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psa around 5, age 62,saw the US Preventive Svc Task Force report

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Posted 1/25/2014 1:04 AM (GMT 0)
I am cautious about having the needles in my prostate as some literature mentions overdianosis and overtreatment.
Frequent urination and getting up once at 4am are my only other complaints.

I haven't seen a urologist yet, my regular Dr wants me to see one, and his rather vigorous DRE came up with no nodules but he said he can't feel the back side of the prostate only about a 1/4 or 1/3 of it.

I live in Greensboro NC and wonder about the MRI screening offered by Virginia Commonweath University Radiology Dept?

I pay the the first $3000(annual deductible) on my blue cross blue shield and have 100% after that per year. VCU appears to use the MRI to ck for tumors.

Has anyone here had an experience with a MRI to ck for tumors?

Has anyone got a compliment or complaint when they used VCU?

Has anyone had any experience, especially MRI experience in NC, Duke, Wake or Chapel Hill?

Free PSA was about 25 as I remember which is good I think.

I can leave my home ph and email if that is permitted on this board. I prefer emails to my home email which is (open email removed - 142) but I can ck this board also. Thanks!

(Please use your profile to allow members to access an email address. Otherwise you'll have spammers from all over the world flooding your mailbox - 142)

Post Edited By Moderator (142) : 1/24/2014 8:56:32 PM (GMT-7)

Posted 1/25/2014 1:36 AM (GMT 0)
Hi JCJR,

Welcome...couple of questions so we can help:

1. What are your previous PSAs and year that you had them done?
2. Have you taken any antibiotics to rule out prostatitis?
3. Was your prostate enlarged upon examination?

Thanks,
Jerry
Posted 1/25/2014 2:40 AM (GMT 0)
Jcjr7,
The USPSTF recommends "No Screening" period and I don't believe that there are many on this forum that hold their "Recommendation" in high regard. My suggestion is that you see a urologist and listen to what he has to say including all options. Some doctors recommend a biopsy if 2 psa's are over 4; others use the "age adjusted PSA" which is 4.5 high end for men in their 60's . I haven't answered your questions which I' m sure our experts will.
Yes, you can have "tests" but a biopsy is the only way to diagnose PCa. I told my PA about frequent urinations and it was determined to be "old age". Yeah, 6 months later I was at the emergency ward. See my stats below!
A biopsy is no big deal; I was drinking a cold beer 1 hour after the short procedure was over. I wish you the best.
Bill idea
Posted 1/25/2014 2:42 AM (GMT 0)
The fee PSA sounds good. You could find the prostate size via a trans rectal ultrasound.
If you divide the PSA by the prostate size you obtain the PSA density. A PSA density of .12 or less is usually safe.
(they do the trans rectal ultrasound with biopsies.)
Good luck.
Posted 1/26/2014 4:48 PM (GMT 0)
Jcjr7
Without more info like age and psa history its hard to respond. But we are all different anyway. Seeing a uro does not mean a biopsy will be recommended. It could be bph or prostattitis. I would follow your docs advice.
bob
Posted 1/26/2014 5:10 PM (GMT 0)
Welcome to HW, sorry you need to be here.

If you'd like to email one of us, look to the little evelope icon on the left of the member's post, if it has some color in it then that member has elected to allow others to email them. Click on it and it takes you to a form where you can send a private email. Feel free to email me if you'd like to.

Andrew
Posted 1/26/2014 10:23 PM (GMT 0)
Jcjr2,

First thing would be a course of antibiotic to rule out any infection.

I had a parametric 3T MRI with and without contrast, with almost 3000 images. The MRI didn't find anything. Yet the biopsy found 6 out of 13 cores with Gleason 6 and 7 (3+4). MRI is only an additional tool for the doctor. Two different urologist at different times didn't find any nodules, yet I had PCa. A DRE will only find palpable tumors that are on the colon side.

I too was very hesitate to get a biopsy, but glad I did. I can tell you the biopsy isn't that bad, sure a couple of the core sampling stung but lasted only a second. And the size of the prostate can be determined at the time of the biopsy, which can be useful for calculating PSA density.
Posted 1/29/2014 10:50 AM (GMT 0)
As are most people here, I am not medically trained. I had an elevated PSA for 3 years, with symptoms much the same as yours. DE found nothing, as did 1st biopsy. 3 years of differing antibiotics made no difference 2nd biopsy was done after a change of urologist. Biopsy is uncomfortable, but I drove myself home after the 1st one, so not too bad. Upside was that I was told to drink as much fluids as possible, including beer afterwards (Well that was what the 1st guy told me, chap who did the 2nd one did not look so pleased when I told him that I was having a big party the next day). In the UK am told that an MRI scan B4 biopsy is the way forward, as the MRI can target suspicious areas for biopsy, and also indicate clear (or unclear) margins if PC is found
Posted 1/29/2014 4:58 PM (GMT 0)
Listen to your doctors. Yes, they are cautious. And there are many false positives, but I didn't see a specialist until it was too late. I "knew" PC only happened in old men, and I "knew" PC was slow growing. Neither of those statements are true. In less than 2 years the cancer spread to my lymph nodes and I now only have a 30% chance of a cure. If I had seen a specialist earlier, and had an RP, that would have taken care of the cancer (probably).

If you have a biopsy, make sure it is an MRI guided biopsy. Without MRI, they are just sticking needles in your prostate, almost at random, and can easily miss a small cancer.
Posted 1/30/2014 9:18 PM (GMT 0)
Thanks for thoughtful feedback. Had anyone used any place they would recommend that would be in the NC or Va area? I am in central NC so UNC, Duke or Wake Forest Baptist would be convenient. Virgina Commenweath Uninversity has a good webpage and they appear to use a lot of imaging, mri I think. I will try to get in touch with the urology dept of unc, wake and Duke. I hate to use my local urologist first, just thinking I may not be making my available to the latest techniques, but I will see the big centers say. Does anyone know of a clinical trial avail for someone like myself who is not diagnosed yet, just having frequent urination and a slightly high (5) psa, previous psa from 4 yrs ago or so was some number under 4. Don't think its an infection as my regular doc ran a ck on the urine and it came up negative for infection. Thanks
Posted 1/30/2014 9:44 PM (GMT 0)
The urine test is looking for bladder and urinary tract infections. When we talk about a course of antibiotics, it is for prostatitis, which could easily not have any indications that would be picked up in a urine test.

A lowered PSA after the round of antibiotics generally is a good thing.
Posted 1/30/2014 10:22 PM (GMT 0)
Most people are unaware that the new MRIs specifically for prostate cancer that use a rectal coil are capable of amazing things.

I recently had the experience of refusing the biopsy and demanding an MRI first. It took a lot of discussion to get that to happen. Since I'm older I simply did not want to take the risk of infection posed by the biopsy unless it was shown to be absolutely necessary.

The MRI showed intermediate to high grade cancer.

One of my doctors said this could not be regarded as definitely cancer but probably was.

One of my doctors simply said, "You have cancer."

So I went ahead with the biopsy and got two 4/3s and ten negs.

Surgery coming up.

My conclusion: If you have access to a state of the art MRI--DO NOT submit to the biopsy--just have the MRI.

The latest technology WILL almost always show you if you need a biopsy.

That's just my opinion from my experience and research. This goes against the traditional practice, but I think the time has come to rebel against the traditional practice.
Posted 1/30/2014 10:49 PM (GMT 0)
I saw Dr. Ashok Hemal at Wake Forest Baptist for a second opinion before my surgery. They have a good program there, I think, although I decided to stick with my original surgeon.

You really need to talk to a urologist somewhere. Prostate Cancer seldom has symptoms until it is quite advanced. The fact that you have symptoms with your reasonably low PSA and your favorable free PSA could easily mean you have something else going on that you need to consult a urologist to find out about.
Posted 1/30/2014 11:37 PM (GMT 0)
Thank you Walnut!  Funny user name!  What state are you in, probably your docs aren't close to mine in NC

nono  

Posted 1/31/2014 1:17 AM (GMT 0)
No, I'm in MN, but most states have one or several places where you can get the state of the art MRI with IV contrast and endorectal coil.

You just have to be precise in asking questions and make sure you're getting the latest technology.

This earlier thread is where I first commented on the issue and reading the thread may be helpful. https://www.healingwell.com/community/default.aspx?f=35&m=2964756

Post Edited (Walnut) : 1/30/2014 6:20:07 PM (GMT-7)

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