe we have one brother here who had 12 biopsies.

Good luck, I hope you don't need to join our brotherhood here, but if you end up with a PC dx, this is a great place to hang out, to gain knowledge, to have support, etc.

Please keep us posted.

David in SC
Posted 5/14/2010 9:07 PM (GMT -5)

Gregz263 said...
...I have no symptoms of infection. Is it possible I could harbor an infection or prostatitis over several years without symptoms?...

Yes.  There are often no symptoms of infection.

Posted 5/15/2010 8:48 AM (GMT -5)
If my Biopsy is to come back negative what test could/should I ask for next?
Posted 5/15/2010 2:04 PM (GMT -5)

Greg:

That's a good question. If the biopsy is negative, then wait and keep monitoring your PSA. If it goes up more, get a PCA-3 test.  That test should indicate if a repeat biopsy is needed.

Also, there is something called a saturation biopsy (more cores are taken). They can always do that, but probably only if you have a few negative biopsies and if they are suspicious that you have PC.

Mel

Posted 5/29/2010 5:14 AM (GMT -5)
Got my biopsy results yesterday. 12 of 12 cores negative. However my Urologist is concerned that he cannot find any other reason for the elevated PSA and that my numbers and velocity are "worrisome".
Looking into color doppler ultrasound. Anyone have any idea where I can find a facility with this equipment in the New England area?
Posted 8/4/2010 12:41 PM (GMT -5)
Got a second opinion and subsequently a second biopsy, again, all negative ***??? Infection, inflammation and BPH all ruled out. Dr says wait 6 months then repeat PSA and likely biopsy again. Anyone have any experience with color doppler guided biopsy or TARGET biopsy?
Posted 8/4/2010 1:53 PM (GMT -5)
<<Looking into color doppler ultrasound. Anyone have any idea where I can find a facility with this equipment in the New England area?>>

You might call Duke Bahn in LA or Fred Lee in Rochester Michigan -- two well known experts -- and ask them for a recommendation in New England. Or, if you are in a position to travel, you could see one of them. Alternatively, you could call one of the docs at Brigham & Womens Hospital in Boston (eg, Dr. Hu) and ask them. You might ask about color doppler, an MRI-guided biopsy, or a saturation biopsy. Good luck.
Posted 8/4/2010 4:08 PM (GMT -5)
Yes definitely get a color doppler from Dr Lee or Dr Bauhn,my husband did[Dr Lee] and it saved him from even getting a biopsy!! Some will tell you that color doppler cannot rule out PCa but I'll will argue long and loud that it can!! [if done by one of the very few experts] My husband and I just got home this afternoon,from Dr Lee's office after quite a few stressful months after family Dr and uro Dr wanted to biopsy. Dr Lee after 2 visits  exam and color doppler,2 wks on Bactrim,wait 2 wks,retest psa diagnosed prostatitis and said see you next year! Family Dr & uro Dr both were sure PCa, after 4 psa's 5.5,5.9,7.1,5.5 Dr Lee after careful color scan,saw some inflammation which was cleared up w/bactrim and no areas to biopsy!
Posted 8/4/2010 6:50 PM (GMT -5)
Color doppler is available from Dr Sconti and Dr Bard in NYC. If have read some of Bard's papers and was not impressed. Have heard some good things of Dr Sconti. If I were on the east coast I would go to Sarosota Fla and the Dattoli Cancer Center for a CDU.
On the West coast you can't go wrong with Dr Duke Bahn or Dr Doug Chin in So Cal. But the master still is Dr Fred Lee in Rochester MI.
JT
Posted 8/4/2010 7:05 PM (GMT -5)
You can look at my history as see you are not alone..My PSA was 14 (adjusted for Proscar) before the third biopsy found it..My U-doc was pushing for that third biopsy sooner but I resisted it..

He said a standard 12 core biopsy will find 90% of all prostate cancers. The second biopsy will find 95% and the third 98%....

Maybe they just make this stuff up, Who knows??
Posted 8/5/2010 6:07 PM (GMT -5)
Just made an appointment for a color doppler guided saturation biopsy with Dattoli. Hope we can put this to bed!
Posted 8/5/2010 6:58 PM (GMT -5)
Greg,
Please give us a report on how it went.
Good luck
JT
Posted 8/6/2010 7:49 AM (GMT -5)
Glad to here it!!!!! Good luck, hope all goes well.
Posted 10/5/2010 2:33 PM (GMT -5)
Latest numbers are in PSA 4.7 FPSA 9%

Color doppler guided saturation biopsy at Dattoli scheduled for 11/03.

Looking for an answer
Posted 10/5/2010 4:23 PM (GMT -5)
Good luck Greg!
Keep posting. I'm hoping for a good ending.
Mike
Posted 10/5/2010 6:41 PM (GMT -5)
History Lessons..
Posted 10/6/2010 3:41 AM (GMT -5)
Seems like a great choice Greg, I can't think of a better option in your situation. I hope you get the all clear but if there is a cancer there this is your best bet.

An
Posted 10/6/2010 5:13 AM (GMT -5)
I think I am doing all I can do. Thanks for the encouragement.
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