Spouse seeking advice

Hello All,

First, it is a great thing to find this forum and all of the wealth of information that it presents. Thanks to everyone for sharing your experiences and your wisdom.

I'm writing as a spouse of someone who recently got an elevated PSA reading. He is 57, PSA 6.5, DRE normal. No family history, no symptoms. The last time he had a PSA test was 4 years ago at 2.75, and the doctor was unconcerned. The current urologist ordered a biopsy. Only comment was the my spouse had a "small" prostate. My husband is doing another PSA today with the Free-PSA (that's the only other one they do around here), but given PSA size comment, I doubt anything if I'm understanding things correctly. My spouse scheduled the biopsy for not until early March. :(

So I would l would love your insight on several questions;
1. Right now, I'm concerned about velocity and density. Is this a valid worry?
2. Is early March putting it off too long?
3. If it is PC, my inclination would be to head straight to a place like John's Hopkins. But given that, would it be best to go straight there and do an MRI biopsy?

Sorry for all the questions. I've tried to read the prior forum posts, too. Again, my thanks for everything.

Sincerely,

pjr

Welcome to HW, sorry you need to be talking to us.

First, the PSA test is not a test for cancer. It simply indicates prostate activity and size. It can be used as indicator that a biopsy may be needed along with other tests such as a DRE, freePSA and that PHI test (prostate health indicator). A rise in PSA can be due to a number of things, infection, enlarged prostate, sex within a day or two of the blood draw. PC is very low on the list. Before going for a biopsy your doctor will want to rule out other possibilities.

To answer your specific questions:
1. No, don't worry about that. Infection could cause that just as PC might. In fact the fast it rises the more likely it's prostatist.
2. No, PC is a very slow growing cancer and you've got time to make an informed choice. Don't go rushing around on this - PC is an old man's disease and moves slowly like some of old guys.
3. You get to pick your doctor, so your choice. But, you don't know if it's PC - that's what the biopsy will confirm. Don't jump to the worst case without cause. In your place I'd do the biopsy locally and if PC is shown, you can have the samples sent to JH for a second opinion.

and how old is your spouse? That makes a bit of a difference too.

and even if the worst is found - you've caught it early enough to have a good treatment outcome with lots of choices and plenty of hope.

Remember, I am not a doctor, just some random guy on the internet.
Hang in there and we're here if you have other questions,
Andrew

I agree with Andrew's comments, except where he calls prostate cancer an old man's disease. We have plenty of guys on the forum who are in the lower 40's. Sometimes it picks on the young. One can never assume that just because they aren't in the 60's or 70's that they won't develop prostate cancer, and possibly even an aggressive case of prostate cancer.

Sometimes prostate cancer behaves like a ***** cat, and sometimes it's behaves like a lion. There's more than one kind of prostate cancer, and some strains can be aggressive. Fortunately, the aggressive ones are the exception.

We don't know your husband's age, but from what you've written, a biopsy seems like a good idea. If cancer is found (and that's a definite "if"), then a second opinion on the slides would be a smart move.

Finally, there are excellent surgeons in every major city in the county, but even if it turns out to be cancer, bear in mind that surgery is only one of several options, and it might not be the best one in your husband's particular case.

Keep calm, see how things work out, and please keep in touch.

pjr64,

Welcome to the forum. Can't think of much to add to the advice you've already gotten.

I will mention, since you are new and unfamiliar with the forum software, that it tries to find bad words and replaces them with asterisks. What clocknut was trying to say was "pu55y cat".

An increase from 2.75 four years ago to 6.5 today is a PSA doubling time of over 3 years.

So no need to be concerned about velocity.

You can feed his PSA and actual dates into this tool

nomograms.mskcc.org/Prostate/PsaDoublingTime.aspx

PSA DOUBLING TIME
Months
Doubling Time 38.7 months
Slope Log (PSA) 0.0
Velocity 0.1 ng/mL/mo
Years
Doubling Time 3.2 years
Slope Log (PSA) 0.2
Velocity 0.9 ng/mL/yr
BASED ON YOUR INFORMATION
PSA Date PSA Value
02/05/2011 2.75 ng/ml
02/05/2015 6.5 ng/ml

Hi Again All,

I posted elsewhere, but figure it's probably best to stick to the same thread.

My husband's (age 57) PSA dropped from 6.5 in Jan to 5.27 last week. His %FPSA is 14.4. DRE negative. His biopsy isn't scheduled until March 5th, and I'm really, really trying hard not to panic. He's not -- hell, he's in Germany right now for work. So I'm by myself and just trying to get as much info as I can -- reading Walsh's book, etc.

Below are the questions that are running around my head. Any at all that anyone can comment on would be so helpful. Even if that comment is to chill-the-f^ck out. :) So here goes:

-The %FPSA is filling me out. There seems to be some "magic" number of 15. But then I realize that if his PSA had dropped even further, he would be higher than 15.
-What could cause a PSA to drop by that much?
-March 5th seems like such a long time away.
-It seems like more and more people are recommending color doppler ultrasound or MRI. Should I look at that first?

Okay... whew. Going to try to chill now. Thanks so much all.

pjr

Hi PeterDisAbelard,

Thanks for your note. Much appreciated. :) I think the wine I'm having is more chill(ed) than I am, but I can't say that it's hurting. :) Everyone's insights on this board are invaluable. Taking it more slowly now. Thanks again.

pjr

Hi Everyone,

I've been lurking and learning since I first sought your advice. My husband went with the 20-core TRUS biopsy that the local doctors do here, and we should find out by Thursday.

I am pretty nervous here (understatement), but thought I would share how he's dealing. Just now, I heard my husband (who is from New Orleans) exclaim from his study -- "OH NO!!!!" Of course, my heart jumped, and I asked "What's going on?" "The Saints no longer have Jimmy Graham -- Oh no oh no!! darn!" he almost sobbed.

Thanks again for all the advice and sharing.... I'll post again when we get results.

Warmly,

pjr