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PSA 16, Biopsy in 2 days

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Posted 1/8/2014 1:19 AM (GMT 0)
Hello,

I was searching the Internet and found this site. Please forgive if I am posting inappropriately in the Prostate Cancer area before I know if I have it.

I'm almost 50. My father has had chronic prostatitis with elevated PSAs for years (his age 35-75). He has had biopsies- all negative. So about a year and a half ago as part of an annual physical I got a PSA test. It was about 4.7. My physician said that was a little elevated and we should keep an eye on it. I was a little late for the annual physical this time, but had a PSA test done about a month ago and it was about 16. (15 point something). I am completely asymptomatic. I started on Cipro 15 days ago, and today I went to a urologist at the local Prostate center (at very large medical center). The dr. today said he wants to do a biopsy with a number like 16. I said the sooner the better. He said he wants to do it this Thursday. He said he would be glad to do a DRE today, and I said since he'll be in there Thursday anyway, just do it then, as I didn't feel the need to experience it twice.

I ask him based on the thousands of biopsies he's done (about 2K), what does he expect will be the outcome. He said most folks with an elevated PSA due to benign causes have symptoms. I took this to mean cancer is likely. I may have not understood this correctly or got it straight as I had a lot on my mind and was on overload. I know no one can know for sure but I'm more than a little concerned and I'm wondering what you all think.

Trying to learn a lot fast. Thanks.
Posted 1/8/2014 2:39 AM (GMT 0)
Hello: Sorry that you have to be here. But my best advice is to simply have it done in a day and a half and you may get some additional information immediatley after the biopsy. That could include prostate size and other issues that could be a possible causation for this high number. I beleive that the Cipro usually takes about a month or so to reduce the PSA if it is indeed an infection related cause. But it will usually take about a week to get the actual biopsy results back. As we all have experienced here, it is indeed a waiting game.

One of the bad things about PCa that it quite difficult to nail down unless a positive biopsy comes back...then it is certain. But you can have a low PSA, negative DRE, a large prostate, symptoms or not, a NEGATIVE biopsy and still have Prostate Cancer. As I once heard "The only certain thing about prostate cancer is that it is uncertain".

I know that this may not be helpful in relieving your anxiety, but try not to over-think things right now. You are on the right course in following your doctors recommendation and doing all that you can. We all hope that your PSA increase is due to BPH or an infection. Good luck!

Bill K. from NJ
Gleason 6, Surgery in July 2011
Doing fine
Posted 1/8/2014 2:42 AM (GMT 0)
Hello Quagmire,

Welcome to the forum! Sorry you have gotten bogged down in prostate worries but glad you found us.

We have lots of guys here who join us before biopsies. It's a good time, actually, since we can often help set some expectations and provide some perspective in helping to understand the results.

Did your uro draw blood today for a confirmation PSA reading? Often when a man has a fast-rising PSA the doctor will give him antibiotics (Cipro is common) to see if that makes the PSA go back down. If it does then that tends to indicate prostatitis and sometimes a biopsy can be delayed or avoided. I'm a bit confused about why your doctor put you on Cipro if he doesn't think you have prostatitis, of if he does think you might have prostatitis, why he didn't re-test your PSA.

Do keep us in the loop. We've been there. You'll be OK.
Posted 1/8/2014 3:25 AM (GMT 0)
Sorry we had to meet this way but you've found an excellent resource.
I only advice is that the biopsy is fairly painless, Mine took less than ten minutes and was not a big deal.
Good luck, let us know.
Posted 1/8/2014 3:54 AM (GMT 0)
Welcome to HW, sorry you need to be here but it's a great place to ask questions.

That is a worrying jump in PSA. A confirming PSA might be in order.

In any case the biopsy isn't that bad an idea. The procedure itself is annoying and undignified but not that painful. The worst part is thought of it. My first comment after the doctor described the procedure was, "you're going to stick what where?"

I think it's useless to do any guessing at the moment. If the results come back positive, you'll have to take some action. If negative you'll have to think about what that means and how you monitor things from here.

Even if the worst is true, you've got plenty of options for treatment and plenty of hope of a good outcome.

Keep us updated on your progress and hang in there.

We're here most days if you have more questions,
Andrew
Posted 1/9/2014 3:15 PM (GMT 0)
Just had the biopsy. Not terrible. Two of the 12 samples hurt significantly more than the others. Mostly I found it alarming because of the mental processing of where the pain was. Not really a place I've had pain before. You hit a thumb with a hammer- you immediately process what happened and kind of know what's going to happen more or less- pain, swelling, purple thumb, and likely full recovery. Since I had never felt that pain there before I just had a strange feeling processing what it meant for me.

Anyway- Dr. said good news/bad news. Said good news is it's enlarged, which can explain the high PSA. No nodules, no "architectural abnormalities". Bad news is the PSA density is .39. I don't know what that is, haven't searched yet. Not sure I will just yet- I'll let you experienced people tell me about it.

Thank you
Posted 1/9/2014 7:57 PM (GMT 0)
Until you know whether the PSA was elevated due to infection or to sex within the 3 days before the biopsy, bike ride, etc., PSA density not necessarily a valid metric.

In case you do end up haivng [prostate cancer, refer to the very first thread that you may have blown by when you signed up

www.healingwell.com/community/default.aspx?f=35&m=2652250

Good luck

LupronJim
Posted 1/9/2014 8:45 PM (GMT 0)
PSA density is psa divided by the size of your prostate in cc. If your prostate was 30cc and your psa was16 your PSAD would be .533.
PASD less than .07 is good, between .08 and .15 is uncertain, and above .15 is highly suspicious of cancer. PSAD eliminates BPH from being the cause of high psa, but does not eliminate infection as the cause of high psa.
Posted 1/24/2014 4:41 AM (GMT 0)
Got the results. 4 came back "PROSTATIC ADENOCARCINOMA, GLEASON PATTERN 3 + 3 = 6."
4 benign, 4 probable benign.

By the way- is it customary for people to post exact results and use the names of the dr's and medical facilities in their posts? Was thinking it might be helpful to let folks know where I am going for treatment and see what other say about it.....

I will post a new post with results. Thanks to all.
Posted 1/24/2014 7:54 AM (GMT 0)
It's as customary and as appropriate as you want it to be....

We've all "been there"... I was hopeful I just had chronic prostatitis but, like you, I came back with adenocarcinoma. Gleason 6 is "good" in reference to how it could've been.

You may have the ability to do active surveillance/watchful waiting. I really wanted it for myself but my biopsy revealed Gleason 7 and I was told I was not a candidate for such.

I see you're not quite 50, so, like me, you're getting this young. I'm going to guess your uro will tell you that you need to act due to your age. Hoping you can wait and see what it does, if you're wired to tolerate such things. Some guys just have to do "something" as the C word is scary and they just want it out.

My thoughts are with you as you decide what you want to do...wait, surgery, radiation, some cutting edge treatment, etc. Not an easy thing. Hoping you find peace with all of this new information and decisions that loom form you.
Posted 1/24/2014 1:34 PM (GMT 0)
Quagmire,

Sorry you have to join our forum as a card carrying member with PCa.
The good news is you have time to investigate what treatment option you want to choose. Every treatment has side effects so find the one that makes sense to you.

A couple of the guys wanted to know if they retested your PSA after you took the Cipro. If so, what was your last PSA before the biopsy?

Mine went from 18.5 to 17 after taking Cipro.

Also, some of us have an even higher Gleason score after treatment so keep that in mind when choosing treatment. Mine went to GL 3+4=7 from 3+3=6 after surgery.

Good luck in the coming months, we are here for you.

Bill from Florida cool
Posted 1/24/2014 2:49 PM (GMT 0)
Hey Quagmire
We are about the same age and I had my biopsy done in October and RALP in November. My PSA was 14.7 and I was 2 out of 12 positive with Gleason 6. Time to get really educated so you can make some important decision. Take a look at books by Patrick Walsh and Peter Scardini. Out of the two I liked Scardini's book better. I'd also recommend talking to a few different Dr's about options you have and you do have options.

Getting the cancer call really sucks and its shock. Now its time to fight and win and in your case you every chance of winning. There are 8 or so of us that just had biopsies and treatment in the last 90 days and if I am correct all of us tested < 0.1 after treatment.

You have come to the right place for asking questions and hearing about other folks experience. This forum was incredibly helpful for me and I am sure we can now help you

Keep us posted
Posted 1/24/2014 3:29 PM (GMT 0)
Mr Mire,

You can tell us as much or as little about your doctors and the facilities as you want to. We do discourage new members from being too effusive in their praise of their doctors, or too harsh in their criticism of other people's doctors, so we don't get the fan clubs of the various celebrity doctors having gang-war shouting matches on the forum. But a question of who is the go-to guy in a particular locale is always in order.

Have you had another PSA since you did the Cipro? With four cores positive it probably won't make that much difference -- I suspect you will want to seek treatment of some sort instead of doing Active Surveillance -- but it would give you additional information. Do take your time in making your decision. Gleason 6 is a slow-moving cancer and you have lots of time to do your homework.
Posted 1/24/2014 3:51 PM (GMT 0)
Hey Quagmire,

I feel for you. The stage you're in was the worst for me: a ton of information out there, strong opinions, and, oddly, almost too many options. The kind of good news is that that I had, and you have, time to confirm, learn, consider and make a decision. A lot of the more experienced guys here can give you information about a second read of your biopsy--it's apparently subjective and my two reads disagreed (7a on one and 6 on the other). The time between my biopsy and ultimately surgery was over 3 months and by then I was comfortable with my knowledge level, my decision for surgery and (most difficult) my choice of surgeon.

One point I've belabored here before is to kind of watch the age of the information you're getting from the net. Things are evolving very rapidly for PCa treatment, and information from even a few years ago may have changed dramatically.

The folks here and over at yananow.org were (and are) a Godsend to Deb and me.

Cheers,

Dave
Posted 1/24/2014 5:47 PM (GMT 0)
Quagmire,
Each of us here have had the same sinking feeling of doom and gloom once we hear the C word. My wife and I were terrified and became very depressed. One Saturday in July 2013, as we were drinking a glass of wine, looking over our beautiful pool, I said, we have already put me in a grave, with nothing to look forward to, when in reality we have many things to look forward to.
If you allow it, this PCa will rob you of every moment of happiness that you allow it to take. Do not let that happen. Each person needs to figure out what that entails. And the most important thing you should fixate on is the fact that no matter how bad the diagnoses there are plenty of things that can be done to extend your life or even cures you. My younger brother has been fighting this for 5 years with Gleason 9 and many bone mets. He has such a good attitude that it makes me feel weak; given the fact that PCa did not attack me as aggressively as it did him.
All you need do is look around on this great forum and you will find inspiration from so many people that it will motivate you for what you are now facing.
Good Luck with your personal journey.
Roy
Posted 1/24/2014 5:59 PM (GMT 0)
Quagmire,

I am also sorry that you're now "one of us". I'm fairly early in this journey compared to many - surgery early this month that will hopefully be my cure. I'm early enough in the process that incontinence and impotence are daily reminders for me.

Do your homework. Really. Seriously. You are young and hopefully have many years ahead of you. Arm yourself with all the knowledge you can learn. Enlist your significant other, if you have one. See as many docs as your insurance will cover. Find the local experts. Ask them questions, even hard questions. Challenge anything they say that seems subjective. Over time, the path you need to take will start to take shape and become more clear for you.

Best of luck on this road. It is life changing.
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