New member - Concerned Girlfriend

Hi! I'm a new member, and a loving, concerned girlfriend.

Sadly, my boyfriend has had some prostate issues lately, which brings me to this forum.

We're at a place where we're starting to research potential next steps online, and it's pretty scary. There's so much conflicting information out there, and it makes it hard to decide what the right course of action is. I guess I'm hoping someone can either point us in the direction of where we might find some answers, or offer their thoughts on our situation.

My boyfriend is 42, and in good health. While he has no family history of prostate cancer, and has no symptoms, there is a strong family history of colon and pancreatic cancer, and so he decided to err on the side of caution, and do yearly PSA screening (PSA & DRE).

He had a baseline PSA at age 40, which was 2.8, and the DRE was normal.

At age 41, the PSA remained at 2.8, and the DRE was normal.

This past January, the PSA increased to 3.2, and his PCP recommended being over-cautious and going to the urologist for the DRE and follow-up, despite the fact that he said he honestly believed the jump to be a fluke. (Not knowing it could affect his test results, we had sex 12 hours prior to the PSA blood draw.)

The urologist did the DRE, collected prostate fluid samples, urine, and drew blood for total and free PSA.

He just got a letter from the urologist with his test results, and a recommendation for biopsy: DRE, prostate fluid, and urine were all normal. The total PSA dropped back down to where it had been all along - 2.8, but the free PSA was low at 11%.


My boyfriend has concerns about biopsy - and is debating what to do about it. He's worried about the possibility of having cancer, but also is very concerned about the complications of over-treatment, given his age, and everything we've been reading about the majority of prostate cancers being insignificant, slow-growing, and non-life threatening. As well, he doesn't like the potential risks and complication associated with biopsy.

He'll be following up with the urologist this week, and will be asking about the pca3 test, and whether the results of it might be helpful in determining whether a biopsy is really necessary at this point.

Given the free PSA is low, but slightly above the 10% cutoff point, and the total PSA seems to not be increasing and is only slightly higher than the 2.5 typical for his age, he's wondering if the urologist is being a little jumpy or maybe over-cautious in suggesting a biopsy.

Any thoughts or comments on this would be most appreciated. This is our first experience with PC, we don't know anyone who's had it, and so we're quite frightened and alarmed.

Thank you for reading, and considering to comment.

Hi Karen,

Thank you so much for your reply!

I just read your story, and it's helpful to understand that we should take time for consideration and not quickly jump to conclusions and decisions. We're freaking out right now, to be honest. ;-)

We've been reading about biopsies being "like finding a needle in a haystack" - a biopsy might not find anything, given its 10-12 samples that may or may not be taken from a cancerous area. I guess one fear is that a negative biopsy will lead to a continual cycle of repeat biopsies - the numbers indicating that cancer is likely there, but based on the numbers, hasn't been found yet. Hence the thought of the pca3 test.

I will definitely post more, when I have more news.

And I'll certainly be watching for your news, and thinking of you both.

Thanks so much for the info, and your reply!
Lisa

When this first started - when the PSA jumped up, we were both so annoyed at the PCP. I kept saying, "If it's a fluke high number because we had sex a few hours before the blood draw, why go to a urologist?? Why not ask the PCP to repeat the PSA to confirm it's not really elevated, FIRST, to see if you even need a urologist."

It's funny, but we were expecting the repeat PSA to be normal, and then he was going to not screen again until he was 50. Of course the repeat PSA IS normal, as is the DRE. The only suspicious thing is the free PSA of 11%. If he'd first repeated the PSA with the PCP, then he wouldn't have even gone to the uro, and we wouldn't have this odd, free PSA number to worry about.

Without a rising PSA, and no symptoms, we wouldn't be dealing with this at all, and at this early age. So I guess while I wish my BF hadn't gone the urologist, now that we're here there's nothing to be done but worry and investigate.

Thanks so much for sharing your feelings. It's very helpful....

It's all pretty crazy-making, isn't it??? I don't know much about free PSA, but maybe you guys could wait and just test it again before proceeding with a biopsy??? I'd be tempted to talk to the urologist about doing that instead.....

Again, I'm new to all this, so hopefully some of the "experts" can give you some good advice!

Chin up!
Karen

Weesa, Welcome to our little club here. You'll find quite a few opinions here on what you should do. The first thing to remember is PC is slow to cause major problems. With your BF's low PSA, you don't have to decide on treatment any time soon. Take your time making decisions, read all you can, & continue to visit us here. There's several great books posted in the top of the forum, many available at a public library. My 2 cents says the urologist wants to do a biopsy to cover his/her ***. I would definately retest PSA with no sex prior as you stated. I wish that's what I would have done. My PSA is lower now than when I went to the uro with a high velocity reading. Nearly steady for over a year now. My biopsy showed a low grade cancer that many men over 50 have. So now I'm in Active Surveilence, monitoring PSA every 6 mo. If you have any ?'s just ask away.

Lisa and boyfriend -
Sorry you are in such a panic , but as the other postings have stated, you are not in a rush and have time to examine what is going on in your boyfriend's body and prostate. And to learn what treatments are out there.

One way to help take pressure off you two is to think of it as your boyfriend has prostate problems and you need to know more about it - it may be cancer in its very early stages - it may not be - the tests will help with more information on that.

One thing to consider regarding family history of colon and pancreatic cancers - that is a completely different type of cancer and does not make the boyfriend more subject to PCa ( prostate cancer) - if there are a family history of breast cancer, then early detection would be benefit to him for PCa ( they are similar types of cancer). My urologist/surgeon dismissed my family history of colon / bladder / sarcoma cancers .

Wishing you and your boyfriend all the best - and no sex for 3-4 days before PSA ( I could be cruel and say a week - others here will have their own timelines )
hugs
BRONSON

Hi Lisa:

First of all remember that none of us here are urologists, we just play them on the internet!  Secondly, while your friend's % free PSA score is in the low end of intermediate it does not necessarily indicate cancer.  I also suspect your urologist is practicing defensive medicine which is not an illogical approach.  As David said, if you want to be safe and conservative, progressing to biopsy is a resonable step (a 16 core sample is state of the art...not 10 or 12).

However, if it was me with those stats, my next step would be a PCA3 test.  See the link:

Welcome — PCA3

If that indicated a high chance of cancer, I would proceed to biopsy.  If not I would re-take PSA, free PSA and PCA3 tests every 6 months to check on changes.

But...I'm not a doc, am not in your firend's shoes and don't know his tolerance for risk.  So...I provide the info with those disclaimers and wish you the best.  Please stick around and let us know how things progress.

Tudpock

Thanks to everyone for all the helpful answers and info thus far. You've given us things to consider and think about.


As far as the repeat PSA without sex - we actually already did that, and the total psa was back down to its usual 2.8.

I say 'usual' because it's been 2.8 since his baseline at age 40.

I will definitely stick around! I want to share this forum post responses with him, and see what he thinks. I think he's leaning toward pca3, which seems like it might help clarify whether a biopsy would be a good idea.

Thanks so much!! Will write me as I have time...

Lisa

Weesa- I post here very rarely these days - only stop in on occasion to see if there is anything which pertains to my particular (unusual) situation, and that is almost never.

My advice: pay attention to what Tudpock18 says and, as far as the others go, note their "Date Joined" and Signature and follow their advice accordingly. The Signature gives an insight as to whether the poster's condition has any relevance to your boyfriend's and also gives insight into the poster's current condition, in part, based on his choice of therapy and choice of practitioners.

Corrected signature to include PCA-3 results.

Mel

+1 to being a loving girlfriend and taking steps so you can be your own best advocate. I'd also recommend the biopsy. It's an office procedure that while uncomfortable (and psychologically stressful for your man), can really aid your peace of mind and actually help decide direction whether the biopsy is good news or not so good news. In addition, the biopsy, if negative, will also provide a pathological test result for PIN (Prostatic Intraepithelial Neoplasia), which can be valuable information. For example (and simplistically), a low grade PIN alerts you to the potential for cancer and lets you take actions well before a cancer develops (which could be 10 years). If a high grade PIN is detected, it's basically a pre-cancer warning. You’ll have time to make reasoned decisions before the cancer erupts (which it will as a high grade PIN), but again, maybe not for some years. I don't want to sound patronizing, but you’ve taken some excellent steps so far, I’d suggest one more, the biopsy. My best to you both!

Hey Gleason 7:

I had mine done at the same place on 1/26. Just curious-- did Dr. Menon do yours? Are you from Michigan?

Mel