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Posted 6/16/2008 11:20 PM (GMT 0)
Hello all, I just joined the forum and appreciate all of the great responses from the members.

I'm 47 years old and went in for a physical and found my PSAs are 4.4. The last physical I had I was 41 and I assume my insurance wouldn''t pay for a PSA test if the DRE was negative. My current DRE is negative also, but I have some dull pain in what I thought was my epididymis region. I had an epididymal cyst 5 years ago and this discomfort is very similar. The cyst went away about 2 months after diagnosis with ultrasound.

My father had prostate cancer and so did my father's brother. I know this puts me at higher risk.

I'm just trying to figure out if I should panic or not! What sort of tests should I ask my Urologist to do or what questions do I even ask? I'm not inclined to think I have cancer, but forums like this have made me think otherwise. Should I ask about ultrasound or other diagnostics before biopsy? I've heard mixed reactions to the biopsy itself. about half of the people I spoke to say they had a horrible experience with it (lot of blood and extended pain) and the other half said it was unpleasant but not that bad.

I don't want to die of cancer because I'm stupid or unwilling, but I don't want to just concede to invasive procedures. I tried to book an appointment with the Urologist I saw 5 years ago. The nurse said that the appointment was 10 minutes long and the doctor would decide if he wanted to order a biopsy. 10 whole minutes to examine me, discuss issues and futures and order tests??? Needless to say I'm also seeing another Urologist.

I'm a bit frantic and appreciate any wisdom the members can share.
Posted 6/16/2008 11:34 PM (GMT 0)
Based on your age and my limited knowledge and experience, I would be inclined to think your PSA is a bit higher than normal. As I see it there are a few options. One is wait and have another PSA test in a couple of months to see if it is moving. Another option would be to ask for a biopsy. I know there are mixed opinions on a biopsy, but as for me I personally recommend it. yes it is invasive and there is some discomfort and bleeding, but it is tried and true. There are also some scans that can be done, but from what I have heard it is hard to get insurance to agree to scans. I believe I would try and find a doctor that is compassionate, cares about your feelings, and wants to get to the bottom of the PSA number. A higher than normal PSA is not indicative of PCa so don't panic, but I would go further. Welcome to our site and I hope you find answers to your questions. please stay in touch with us. We do care.

peace and grace
Dale
Posted 6/16/2008 11:46 PM (GMT 0)
Given your high (especially for your age) PSA and your family history, a biopsy might be in order.

Will be interesting to see what your urologist says.

 

By the way, my DRE was negative, yet my PSA rose from 1.8 to 14 in a little over a year and I have/had a very aggressive cancer.....so negative DREs do not mean a lot in some cases.
Posted 6/16/2008 11:57 PM (GMT 0)
KC

If a negative (nothing noted on DRE) was the only thing to consider I would probably be sitting at   home being eaten up with cancer. 

Insist on a PSA check even if you have to pay for it. If is shows anything insist on a biopsy.

You have come to a great place for informationa nd support, none better in my mind. 

Keep us informed and ask all the questions you think  of.

Richard yeah   tongue yeah

Posted 6/17/2008 12:17 AM (GMT 0)
WOW!!! It took less than an hour and 3 good responses.

Thanks SO much for your support. I do have other cancer victims in my family. My youngest sister just died at age 42 of very aggressive melanoma so I'm still a bit raw from the short, horrible path there.

Has anyone heard of a newer biopsy procedure done under general anesthesia? I just heard of it and understand that the Gleasons from that test are superior. If I have to look into the maw of the evil cancer, I really DO want to have every fact and know more than my doctor if possible!

So would the general consensus be to get the biopsy if the Urologist "offers" it? I thought an ultrasound might be first steps. Is this common???

Do I care if my doctor is board certified??

I am very "chatty" so be ready for me!!!! If I have the time I will certainly be out here a lot asking questions and getting the good information from you men that have gone through this. God bless you one and all! (Or insert your favorite diety).
Posted 6/17/2008 12:49 AM (GMT 0)
Good point selmer. I think more information is in store. I realize your family has a history of cancer which makes you a bit anxious and rightfully so. Consider asking your urologist about a biopsy or maybe share your exact concerns you have shared here with your doctor. If he or she does not listen to your satisfaction find one you are comfortable with.

peace and love
Dale
Posted 6/17/2008 1:00 AM (GMT 0)
KC,

3 out of 4 suggest you consider having a biopsy and I agree with the majority. I had 2 biopsies and it was a piece of cake, nothing to really be concerned about. I realize everybody reacts differently to any procedure but all I felt was several pinches and a little soreness for a few days. I wouldn't do any bike riding for several days but other then that it shouldn't disrupt any plans. Just for the piece of mind would be worth having it done.

Ken
Posted 6/17/2008 1:07 AM (GMT 0)
Whatever you do, find doctors that you can relate to! Almost as important as the doctor is his/her staff in the office. A good staff usually means a good doctor is in charge. If any of these people are to busy to talk with you or they are running a medical mill, walk out. A biopsy is the only thing you need to get done at this point, get it done, it is an easy procedure, in the meantime, do not borrow trouble. A higher PSA can be caused by having sex the night before your blood test or a slight inflamation or infection. Relax and go get the biopsy -- it will rest your mind or catch your prostate cancer early, so it is a win-win thing to do.
Posted 6/17/2008 1:53 AM (GMT 0)
KC,
My husband was on antibiotics for 2 months. No change in PSA. Went and had a a dre and according to the doctor, his prostate felt normal for a man his age. The doctor wanted the biopsy anyway just to be sure. Came back with half of his prostate with cancer. Get the biopsy. My husband walked out after the procedure with no problems. Alittle bleeding when he peed but that only lasted a day or so. I just feel its better to be safe.
Posted 6/17/2008 2:25 AM (GMT 0)

If it were me I would go ahead and find another doctor that would give you a little more time and have a biopsy done.  That way you will know.

KW

Posted 6/17/2008 2:31 AM (GMT 0)
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Posted 6/17/2008 2:47 AM (GMT 0)

Welcome KC9AOP,

I hope you consider yourself as always being with us.  There are a lot of great folks here with varied experience with this disease.  We're here to discuss our challanges and to comfort each other.

I had a PSA of 4.3 at age 54 and an inconclusive DRE.  I decided for the biopsy and it really wasn't too bad.  It lasts a short period of time and people typically have no trouble with it.  Fortunately, we caught the cancer in the early stages.   That is what you want to do to give yourself the best chance possible.

The biopsy under the guide of a skilled surgeon is usually very accurate in detecting cancer or not.  It will provide you peace of mind as to what is really going on with your body.

You are entitled to as many opinions as you wish.  With PCa in your family history, that is a cause of concern as well so, in my humble opinion, it is worth all the effort you can give it.

Stay calm and focused and you'll be able to get through this.

Continue to stick with us and ask all the questions you like.

Again, a very warm welcome to you!

Kind regards,

Posted 6/17/2008 2:54 AM (GMT 0)

Selmer said...

Been there said...
A biopsy is the only thing you need to get done at this point, get it done, it is an easy procedure, in the meantime, do not borrow trouble. A higher PSA can be caused by having sex the night before your blood test or a slight inflamation or infection. Relax and go get the biopsy -- it will rest your mind or catch your prostate cancer early, so it is a win-win thing to do.

Am I missing something here? Everyone seems to want KC9AOP to get a biopsy regardless of whether his PSA was accurate. Like you said, sex, inflammation, infection, DRE, etc can cause a significant rise in a otherwise "normal" PSA.
Perhaps I misunderstand what everyone is saying. A biopsy, sure, AFTER its established that he really has a 4+ PSA.

Selmer,
I do understand where you are coming from and you are right.......he should try to eliminate other causes of an increased PSA before opting for any invasive procedure. But as you can see from my stats........not a high PSA, nothing felt on DRE by either my G.P. nor my intial urologist. But, after the Da Vinci, pathology revealed substantial volume of tumours (Gleason 4+4) to both sides, top to bottom, but at the front of the gland where it can not be felt on DRE.
Bill
Posted 6/17/2008 3:31 AM (GMT 0)
Hey KC9AOP,

You can get as many opinions as there are participants here. Go see your doc, discuss your concerns and go from there.

Jim
Posted 6/17/2008 3:48 AM (GMT 0)
You have an above-normal PSA for your age.  This could be caused by any number of things, including prostate cancer.  You have a family history of prostate cancer which must be weighed in considering how to approach this.  A negative DRE, of course,  doesn't mean you don't have prostate cancer.

My guess is that the urologist will have you retest your PSA first, then if it is again higher than normal, recommend a biopsy. 

If it is cancer, the likelihood is good that you've caught it early and have every reason to hope it's treatment will result in becoming cancer-free for the rest of your life.

Find medical practitioners whom you can trust and relate to. 

My two pennyworth...Tim

Posted 6/17/2008 5:04 AM (GMT 0)
Welcome to a great forum brother this can be a tough time in your life ,the uncertainty and all, my psa was 3.9 and my urologist took a very modest 6 cores not expecting to find anything at 43 yrs old im so glad he found it early, this is not to say you have cancer ,however in my opinion a biopsy is the only difinitive way to say yes or no ,the biopsy isnt that bad .it is a little uncomfortable but not the worst thing ive ever experienced. relax take a deep breath ,the biopsy is a very small speed bump in the road of life in the grand scheme of things, ..........dirtmover

Posted 6/17/2008 7:24 AM (GMT 0)
Hi KC,
And welcome to a great site. Great responders across the board have already posted. Each of our guys above have thoughts that represent all you should consider. But I have another perspective for you. At age 44 my PSA was 19.8, DRE negative. If I was able to get back to a point my PSA could have been discovered at 4.4, I easily would have had the biopsy done. I might agree a second PSA after a few weeks to verify the abnormal reading was not due to infection. But if it confirmed, biopsy is the only choice for me. And if positive acquire the services of a great da Vinci surgeon given my age (Tony's Opinion). After enduring many therapies after a surgery and still a late stage disease, I would love to have gotten at it at an earlier point.

Tony
Posted 6/17/2008 12:29 PM (GMT 0)

Just to add another opinion....

The biggest thing I would have done over again in my treatment course is to have insisted on a biopsy when I first found out my PSA was high (admittedly, MUCH higher than 4.4).   If you're squeamish about the biopsy procedure itself, ask for drugs to take the edge off.

Good luck!

Posted 6/17/2008 12:58 PM (GMT 0)
#1 - Make sure you have an accurate PSA reading.
#2 - With PCa in your family I would err on the side of caution and go for the biopsy if your PSA is high enough to meet your doctor's standards.
#3 - My doctor's PSA standard was 3.5. I had a PSA from Lab A in March 2006 that was 2.5 - no big deal. In December 2007 Lab B said it was 4.5. My doctor told me to go back to Lab A and have it re-done. I did so and they came back with 3.7. Based on the 3.7 and the velocity rate, I had a biospy. After surgery they determined that 15% of my prostate was cancerous. And I never had any symptoms at all.

One of the 3 doctors I talked to told me he had just done robotics on a 41-year-old, and a guy in his practice had just diagnosed a 35-year-old man with PCa. It is never too early!
Good luck,
kcragman
Posted 6/17/2008 1:25 PM (GMT 0)
Thank you ALL for the fantastic response! I'm tearing up as I read on...

A few questions popped up along the way I'd be happy to answer.

1. Blood was drawn before the DRE
2. Sex happened within 48 hours of the test
3. This was my first PSA test so I don't have any velocity figures to offer

Since I had the epididymal cyst, I wonder if I'm not a candidate for prostitis or other disease. I'm fully willing to admit that I don't like the idea of the biopsy, BUT, I'm unwilling to die because I'm squeemish about a test.

I will absolutely make sure the PSA level is accurate. The urologist I'm going to see did not prep me in any way for the visit, but I will abstain from "activity" for 3 days prior and will discuss with him my symptoms.

The "run 'em through the mill" doctor may just get a cancellation from me after this Friday's visit with Urologist #1.
Posted 6/17/2008 1:38 PM (GMT 0)

Yes, nothing wrong with getting a quick follow-up PSA first, but if it were me I'd want the biopsy if the second PSA shows similar results. Joining the bandwagon, I'd really stress the importance of early detection...

John

Posted 6/17/2008 2:41 PM (GMT 0)

One other thought.....in my case, I did have a prostate infection....and took antibiotics for about 7 weeks....and my PSA continued to rise quickly.

My point in mentioning this is that in some cases, a person has a prostate infection AND prostate cancer...

Posted 6/17/2008 2:50 PM (GMT 0)
 about the prostate biopsy--Men vary widely in their experience of pain, but for most men this procedure has a low pain quotient and it is described as uncomfortable rather than painful. Numbing medication ahead of time usually takes care of the pain. For me anticipatory anxiety was the worst part.  I wish you well....Tim  

Post Edited (TimG) : 6/17/2008 8:59:41 AM (GMT-6)

Posted 6/17/2008 3:10 PM (GMT 0)
hey there kc9aop one thing  in my opinion that will help you along in this journey is ...if you dont have the utmost confidence in your urologist DITCH HIM i went through 3 before i was comfortable with the treatment and the answers i was getting,your gonna do great get the biopsy  please. you wont be sorry, i was 43 . as far as the doc thing  it is even more important to get that warm fuzzy feeling if you have to choose a surgeon. but lets not get ahead of ourselves you dont know right now if that biopsy will come up negative either .good luck brother we will be right here when you need us................dirt

Posted 6/17/2008 5:12 PM (GMT 0)
Biopsies are a pain in the butt...kind'a...

But I'll join the chorus to say that it nailed down my PCa at an early point, so I'd say go for it. It is rather an affront to one's dignity, but not really painful.  I would suggest that a little yogurt is a good thing when they give you the antibiotics, as it helps to revive the healthy bacteria in the gut. Good luck!

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