May be a bit early but...

Hello all.I'm amazed how helpful you are to one another and people who post here.
My husband's PSA has been on the rise for awhile now.He has BPH but symptoms are minimal.
His PSA was 1.7 in '08 and this weeks PSA number was 4.8.Up from 4.7 last 5-6 weeks.His urologist put him on a two week antibiotic to see if the number would go down due to possible Prostitis.Well it actually seem to rise .1.
A little history.
My husband is 59 and no prostate issues in his family.Though his mother passed of uterine cancer at 59 and dad with AML which is said to be a leukemia can effect people 55 and over.
Over the last two years has had two biopsies and 2 PC3 or something tests(prostate massage and urinate a little bit into a cup and test cells) and no cancer was found.
His urologist only takes 8 lobes because he says my husband bleeds too much which I find disturbing because I read 12 is the norm.
His first biopsy went ok at the office and at home after he was able to urinate.
The second biopsy was more painful and he had a reaction of nausea during the procedure.His recovery though not bad was a bit more problematic but nothing big but worse then the first biopsy.
Both biopsies and PC3 testing was done by the same urologist.
He has an appt tomorrow with the urologist.Our urologist is 62 years old,has a good rep and does attend Prostate lectures in such out of state and isn't retiring soon.
Can you help us with any questions we can ask?
He'll probably want to do another biopsy.

Thank you so much for that thread.
We'll both definitely read it together.
I'd like to add that the urologist said that if he did find cancer he would recommend the DaVinci robotic removal.
we're in NJ and the inventor of the procedure office is nearby in Maywood.
My husband has had an anxiety issue and light depression of which he has overcome but this situation is testing that.

Hey Cindy, and welcome

That's the problem with a 8 core biopsy, its too easy to miss cancer, if there is any there. Hopefully, there isn't any to find, but on the other hand, it simply may be missing it. It took 3 biopsies (2-12 core, 1-7 core) to find the cancer my doctor knew was there. After the 2nd, the doctor targeted 7 cores into 2 suspicous shadows on the screen, and found the mother lode. Lucky me.

Good luck, and keep us posted.

David in SC

Hi Cindy,
Your husbands journey sounds very similiar to mine. I also had the 12 biopsy with nothing shown. My PSA continue to have a gradual rise and each time an antibiotic brought it back down. Then last year in jumped almost 2 points. Jan '11 I had a saturation biopsy of 40 cores and 1 was postitive. I decided to wait and have a watchful eye and next PSA was 11.8. Started talking to oncologist and opted for radiation. My PSA dropped again prior to starting radiation to 6.8, the same it was before the biopsy.

I am now 7 weeks post 44 radiation treatmenst and doing well. I has some minor problems during treatment and some now. I was not a candidate for seeds as my prostrate was too large to place seeds in one part. By the way I am 64.

It actually was a relief when they found the cancer as not knowing was nerve racking.

Good luck to you and your husband and keep us informed.

Thanks for the the replies.
My wife told me about this forum.
A wealth of information and we thank you for that.

Just came back from my urologist and he did a PC3 test.I don't know if that's the correct term for the test.The massage of the prostate and urinating a little bit into a cup right after for testing.My 3rd PC3 test.
Much better than a biopsy.Will know results by next week.
I'm guessing if no cancer is found,my Urologist will do what he did last time.Wait 4 months,take a blood test for PSA and see where we are at.

Once again the wife and I thank you all very much.
I read the Prostate Cancer: The Really Useful List made by HW people for HW people posted above and it's a great thread.
Really tells one of what is ahead if the cancer is found.


Joe

Joe,
Believe me there are a lot of other options available than the psa/biopsy treadmill you are on. I know because I was on that treadmill for 10 years. At least your doc is giving you a PCA3 test. The first thing is to go back to your previous biopsy and it should have the size of your prostate on it; it should have been measured by the ultrasound so it will be accurrate. The normal benign psa generated by a prostate is .066 to .1 per cc of volume. You mentioned BPH, so your prostate would have to be smaller than 47cc to be a concern. Your psa doubling time is 2.8 which can indicate PC, but a very slow growing pc. ( doubling times over 3 years are a concern).
I would take Adovart or Proscar to establish a new baseline psa. It will reduce the amount of psa due to BPH and any increases from the new baseline would be more indicative of PC. What were the results of your previous PCA3 tests? 35 is high normal.
The other option available is a Color Doppler Ultrasound given by an expert, usually an interventional radiologist. This is much more accurrate than a normal biopsy, and a biopsy will be taken only if an area is deemed suspicious. It will also give the exact location and size of any tumor found which is information not available from a normal templet biopsy. This is very important in choosing a treatment option. I would highly recommend this as you have already had two biopsies. Urologist use a standard templet which means they are biopsing the same area that was biopsied the last two times and will most likely find the same thing. A CDU will examine areas that are not normally biopsied.
I would also be concerned that your doctor has recommended a treatment option (surgery) before identifying the type, size and location of the tumor. It's like a mechanic telling you you need a new engine before he performed any diagnostics.
I would not be surprised if your urologist would be against the above recommendations, and that's why he is a urologist and not a diagonistic specialist in PC. It toook me 10 years, 13 biopsies, over 100 psa tests and 5 urologists before I finally figured this ouT.
Given your psa kenitics and two negative biopsies plus your history of BPH, if any cancer is found it will most likely be the clinically insignificant cancer that over 50% of men your age are walking around with. Given enough biopsies one is bound to find insignificant cancer clusters in a man your age.
JT

Joe,
Both CDUs and MRIS are normally covered by all insurance companies. The biggest obstacle to image guided biopsies and the development of newer technologies are urologists who believe that biopsies are their territory and will fight tooth and nail to keep other professions from doing biopsies. All image guided biopsies are being done by interventional radiologists and not urologists. You will never hear of a urologist recommending a CDU, yet most prostate oncologists routinely recommend them for diagnostic purposes and biopsies. Unless you go to a prostate specialist or find out about CDU from patients on forums like this you would never know that this technology existed.
JT

Joe,

I think John T must have better insurance that I do - mine (a big, national company) does not cover Color Doppler Ultrasound. They consider it experimental.

A good rule during your PCa journey is to get everything pre-approved IN WRITING from your insurance company. Mine has a policy that everything approved by an in-network doctor is covered. But when my in-network doc ran a test that got refused, I learned. Ask always, and as they tell you yes, ask (very politely) if they would please send a confirmation. I had one case where they confirmed, then decided later that the item was not covered. Having that letter in hand saved me $600.

Joe,

Take good news for good, put that next appointment on your calendar, and enjoy the season.

By the way, my insurance only pays for a 6 core biopsy. My uro did 12, and I was at the mercy of the lab for the other 6. The lab actually wrote off the other 6, saying that the paperwork and time to sort it out was not going to be beneficial to anyone. That is why I have good things to say about Bostwick. They may have handed me the cancer card verification, but at least they didn't give a copy to a bill collector.

Now get the heck out of here and don't come back for a long, long time.

I'm told there's a chance it could be inflammation but I definitely got a bad feeling about this.

i have a good feeling about you being so proactive

ed

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F8 said...
I'm told there's a chance it could be inflammation but I definitely got a bad feeling about this.
i have a good feeling about you being so proactive

ed

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Thanks,ED.

Hi Cindy,

Sounds like you are caught between a walnut and a hard place on the MRI or ultrasound biopsy. I also have BCBS in Alabama and they would not cover Color Doppler Ultrasound nor MRI type screening unless a needle biopsy is first positive for PCa. The continued rise in PSA is suspicious and you may need to enlist your docs help in a appealing to BCBS on coverage.

Good luck

Terry TWG