Hello

I saw Dr Ashok Hemal at Wake Forest Baptist Medical Center once for a second opinion. He seemed knowledgeable and competent. He's a bit down the hill for you but it shouldn't be too bad a drive.

Welcome to the forum. Sorry you have worries but glad you found us.

A PSA of 5.5 May not be all that high if you have an enlarged prostate. You PSA will increase as your Prostate increases in size.

Welcome. Keep your chin up. Lots of reasons for high psa. Until you have rock solid proof of PCa inwouldnt get too excited. Even so t there are so many options out there as far as treatment goes. If it is Cancer then hopefully it will still be organ confined. Regards, todd

Frankly I wouldn't limit myself geographically if I were you. Why not go to Duke?
Bob

Marktee,

No, I had my prostate removed by my regular urologist who is something of a robotic hot-shot in the Raleigh, NC area. My visit to Dr Hemal was just to talk to a second surgeon about my case.

Some of the other guys have suggested that you may be getting ahead of yourself in your worrying. They are right, of course. Your PSA is high for your age but not that high. You need to find a urologist to get checked out but that is enough to worry about for now.

At Emory urology they said they do a biopsy "almost always" when PSA is above 4.0.

I guess age and other health issues would have something to do with it.

Mine went from 2.5 to 4.6 and my primary doc nearly flipped out. He didn't even continue our appt. and just talked about getting me to a urologist.

They said that didn't mean I had cancer, and you might not either, but I'd say it's 50/50 you do. Keep in mind I've only studied this for a few weeks though so I could be off.

I'd get a biopsy.

Hello Mark and welcome to HW. Of course there are great doctors in Winston-Salem associated with Wake Forest and there is always the excellence of Duke. But I suspect that is getting ahead of yourself. Yeah, what you need now is a local competent urologist who can do some triage. You need a thorough DRE, you need an assessment of whether or not the PSA is due to your enlarged prostate. You need someone to rule out other issues before rushing off to biopsy. But I suspect you know all that so I'm just reinforcing your thoughts.

I personally do not know anyone in Asheville. But here are some ideas about how to find one:

1. Start a new thread here titled, "Need a urologist in Asheville".

2. Call the office of the doc who moved to SC and see if he can recommend one of his former colleagues.

3. Call the departments of urology at Wake Forest Baptist and Duke to see if they can give you a reference for the Asheville area.

4. See if there is a PCa support group that meets in Asheville; attend that and ask for physician references.

5. "Ask around" among family and friends.

I'm sure there are other ideas that folks might have but I think these might at least get you started in the direction of finding a local (and competent) urologist.

Best of luck,

Jim

marktee,

Sounds like you're making progress and learning more.

Only thing I'd add is I wouldn't worry too much about distance. A lot of these places have lodging that is supplemented by charity organizations and such. In Atlanta, for instance, they have a "Hope Lodge" for a modest per night fee for those coming from a distance. I'm sure Duke or Wake has something like that.

I have no affiliation with Duke, but from what I've learned these "Research Universities" might offer more expertise and more comprehensive care than others.

So I guess I'm saying I wouldn't let 100 or more miles be the deciding factor on where to go. And Charlotte probably has great doctors as well.

Jim-

I am starting to slow down but then when I think of all I do not know I speed up again.

In the past when I wanted to see a "specialist" they always said I had to have a referral from my GP first. I never understood that as I would be a paying customer. I put it down to a Medical club thing.

I called the two largest urology local offices and the only two choices on the phone were ---was I calling from a doctor's office or did I want to pay my bill- not even an operator.

The SC urologist has not called me back-- I will post him back tomorrow and if no response try a call on Monday.

You have no idea what your doubling time is since 3 years passed. But if you must have answer, and the specific metrics other than 1st and last psa 3 years apart, are unknowable, Id rough at out at 18mos, which is quite long for a 64 y/o. If that stuck, based on 40 doubl times to kill you, a figure that is bandied around here from time, a figure that sounds reasonable to me. that would get you to early 80's. I say this not as a plan of action, but to ease your mind as you take considered, reasoned out action at a comfortable pace to find out what is happening. As you are doing all this, you can remember if you did nothing at all chance,s are pretty good you would make it into your 80"s anyway. Anyone mention getting a turp{google}. Take the time to get a topnotch urologist, preferably between late 30's to early 50's. they tend not to be as set in their ways or out of the loop on Pca. Trust me there are many,many urologists out of the loop,. I won't even talk about GP. another point. When you see the urologist do NOT go in there all anxious about Pca, worrying about dis or dat. You are seeing him because you are concerned about a relatively small rise in psa[Based on your age and bigger than "normal" prostate. Personally I wouldn't even mention PCa. They will if they think it could be. They will start drawing you in to the medical system with a focus on PCA, if they feel you think it could be. And then the fun begins, a test to see if you need another test to see if you need….. Based on what you have posted, I think the prudent think to do is, ironically, based on my earlier generalizations of small town gp/urologists, is to do what your doctor suggested. A 3 mos wait for psa test, but ask if there is a drug you can take to reduce the size of your prostate, during that span.. Also change life style, if needed get fitter, lose weight, chill somewhat, enjoy your life in such a beautiful place that you are fortunate to reside. I also wouldn't hang out too much at the forum, as that will push your anxiety as you read this, hear that. We know a lot but there is more we don't know on average. Why barrage yourself with a bunch of information, a lot good, more not that good. It will just confuse and worry you. tThen come back in 3 mos and if you must you can start to worry then. We are much better cheerleaders, than medical experts, {tho there are a handful of pca knowledgeable folks that will put a gp to shame and some of the older local kine urologists here.} So to wrap it up, I suggest to do what your local medico's have said, with a prostate reducing treatment treatment in the interim{3 mos.}before another psa test. The advice after the word "google" and before the word Based.
{ I changed my mine mid post when I saw the GP"s plan}in this post,should not be followed unless the 3 mos psa test indicates the need. Also I do not think prostatitus would cause a rise as small as the one you are experiencing, again based on your age and enlarged prostate. But check with your doctor on that. Good luck Marktee!

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Thanks- judging from your number of posts you have seen it all many times and your advice is one I need to strongly factor when I make a plan of action.

I need to read up on doubling times to fully grasp the reliability of the length of life it predicts. I have not seen the numbers which predict how many years of life you have if you have different levels of aggressive cancer.

In general I believe you are saying three months is not an issue with my numbers so low so do not rush into anything. I am trying to keep in mind that the medical profession is also a business and at times doctors cannot help be somewhat tilted by that-- especially by large centers where the doctors see large numbers of patients and have heard many of the stories/fears/concerns/questions many times before.

I have only asked my GP so far if I should take one of the drugs that shrink the prostate prior if it would help get a more accurate biopsy. He said it could but not enough to matter and while the PSA number go down they normally double the number if you are taking this drug. Also he had not heard of any study that shows this drug will have any affect on the cancer. All of my leading questions about this.

The text in many of the threads do not ratchet up my fears-- it is reading the signature blocks and seeing the results of biopsies based on numbers closed to mine. In the big picture the members of this forum may represent only a very very small percentage of the guys with the same numbers and find nothing and go on with their lives. Hard to repress the urge to find out as soon as possible to see where I stand in that percentage curve.

Mark

Welcome aboard Marktee! Hopefully you are just pasting through.

I had PSA numbers from 5-9 14 years ago because of enlarged prostate. I had 2 negative biopsies before the 3rd one was positive. However the biopsy in 2004 I believe missed the cancer.

It wasn't until 2012 before the cancer was discovered.

Good luck to you.

Bill from Florida