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hard to find prostate cancer

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Posted 10/3/2013 11:48 AM (GMT 0)
Does anyone have a answer as to why a lot of guys hit a psa of 4.0 have a biopsy. Cancer is found and they move on and others like me have psa's that continue to go up and have multiple biopsy that keep coming back suspicous but neg.???
Posted 10/3/2013 1:00 PM (GMT 0)
Are you doing a free PSA test in addition to a PSA only test?
If the free PSA/total PSA %age is above 10 it could be because of BPH or prostatitis.
<10 indicates it could be PCa.
Has that been ruled out?
Posted 10/3/2013 2:10 PM (GMT 0)
A PSA of 4.0 was the long time old standard whereby a doctor would typically refer a patient to a urologist to see if a prostate biopsy was warranted. With some of the newer thinking, 4.0 is no longer an exact line in the sand. They also look now at PSA velocity, which is another factor.

However, a PSA of 4.0 is not a guarantee of prostate cancer, but it could be. It could also be the sign of a prostate infection, an enlarged prostate or both.

Even if a biopsy is ordered, a typical 7-12 core biopsy is no guarantee that it will find any cancer if present. In my case, it took 3 biopsies spread over about 15 months to find my cancer. It was there all along, the first (2) 12 core biopsies simply missed the cancer, the third one found it.

david
Posted 10/3/2013 4:33 PM (GMT 0)
It's not uncommon and there are a few reasons.
1. The patient doesn't have prostate cancer and high psa is due to:
a. BPH
b. prostititis
c. psa leak at a higher level than normal.
2. The patient has PC, but it hasn't been found. This is primarily due to having a transition zone or anterior tumor that are difficult to hit with a transrectal biopsy.
If psa levels off at a high level it is most likely BPH or psa leak. If it goes up and down by significant amounts it is most likely infection. If it rises at a steady and consistent rate it is more likely to be cancer.
After a few negative biopsy and a rising psa the patient should get either a transperinial saturation biopsy, or a color doppler or multi parametric MRI guided biopsy that throughly samples the anterior.

JT
Posted 10/3/2013 6:18 PM (GMT 0)
The 4.0 thing is changing. My Uro and my brother's both told me it wasn't the PSA number that got them concerned but rather the rate of change or doubling time. I had my biopsy at 4.2 but my brother didn't have one until nearly 10 after it went up 2 points in three months.

Andrew
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