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Posted 4/19/2014 3:52 PM (GMT -5)
All,

After several years of lurking, i have decided to join.
Right now i am in PSA purgatory.

After my last PSA of 6.1, urologist wants another biopsy. He refused to entertain any discussion of alternative testing or waiting.

I decided to get a second opinion from a world renowned urologist at the University of Miami.
After performing a very very thorough DRE and looking at the below numbers, he seemed unconcerned and recommended i do nothing at this time. He advised to come back in year. I told him i would be more comfortable with 6 months, and he said OK to that.

I just wanted to get some input from the folks here as you have been a great source of real time information and support over the last three years.

thanks,
Eric
Posted 4/19/2014 4:38 PM (GMT -5)
Eric:

I am not a doctor, BUT:

you have a family history and a slowly/constant rising of your PSA (one downmove but all others increased).

It would seem malpractice to ignore this.

I would strongly think that this is biopsy time.

I might add that most of us had a normal DRE before dx.

Perhaps others can chime in. Maybe my opinion is way too strong here.

(Also, sorry as I know this is not what you want to hear)

Good luck

Mel

Posted 4/19/2014 4:49 PM (GMT -5)
What is your age?
What is the size of your prostate?
Those are significant factors.

I would get a free PSA blood test. (higher is better on this test).

You might compute your PSA density that is PSA divided by prostate size. (less than .12 is a good omen.)

Good luck.
Posted 4/19/2014 4:58 PM (GMT -5)
Thanks for the reply, I updated my profile with age and free PSA that was performed 12/13.

i don't remember my exact size from the biopsy, but i don't recall it being over 30-40.

Second opinion doc said it was small and smooth.
Posted 4/19/2014 5:52 PM (GMT -5)
I can see why no one is in a rush to do a second biopsy. All your numbers are "on the fence." Slowly rising PSA could be age-related/BPH. PSA Density of .15-.20 is normalish. % free PSA is borderline.

Second TRUS-guided biopsies usually don't find anything. There's a possibility of some cancer in places that can't be reached by even the best DRE or TRUS-guided biopsy. You would have to use an mpMRI-guided biopsy, a CDUS-guided biopsy, or a saturation biopsy to find any there. The probability of an anterior tumor is higher if you are African-American.

You can have a PCA3 test (it's a urine test following prostate massage) that your insurance should cover because you've had a negative biopsy. All the other potentially useful biochemical tests would be fairly expensive for you or only available within a clinical trial.

Another approach you can discuss with your doctor is to take Avodart or Proscar and see what it does to your PSA. If it drops (average 50%) and stays down, that's a good sign. If it drops and then rises or if it never drops, then one of those fancy biopsies may be a good idea.

- Allen

left out the word 'free'

Post Edited (Tall Allen) : 4/19/2014 5:32:49 PM (GMT-6)

Posted 4/19/2014 6:07 PM (GMT -5)
Blinky,

I think that in your shoes I would get a biopsy after seeing what a course of antibiotics does to your PSA. The good news is that your PSA is doubling slowly, the bad news is that it is consistently rising. If your Prostate is on the small size then your PSA density is of concern. My view would be at age 56, if you are in good health, you have 30 years to go at least and you do not want anything that could cut this short to remain undiagnosed.

The fact that the DRE showed a smooth prostate is positive however the vast majority of people diagnosed with PCA would have had the same observation prior to diagnosis. Many here have had to do multiple biopsies before finding cancer.

The second doctor has made a call on risk that runs counter to the more conservative opinions of your first doctor. To a certain extent this does depend on your temperament - some people might be driven crazy by the thought that there was potentially undiagnosed and potentially growing PCa in them - others know that in the majority of cases PCa is a slow growing and manageable disease so if you have it waiting six months or a year may not make much difference.

An
Posted 4/19/2014 6:19 PM (GMT -5)
Blinky,

My numbers are close to yours, and I too was on the fence. My numbers slowly increased to 6.2 and free PSA went from a 10% (scared) to 20% (relieved) after several weeks of Cipro (antibiotic). My urologist then suggested an ultrasound to measure the prostate and to calculate PSA density. Well my prostate was around 35 grams which put the PSA density on the high side. During the ultrasound he saw many small prostate stones, a little bigger than grains of sand. He said that is probably causing the PSA to jump all over the place.

Well after several more PSA test he referred me to his associate (did his fellowship at MD Anderson in Urology oncology) and he said the stones could be causing the elevated PSA, but if it was him, he would get a biopsy. So I scheduled the biopsy the next week.

Well, what a surprise, I had prostate cancer, I underwent a multi-parametric MRI with and without contrast which showed nothing. So I decided to undergo robotic surgery.

The point I would rather be safe then sorry and detect it at the earliest stage which gives me time to make a decision and for optimum positive prognosis.

Nick
Posted 4/20/2014 7:58 AM (GMT -5)
Blinky, Would you consider a MRI guided biopsy.  The MRI guided biopsy has a much greater chance of finding the cancer then a random TRUS biopsy. 
Posted 4/20/2014 9:33 AM (GMT -5)
If it were me knowing what I now know I would seriously consider brachytherapy.
Bob
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