New Here...and given PSA values....just one of many

Hello JS,

Welcome to the forum. Sorry you need to be here -- and it sounds like you do -- but glad you found us. Hope we can help.

That trip to the urologist sounds like a good idea. May be a couple of years overdue. But your PSA has been growing slowly and still isn't tremendously high. The fact that it hasn't taken off to the races at any point is sort of a good sign. Your PSA velocity is modest and your doubling time is long. Those are indications of a less-aggressive disease. That's the good news. The bad news is that recent studies looking at the predictive value of PSA velocity and, especially, PSA doubling time have found them to be fairly lousy at predicting aggressiveness and doctors aren't paying as much attention to those measures any more.

A biopsy seems appropriate to me. I had four of them. Never learned to like them. I found that I did better with a bit of Valium. The actual procedure is more annoying than painful and a bit of pharmaceutical detachment helps keep me from wanting to hop up off the table and jamb the ultrasound probe up my urologists keister to see how he likes it. But one gets through it and, generally, waiting for the results is the hard part.

To a large extent the answer to your question about spreading to other body parts (metastasizing) will depend on the result of the biopsy. Your PSA has gotten to the range where aggressive disease can start to spread but most guys don't have aggressive disease. If the biopsy result shows Gleason 6 or less then you are probably OK as far as metastases goes. If your score is 7 or above then you can continue to worry.

If you are diagnosed, plan to talk to a number of doctors. Be sure to talk to a radiation oncologist and be sure to ask about brachytherapy. Good luck. We'll be here.

Welcome to HW,
Sorry you need to be here but this is a good place to be.

You need to talk to a URO and get that biopsy. You're PSA numbers don't look so good - the pattern you have, slow steady rise is what sent a lot of us to the URO and eventually into various treatments for PC. I am surprised you weren't sent to the URO about 4 years ago for a consult.

The biopsy it annoying and undignified but not really painful. It's what you really need right now to determine the next steps.

It is possible for PC to spread - bone and lungs are most common and painful in the extreme if it lands in your bones. In most cases the higher the PSA number the more likely it has or could spread.

I'd get that URO referral going and get the follow on testing you need. The more information you have the better. PSA is only on possible data point here and really only an indication that you need more testing to understand what is going on.

Hang in there and keep us updated on your progress.
Andrew

Js
You've received good advice. My psa was at your level when I got a biopsy. I wish I had gone years earlier. I did not find the bx to be a problem. In and out and painless. Good luck!
Bob

jsdewar,

Sorry to see the PSA climb. Your first PSA 2008 should have prompted your physician to refer you to a urologist. Anything PSA over 4.0 should be a red flag unless you have an enlarged prostate or infection, both of which should have been dealt with back then and then another PSA taken.

I was told by my urologist that a 50 year old man has a 50% chance of PCA and a 60 year old man has a 60% chance of PCA and each additional 10 years increases you probably by 10%. Luckily, most men die from old age or other diseases or accidents before PCA kills them.

I would definitely see a urologist and have him do a complete exam and he will probably want to do a biopsy.

jsdewar,

Biopsies are Good; and the ones showing negative cancer results are even better.

.

JS,
Welcome to HW. The last sentence in your post refers to the spread of cancer cells. Are you asking if the biopsy procedure itself can spread cancer cells? Although uro`s say no, I have always wondered about it. I hope all goes well for you.
1snake

Update time:
Age: 67.5
Prostate biopsy done on Nov 6.
PSA 13.3
Gleason = 8
Stage = T2b or c
Diagnosis: "aggressive" prostate cancer; likely spread to seminal vesicle and some lymph nodes
Prognosis: miserable.
Next steps:
Either robotic prostatectomy (complete) followed by 6-8 weeks of targeted radiation, or
Targeted radiation, followed by "seeding"...
End result: improbable that all cancer will be "killed" or removed. Will most likely require continued radiation, chemotherapy, possible castration, and the rest of the lexicon. Final results...five to seven years....maybe.

So...it is what it is. Tough to wrap one's head around it.

Mel: I am as crystal clear certain that my take on the "future" is completely filled with self-pity and a depressing resignation! So there!
On the other hand, give me a day or two, and I'll return to "normal"!!

Thanks for the "head slap"!!

Jim

Jim
I'm with you. LISTEN TO ME. GET A SECOND OPINION ON THE SLIDES. have them sent to Dr Epstein at Johns Hopkins or Dr Bostwick at Bostwick Laboratories. Your Uro will know who they are and not disagree (if that's not the case get a new URO.)

I don't want to give you false hope. But I was given a report on Monday of 2 cores G6 and 1 core G8. On
Wednesday Epstein received my slides, and on Friday I got the report and it was downgraded to a G6.

Now, like I said I don't want to give you false hope. Your PSA is higher than mine was. But it's possible, and in any case you should have a second opinion froma pathologist who looks at all or mostly Prostate slides.

Even if it's confirmed G8, don't buy that 5-7 year crap. They don't know. Your Uro is probably looking at old stay, and the treatments are getting better and petter. Also, someone here with more knowledge can correct me if I'm wrong, but I don't think they can say definitively from a biopsy that there is spread to seminal vesicles and lymph nodes. So I don't buy that crap either.

One more thing... Get the best docs you can find. I looked at your profile and see you are in the Midwest . Try to get a consult with a team at Cleveland Clinic or Mayo.

Good luck, and stay around here these guys are really terrific in both support and knowledge. I would have never gone for a second path opinion without them, and would have rushed to surgery without considerable thought

I was where you are two days ago . Stay strong. There are lots of G8s here as well as g9s who have had success.

Jim, if you're Urologist was basing the "probable spread to seminal vesicle" on the ultrasound that guided the biopsy, wanted to give you a ray of hope. The top urologist at the top cancer center in our state did an ultrasound and told us he was 95% sure there was spread to the seminal vesicles. Post-surgery pathology showed NO spread to SM.

I think reading the images is as much art as science.

You're in the worst days of the process (speaking, of course, as a wife). It will likely get better.

Based on the strong, sensible advice from most of you, I've contact <by email> Dr. Epstein @ Johns Hopkins and Dr. Bostwick at Bostwick Laboratories to find out if they would be ammenable to offering a "second opinion" regarding my biopsy results. We'll have to see.
Regarding the biopsy results I was given....I feel that it was not very detailed. I didn't get nearly as much information as some of you.
What I received was a Gleason of 8 (no breakdown as to how this was calculated), and a stage of "T2b or c". Nothing else. From that, the doc is ready to do either surgery, the "radar", or "radar" followed by "seeds". Seems a bit "short and sweet" to me.
What do I need to ask for specifically?
Thanks to all....especially the wives who've responded!
Jim

You need another reading on that biopsy. If radiation is going to be required, then I'd be tempted to say, skip surgery. Other than getting a more detailed pathology report and more side effects it won't buy much. Radiation followed by HT might be the best course.

and no need to worry too much. It's a punch to the gut for sure, but you have every hope of keep the beast at bay for a very long time.

While you're waiting for test results, take some time to work through the mental and emotional shock that the news gives. It's more than a little shock to the mind - go do something nice for yourself. This game is as much about brain as it is your prostate.

Hang in there, you're doing fine so far,
Andrew