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High PSA and firmness in prostate

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Posted 9/24/2013 6:50 PM (GMT 0)
Hey there, looking for some info and words of wisdom. 

Age is 49, PSA test (first one ever done) showed a 4.3.  Doc made appt. with urologist and DRE showed firmness on left side of prostate.  He made appt. for ultrasound and biopsy for later this week.  I worry that a high PSA combined with firmness is not good news.  Any help would be greatly appreciated.

Posted 9/24/2013 7:40 PM (GMT 0)
Welcome to the site that no one wants to be a member of...

You just need to sit tight and see what the biopsy says.
Posted 9/24/2013 7:51 PM (GMT 0)
Welcome aboard Wildcat and welcome to our world of WAITING!!!
You have had your PSA test and had to wait for the results,
now you will have a biopsy and have to wait for it then you will have to wait for the results.

We all know, we all have been through it and still wait for regular PSA tests to see if our treatment is working. One test at a time, one foot in front of the other, one waiting period after the other.

I had 3 biopsies over 12 years before I got PCa. So I waited 12 years before joining this group.Hopefully you will not have to join our club and are just visiting but we are here for you now and in the future.

Bill from Florida cool
Posted 9/24/2013 8:05 PM (GMT 0)
Welcome to our world.

What you know so far is that you need a biopsy. Beyond that it's all speculation. It's easy for us to say,"don't worry for now," since we been through it. But I know how it must be weighting your mind right now.

Even if the worst is found, you'll be fine. You might need treatment, you might not. If you do need treatment, you'll have plenty of options - you won't like them and normal will change but you have every hope of getting through just fine.

As for words of wisdom. Well, how about:
Look both ways before you cross a street.
Do something to distract your mind from your up coming fun with the biopsy.
Buy low, sell high.
Just go live some life.

Keep us updated on your progress and let us know the biopsy results. We can share better stories then when you've got more details.

Hang in there,
Andrew
Posted 9/25/2013 1:11 AM (GMT 0)

InTheShop said...
Welcome to our world.

As for words of wisdom. Well, how about:
Look both ways before you cross a street.
Do something to distract your mind from your up coming fun with the biopsy.
Buy low, sell high.
Just go live some life.

I don't want to make light of your situation -- or any of our situations, but Well said, InTheShop for the best advice I've heard from anyone, anywhere, about just about any aspect of life.

We all have stuff to worry about and none of us like the uncertainty of our medical (or employment, or legal, or investment, etc.) situation. But worrying just gets in the way of an otherwise good day.

Best of luck with the biopsy. The procedure is really not as bad as the anticipation. Here's hoping you have good results.

Jim
Posted 9/25/2013 1:16 AM (GMT 0)
I'll also wish you the best while hanging in there. I'd also say try not to think about it, but that's probably not possible. That said, try to think of other things from time to time as much as possible. And good luck with the biopsy. Keep us posted.
Posted 9/25/2013 3:03 AM (GMT 0)
With your age, your PSA, and the firmness felt, doesn't look good at face value, but all of that could still be explained without it being PC. Hope you get the all clear from the biopsy, that's the best way to rule in or out on the cancer possibility.

Hope we get to turn down your membership application.

David in SC
Posted 9/25/2013 3:07 AM (GMT 0)
Welcome Wildcat and I'll simply add to what others have said about learning to wait. . . . keep us posted, we'll be here to help you understand what the biopsy says.

Best to you.
Posted 9/25/2013 3:25 AM (GMT 0)
Hi,

Yes, your PSA is a bit higher than normal for your age. However, it is not extremely high. The idea of PC spreading to other parts of the body becomes a concern when the PSA is in double digits.

Let's hope & pray that the biopsy does NOT reveal any cancer.

But, if it does, your PSA number hints that it would probably still be confined to the prostate and, hence, is a curable situation.

Good luck!
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Pathology showed Gleason 3 + 3, pT2c, N0, MX, R1
adenocarcinoma of the prostate.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, 9/9/13 PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.
Posted 9/25/2013 2:18 PM (GMT 0)
Thanks so much for the responses, guys. It's much appreciated during this very stressful time.
Posted 9/26/2013 1:00 PM (GMT 0)
Wildcat,

Since I'm new to HW and being DX with PCa, I'll just add to what's been said, be patient, try not to worry and take it one day at a time!! Trust me, being DX last Oct., I'll have to say that having PCa has changed my life 5,000% and I live as thought I'll live 50 more years on this earth. I'll be thinking and praying for you and your family.

I've found HW to be the BEST place to be if one has PCa. Stick around because there's a ton of people here that can help you along the way. You're going to be just fine.

Have a great day!!

Dave in Bartlett, TN
Posted 9/26/2013 4:40 PM (GMT 0)
I wouldn't put much faith in "firmness". I've had more than a hundred DREs and some doctors said it was firm and very experienced doctors said it was perfectly normal. Firmness means nothing; if a nodule was felt then it would be a major concern. Your psa is a concern and needs careful monitoring and a biopsy if it rises further.
Posted 9/26/2013 6:01 PM (GMT 0)
After experiencing 2 months of complications from a standard "blind" biopsy, my advice would be to try, as an alternative, to get a Color Doppler Ultrasound (CDUS) and a targeted biopsy if possible. If you live on the West Coast, Dr. Duke Bahn in Ventura, CA is the man to do it, but there are several others elsewhere as well.

In this way, the CDUS will be able to image any tumor and only one or two needles will need to be used in the biopsy. Plus, you will get more information on its exact size and location, if present.

Alternatively, if you can have an multi-parametric MRI (with or without an endorectal coil), it should be able to tell a lot while being less invasive. If a tumor is present, then they can perform a more targeted biopsy. I believe this will become the future of biopsies.

There is a significant chance of serious infection from any puncture through the rectum so the less there are, the better. If you do have the blind 12(?) core, then make sure you take the antibiotics and enemas, and have no history of antibiotic resistance.

I don't think it is so applicable to your case, but there is a debate about whether a biopsy can spread cancerous cells outside the prostate.

Hopefully it will be nothing, but for anyone seeking advice about a biopsy, they should be aware of the alternatives and the risks. If I had to do it over again, I would have paid out of pocket and traveled thousands of miles to avoid the 12 core blind biopsy.

Good luck in any case!
Posted 9/30/2013 5:55 PM (GMT 0)
Well, I had my biopsy on Friday. Bohemond was right on cue - the anticipation was much worse than the actual procedure. Not to say that there's not a boatload of other things I'd rather be doing on a Friday afternoon, however.

I took a .5 ML Zanex about a half-hour before appointment. The doc was a little late, so I took one more .5 while in waiting room. That's when it started to kick in. Shortly after, I was called and went into the room. When the urologist came in, I had fallen asleep. Was awake for the procedure, but it wasn't THAT bad. They did 13, and it sounded like a stapler each time.

I had talked to the nurse beforehand, and I was talking to her about the possibility of spreading or not if I'm diagnosed. And about the severity of a 4.3 PSA at my age (49). She said she doesn't recall coming back with a diagnosis with that score. When the urologist came in after procedure, he said the ultrasound actually showed darkness more on the right side (he had felt firmness on the left side during the DRE a week earlier) and the left side was lighter. Just from the info he had at the time, he thought it was 50/50 that I had cancer. I guess the good news if I am diagnosed is that HOPEFULLY it is contained to the prostate. I go back on Friday to discuss the results with the urologist.
Posted 9/30/2013 7:00 PM (GMT 0)
Just got call from urologist office. Said that urologist had some cancellations and would be able to meet with me tomorrow morning instead of the scheduled Friday appointment.

First thought - is this bad news that he wants to meet me tomorrow? Or is that good news? Or is it just the fact that he can see me tomorrow and it doesn't necessarily mean either good news or bad news?

Just got to keep my mind occupied until tomorrow morning...
Posted 9/30/2013 8:36 PM (GMT 0)
He proabably had a cancellation and knowing the stress of worrying they worked you in early.
Posted 9/30/2013 9:26 PM (GMT 0)
Oh, and one other thing - the urologist did say that my prostate was enlarged. about twice as normal?
Posted 10/1/2013 12:36 AM (GMT 0)
Hi,

In a perverted sort of way, the enlargement could be good news for you. Not because this means you probably have BPH (a benign enlargement, but very troublsome when trying to urinate), but because larger prostates yield larger PSA numbers.

So your larger prostate can easily explain your elevated PSA which, by the way, is not extremely far from the high end of normal.

Thus, chances are that the PSA is only from BPH.

One caution, though, is that my prostate was FOUR TIMES the normal size (98.3 grams), which offered a good explanation for my 5.7 PSA. However, as one of my urologists cautioned, this can also be masking the presence of a tumor(s) in the prostate -- kinda like a sleeper pin we encounter when bowling.

So, in my uneducated opinion, you stand a good chance of having a negative biopsy. If you are beginning to have urinary symptoms, perhaps the uro will put you on Flomax.

At the same time, if they should find prostate cancer, your relatively LOW PSA reading suggests that it WOULD still be confined to the prostate and, hence, very curable. PSAs of 10 or higher can often be suggestive of PC that has spread to other parts of the body -- and this would not seem to be the case with you.

If your enlarged prostate is beginning to cause urinary problems -- and if you should ever develope PC -- your particular situation would be conducive to having surgery as opposed to radiation. This was the case with me because, while radiation could have cured me, surgery was the logical option because it removed the cancer and ALSO removed the source of my urination problems.

Good luck!
Chuck
Posted 10/1/2013 4:33 PM (GMT 0)
Jeez...

I get down to my appt. (which was moved up from Friday because they had cancellations for today).  They take my blood pressure, I pee in the cup, go into the room to wait for urologist.

Then the nurse comes in apologizing profusely.  There was a mix-on the scheduling - they didn't realize I had just done by biopsy on Friday, so they still didn't have results from the pathologist.

So I go back on Friday as originally scheduled.  Think I'll call first before I leave the house just to make sure...

Posted 10/4/2013 11:47 PM (GMT 0)

Whew! I got great news - no cancer found! This was out of 13 cores. He did say my prostate was at least double the normal size and gave me a prescription for avadart. I go back in six months (provided I'm able to continue with the avadart - otherwise three months). PSA test a week before that appointment, and he's hoping to see the PSA around 2.0 at that time. If it's still around 3.5-4.0, that will be cause for concern. There's still the possibility of a false negative (moreso with having a larger prostate), but hopefully the high PSA score was due in large part to the BPH.

Thank you guys so much for your help, your knowledge, and your support during this time. I'll still be checking in to the site to learn more and see how you guys are doing. Good luck and good health to all of you!

Posted 10/4/2013 11:51 PM (GMT 0)
my advice would be to try, as an alternative, to get a Color Doppler Ultrasound (CDUS) and a targeted biopsy if possible.


I wonder how practical that is for the average guy with average insurance? 

ed

 

Posted 10/5/2013 5:09 PM (GMT 0)
Ed,
I think a CDU is on the order of $800 and the biopsy is in addition to that. so the extra cost is around $800 which insurance had no issue in paying for the 2 that I had.
The biggest issue is travel to a expert that does them. I drove a couple of hundred miles to see Duke Bahn in Ventura. Fred Lee is in Minn and Dattoli is in Florida. I personally would fly from Idaho to see Bahn if I had a reoccurrence and gladly pay the extra $600 in travel expenses; I'de go in a day or two early and make it a vacation on the Beach in Ventura.
I like the idea of a patient having to make cost based decisions concerning medical care as I think it's the only rational way to reduce health care costs. If I can pay $100 for a dinner or a few grand on a vacation It would be hard not to justify paying a few hundred more for specialized medical care that will have a significant impact on your life or on your future medical decisions.
Wildcat,
The biopsy report should mention the size of your prostate in cc. The rule of thumb is to divide the volume in cc by 10 and that would be the normal psa for your prostate size. A 40cc prostate should create psa of 4. If the ratio is greater than 1.5 or a 6 psa for a 40 cc prostate then you should be concerned. Also if psa still rises after being on Adovart for a few months the increase is more likely to be due to cancer, and not BPH.
Posted 10/7/2013 5:36 PM (GMT 0)
Thanks, John.  I believe he told me my size was 39.2, so my initial 4.3 probably wasn't that much out of the ordinary.  He'd like for it to be around 2.0 when I go back in six months after being on Avodart.
Posted 10/7/2013 5:44 PM (GMT 0)
Wildcat,

I had three (3) biopsies before I joined the club about 2 weeks ago.  I too am a new member and scheduled for surgery on 11/05.

Hang in there.......This is an excellent site for information.  It has helped me so much.

I pray you get good news.................Berk

Posted 10/7/2013 6:03 PM (GMT 0)
Hey there, Berk. I actually did get good news. Came back negative. Good luck with your surgery, and you're correct - this is a great forum.
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