Prostate Nodule Detected

Hi all. Just joined this forum after reading some posts that intrigued and enlightened me.
I'm a 61 year old Navy retiree. My urologist at the local VA Hospital found a 'worrisome' nodule on my prostate during a routine DRA. I am still awaiting results from the PSA test he ordered the same day, BUT he indicated that he would re-examine me in four months. Now, perhaps I am over-reacting, but four months seems like kind of a long time to wait for a follow-up DRA. What's the general consensus and I thank you in advance for any replies.
Dar

Well, you've come to the right place for information. All I can do is describe what happened with me. I had a DRE performed during a routine check-up in August and he discovered what he described as a pea sized nodule. My PSA was just 1.6 and it had never been higher than 1.9 over the past ten years or so.

I went to a urologist and he actually had a hard time feeling this nodule, but we agreed on a biopsy anyway. You can see my stats in my signature. The bottom line for me was that even with a PSA of 1.6, I had Pca. And my path report after surgery went from a Gleason 6 with Pca on one side to a Gleason 7 showing Pca on both sides.

Needless to say, I followed my gut on that one and glad I did. Think about it!

Dar,
Regardless of psa any nodule should be checked out. Get a second opinion from a urologist even if you have to pay out of pocket.

Lath:

Let me get away from the PSA test and echo John's point. A nodule dominates over any PSA result.

GET A SECOND OPINION. If it confirms a nodule, then I think the current opinion is that a biopsy is mandatory.

I know the responses have not been what you wanted to hear.

Good luck to you. Keep in mind you are reading a Prostate CANCER Forum. I'm sure there are a huge number of situations where these nodules turn out to be nothing. Those folks are not posting here.

Mel

Dar,

DRE is a lousy test - so is PSA As we get older, there are calcifications and benign cysts that crop up. PSA goes up naturally with age and prostate size and is not specific to prostate cancer. There is another (lousy) blood test - % free PSA - that can add another piece to the puzzle. Putting all of those lousy tests together, and eliminating sources of error like prostatitis and BPH, it might indicate that a biopsy is worth doing. Standard biopsies are less lousy than the previous tests (they are random and can miss stuff).

I agree with John T that a positive DRE is worth exploring. Perhaps get another finger up there to confirm. They can also do a cheap, quick and non-invasive pelvic ultrasound probe to see if that shows anything, and perhaps more importantly, to get a size reading on your prostate. PSA density - PSA divided by the prostate size - is an indicator of PC -- less lousy than PSA alone.

- Allen

I too had nodules. (plural) Mine were found by a URO at a free health screening...

I went to my GP who couldn't feel the nodules...Then again, he's a real small guy... Went to another URO who could feel the nodules.

Unfortunately, my nodules weren't calcium build ups like I had hoped they'd be. And my PSA never got over 1.3 ...

Odds are a biopsy is in store for you.

To amplify richh's comment, MRI *then* biopsy. If you biopsy first, it compromises the MRI images afterward, for several weeks. If your insurance will pay for the MRI first (so enough preliminary indications to justify it), do it first. Free PSA less than 25% (mine was low), and PCA3 higher than 25 (mine was 31) or so are supporting indicators.

I had a biopsy first, and based on the severity of the result we did a 3T MRI with and without contrast and Diffusion Weighted Imaging (DWI) not too long afterward anyway. The docs figured even though it would be affected by localized residual bleeding from the biopsy, they could see enough to guide the treatment plan. It worked, but it would definitely been better to have done the MRI first.

Hi there,

Indeed, as others have said, a PSA test should not be taken right after a DRE. In fact, in the 72 hours prior to the blood test, there should be no sexual activity, vigorous exercise, DRE's, etc. These can definitely put a temporary rise in the PSA reading.

With that said, as others have also said, it is very important to have any nodule checked out regardless of PSA reading.

Funny thing is that my general family doctor said he detected a small nodule on my prostate & sent me to a urologist -- who said I did NOT have any nodule. But even without one being detected, I still had PC.

PC is quite curable if found early. So, if you should be DX'd with it, you are hopefully finding it early enough to take care of it.

Also, THANK YOU for your service to our country!!
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.

Dar,
We all have PCa here and our opinions differ. I suggest that you see a civilian uro for a PSA and dre; then prior to your VA appointment have a PSA test there so you and your VA uro will have info!
Mistakes happen so keep tract of your medical information and don't rely upon a doctor since position changes are frequent. My "new" pcp's notes stated "PSA 4.89 high and rising-monitor". Of course this info wasn't provided to me until I had an emergency and was diagnosed by symptoms; just sayin!
Bill

Allen,

Did you perhaps mean to write to Joe in his thread where he had a 1.8 PSA bounce after HDR brachytherapy and a worried wife rather than Dave who does not have a bounce that I can see from his signature. Or maybe it was intended to be to Dave?

Regards,
An

John T said...
Dar,
Regardless of psa any nodule should be checked out. Get a second opinion from a urologist even if you have to pay out of pocket.

Totally agree. Regardless of PSA you need to have the nodule checked out and it seems unlikely a nodule would go away so I'm puzzled what he expects to change in 4 months.