tPSA up more than 1ng in one year

46 yr. old, white, no family history for PC. For the last few years, 2004-2008 my PSA was between .6 - .75 with the last values on June 2008 .61. Free ratio was .57. Annual check up on June 2009 said PSA 1.75 and frees ratio .27. Seeing the urologist on July 2009 he said that I should have a biopsy, which it is coming on October 5th, 2009. In the last six years, I had asymptomatic microhematuria in urine, which disappeared for a while and coming back. Always traces no small amount. The specialist performed cytoscopy on July 2005 and June 2009 and he did not found any reason for hematuria. I have a discomfort on my pelvis, no back pain, no joint pain only burning on urethra after urination. That happens when I drink a lot of water on short time and I need to go to washroom more often. Over night going out one time and not on every night. Starting with 2005, the specialist put me on Flomax which helped to remove the symptoms on the beginning but on 2007 the doctor said to take one in the morning and one in the afternoon. I am still on Flomax, once a day for now how the specialist prescribed. End of July 2009 the urologist performed DRE and he told to me NAD - supposed to means that nothing detected. I will go for transrectal ultrasound on next week. Now, on September 09, 2009 I ask my family doctor for one more PSA and free ratio to see the evolution over three months. The result scared me like crazy because PSA came back 2.25 and frees ratio .33 - this values bigger than June 09 does. The first result did not scared too much because I supposed that I was lucky to catch something pretty earlier, but the second one make me crazy. I am taking prescribed pills for sleep and also pills for days, so I can be able to concentrate at work. The DRE was done on July 25, 2009 and it was a hard one because the doctor used a lot of pressure to try to catch something on my prostate. As I already told you, NAD. Can the result from September 09, 2009 be not so accurate because of the DRE done on the end of July 25, 2009? Or the disease is aggressive? Also, can I have other symptoms? I asked urologist couple of years for a biopsy but his answer was NO because my entire test. This year, he asked me directly if I want to have a biopsy or I want to stay and watch. I choused biopsy but I am really scared. Can somebody tell me something from own experience and has an advice? I am dealing very hard with this situation. Thanks a lot

Welcome Gog, to Healing Well, Prostate Cancer group. Your current fears and worries are normal and expected at this point, so don't feel bad or alone.

You definitely need a biopsy at this point, good advice from your doctor. If your doctor felt something, and with your psa velocity, it's the right thing to do. And keep in mind, one biopsy doesn't always detect cancer. If it comes back clean, doesn't mean cancer isn't there, means it didn't find it on that pass. I had 3 biospies before they hit pay dirt. I believe someone else here had 10. Not saying that to scare you.

If it comes back positive, the good spin to it, is that is early detection and that is always good not only with prostate cancer but with any cancer. And if it comes back with a low grade case of prostate cancer, you will have many if not most primary treatment options in front of you.

Not going to tell you there's nothing to be afraid of, we all face our fears everyday when dealing with cancer. We are a great support group, lots of experienced men, and men new to our world. We support each other and look out for each other.

Please keep us posted.

David in SC

Yes it is scary but take a deep breath. First of all there are reasons other than prostate cancer that your PSA might rise. Second, if it is prostate cancer your PSA is in a very low range which would mean that you had lots of time and mny good options. Remember that PC is a very curable cancer -- not a death sentence.

At your level it is very very likely that you would have no symptoms and a negative DRE, but the thought of PC can cause the mind to find all sorts of things.

I think that the biopsy choice is a reasonable one, You might want to search this site for what to expect

Everyone here can relate to how stressful your situation is. We have lived this, It is no fun, but you will survive. You may want to look at the permamant links above for some recommended reading -- especially some very good books.

Remember that if it turns out to be PC, we are here with you and for you.

Hi everyone,
Thanks for your word and for giving me help with this one.
I can be a little calmer right now but still worry about the final result.
I got the result from the ultrasound and it is came back negative and with a prostate volume 29 cc. Four years ago the volume was 20.8 cc. The report stated that the size is normal (I read that the cut-off value is around 30 cc, so I am pretty close) and no other abnormalities detected. Yesterday I went under biopsy and cytoscopy also, but my only concern is that the doctor did not made an ultrasound biopsy because he said that it is not necessary at this time. I was told that he will use DRE and he will perform the 12 points biopsy based on his DRE. I do not understand why he did on this way and checking around I found good words about him. I really do not know how accurate the biopsy can be without ultrasound. I am thinking that he used the ultrasound done before and he did not think that it is necessary at this moment. Can somebody help me with that?
I am also researching to have another option making everything again at Ford Hospital in Detroit. I am living in Windsor, so it is not far from my house. Can somebody help me with some information about doctor's name to choose for a second opinion? Please, I need more information so I can speed up the process in case that the biopsy it is not accurate.
Thanks again for all your good word and God helps all of us.
Gog

 

Hello!

I am so sorry you had to join our club here, but we are glad to have you! There is so much good info from the members and the moderators. Don't be scared to ask any question. The best results come from informed men who know their options.

I am in California and had my biopsy done in a small office. The doc used a black and white ultrasound. He did find several areas of cancer. Then they referred me to Univ of Calif San Fran and there they used a color doppler and found even more.

So I am a supporter of color ultrasound. And also it is good to get a second opinion. Since I am not from that part of the country, I am sure others will read and suggest a place to go in the Detroit area.

I was panicking that I might have prostate cancer and what if I would lose my erection capabilities, be incontinent, or whatever. Well, not that 15 months has passed by since surgery, it was not that bad..... And having the cancer gone is better than getting an erection whenever I wanted one. I have no problems, especially if I use Viagra.

So take it from the ones who have been there, it can be scary, but gets much less scary when you know the facts.

Hello,

Thanks for your good advises. I was talking with my GP and his advice was to wait for the results from the biopsy and we will go from there. I asked him if I should look for a second opinion and he agrees with that. The only thing is that here (Canada) it is taking 2 - 3 months to get an appointment to urologist and so on. I do not know if it is a good idea to wait so long or it is better to go for a second opinion to Ford Hospital. Because the urologist did not perform a TRUS guided biopsy, I am not sure about the accuracy of the procedure. I made all kind of calculation relating tPSA (2.24), f/tPSA ratio (33%), PSAD (0.77), prostate volume (mine is 29 cc) and estimated tpsa (volume x 0.12) and the results did not showed up to be so bad. The only thing worrying me is the velocity and I am not sure if all the calculations should be accurate when you have a high velocity. Please, can somebody help me with my worries? Also, I started to go more often to the washroom but not for nothing. My wife advised me that it could be from the stress because she did not recall worrying about this before getting the second result on September.

Do you know how long can take for the result to come back? The urologist left a notice for me after the procedure stating for an appointment in four weeks. It is look like a long waiting time for me. Is it possible to call me back faster if the result is positive?

Thanks again,

Gog

I was under the impression that fPSA could only be tested if the PSA was at least over 4 (maybe I'm wrong with that, but that was my understanding).

Gog...not sure, but I was of the understanding that if the free PSA was 25% or above...then that was an indicator of BPH...which is what your biopsy reported. At this point the only other thing you could do, is to have your biopy samples re-read by another pathologist to confirm the original results. It won't hurt to get a second opinion on this before attempting any more tests.

Thanks for your answer,

LV-TX, I just talked with the laboratory and it is no problem to consider a second opinion on reading the slides. I just need to find good laboratory but I still have some doubt because the biopsy whas finger guided.

geezer99, your words made me feeling better but I am still worry.

As I already said, a lot of people around me think that it is coming from my head.

So, is it a good ideea to take a blood test, PSA and fPSA and one more color doppler ultrasound followed by biopsy if the US shows up something on the screen?

I know that they have a color one in Rochester, MI but I do not know if they have it @ Vattikuti Urology Institute. Any suggestion and how reliable those tests are? Also, can you point out for a good doctor to do the tests?

Thanks,

Gog Goga

 

In general, prostate cancer is fairly slow growing.

Why don't you try to take some deep breaths, believe the biopsy results, and give it 6 months, then have another PSA test? If the test comes back lower, or at the same level, give it another 6 months if you just can't wait.

You may want to see a counselor also to help alleviate your fears. Stress and anxiety can be just as harmful to you or maybe even more than low level prostate cancer.

We will try to help you here, but without lab results, or pathology, it is hard for us to know what to recommend.

Thanks all of you for replies.

James C. got my point here regarding my concern about the way how biopsy was conducted. Checking on the internet, I found out that is a way to have the biopsy using a flex cysto. I do not know how accurate this one can be and if it is taking samples from whole prostate or just a little bit of it.

Right now I don't exactly know if the uro accessed the prostate glande through the urethra, using a lighted scope with a small cutting loop inserted into the urethra to collect the samples or he used the flex cyto to view the prostate and he took the samples using fingers to guide the core needles but through rectal wall.

Now, if he gone using the first method, was he able to perform accurate sampling with samples from all around the prostate or he took samples just from where the urethra passed the prostate. 

Before the procedure, I ask him if he will do a TRUS prostate biopsy and he told that he will use the finger to guide the needle.

Can somebody give me more explanation about these situations?

Thanks,

Gog

Updates after meeting with GP
Now I am clear because I have the operative report. The biopsy was transrectal and guided by rectal exam. The samples were from suspicious area and random areas from lateral medial apex, middle and base from both sides. Total of 12 biopsies. The report specifies that digital rectal exam found irregular prostate!
Can somebody tell me what irregular prostate means because the biopsies came back negative for cancer but benign portion of tissues?
Also, the ultrasound done a week before the biopsy did not show any abnormality in the prostate.
What you guys think about this?
Thanks,
Gog

I do not understand why the urologist did not tell me about the irregular prostate. When he performed a DRE back on July 2009 he stated NAD and now he wrote down about irregular prostate on the Operative Report. Also, he stated that he took samples from suspicious area and came back negative. Is it possible for that the pathologist not reading properly the samples? Also, why he did not put the samples on separates cassette?

Seeing my GP yesterday, he gave me some med for depression and also he did not want to give me paper for PSA test.

Thanks,

Gog