What do you make of this? Opinions needed......

Hi Mugsy,
I am no expert but 19 is high for a man of 54. Higher psa can be caused by an enlarged prostate. You did not say what size his has been determined to be. There are other scans that do a better job of finding small volume tumors. If you are in Arizona there is Dr Alameda. In Minnesota Dr. Kwon at Mayo. I am sure others will comment with better information than I have provided. Just google either doctor and state.

I hope that there is nothing to the tests since the biopsy keeps coming up negative. I had a friend with a similar circumstance but not as high a number. Never did develop into anything. Hoping that is the case for you.

Best to you and your husband.

Don

Hi Mugsy,

I also have a PSA of 19 but I am 10 years older than your husband and diagnosed last week with PC.

You do not mention the type of Biopsy that your husband had. This could make a big difference between negative and positive results. The rectal type is only 25% accurate and may have to be carried out 4/5 times before a true result is found. However, the transperineal biopsy is 95% accurate. Is this the one your husband had?

mugsymagoos said...
His records say he had a TRUS biopsy (two of them).

TRUS is the one that is only 25% accurate, so those results are not gaurenteed. I know of a guy who had 5 of those before they found the PC.

Another thing that should be looked at is the possibility of Prostatitis. It can be as tricky to detect and treat as PC, and will often come and go at random times. But a good biopsy can detect it the same as PC.

I had my MRI first, but it showed nothing. So I went for a transperineal biopsy and that is when they found the PC.

I assume that he had part of his prostate removed because he had problems urinating!

If the place he had his biopsy done had the transperineal facilities then I am sure they would of used it. I had to change hospitals because the first one only done the TRUS biopsy.

Usually when part of the prostate is removed because it has become too large and the man has trouble urinating the doctors do what is called a TURP (Trans-Urethral Resection of the Prostate) where they remove tissue from the prostate in the area near the urethra. The tissue so removed is usually inspected by a pathologist to look for prostate cancer.

Some men are diagnosed with prostate cancer from their TURP pathology report but often cancer is missed since the tissue selected for removal is chosen to help the man's symptoms, not to look cancer.

How long ago was that procedure?

There is not much else I can add mugsy. I can only suggest things that I have experienced myself recently.

I do know that a standard MRI will not always detect PC, but could show suspect areas of the prostate they should target during a biopsy. Hopefully some of the more experienced guys here will drop by and give there opinions. Prostatitis is still a possibility though and can be a bugger to detect and treat. A biopsy can find it though, but even with treatment it can still return. On the plus side Prostatitis is not a life threatening condition, you just have to learn to live with it. I know what I would rather have.

Good luck for tomorrow. Let us know how you get on.

I have a friend who had a PSA closing in on 20. After repeated biopsies...still nothing found. He had some procedure done, but it wasnt' prostate cancer...I will email him to find out what it was...not always cancer though...

Forgot to tell you that UFHealth (Shands) is on the forward edge of prostate cancer treatment. They have a scan there where they use iron particles to image small tumors. I think it is called feraheme. They are in Gainesville and I think Jacksonville as well. But Florida is a relatively small state so within a few hours drive from most locations.

Don

Oh and here are the dates with the PSA levels....

6/2011 - 11.75
1/2012 - 10.51
7/2013 - 14.51
4/2014 - 16.6
7/2014 - 17.4
11/2014 - 19

Had a biopsy done in 2/2012 - Negative and another 8/2013 still negative and then the PCA3 Test in 8/2014 which came back with a 5 (negative). PSA just done and at 19 which is why doc wants MRI done now.

Oh, and he had the prostate surgery done to remove part of it since it was so enlarged in 3/2012.

Mugsy - your husband's case is somewhat unusual. Here's what I see in these numbers:

1.) the slowness and steadiness of the rise makes an infection or prostatitis very unlikely.
2.) The slowness of the rise would suggest more a situation of benign prostatic hyperplasia (BPH) than cancer
3.) However, 54 years old is on the young side for that much BPH.
4.) The rate of rise is increasing (more on this below) and that is of some concern.
5.) The good news is that if it *is* cancer it is pretty slow growing for cancer. A cancer growing that slowly is almost assuredly a low grade cancer that would respond very well to treatment and not be a life-threatening situation.
6.) If I had to guess, it seems like a small cancer might be underway and because it’s small it’s hard to detect. But most of the rise in PSA is a result of BPH rather than cancer. I’ll underscore that is only a guess and I am not a physician.

Has he had a DRE? (Digital rectal exam) Did the DRE detect any nodules? (the urologist presses on the prostate with his finger against the rectal wall, and is feeling for the presence of any nodules or hard spots within the prostate. An enlarged prostate itself is not a sign of prostate cancer. Nodules or lumps within the prostate are signs of cancer.

Find out how big the enlarged prostate is relative to a normal prostate. (They can tell this from the ultrasound; it is probably in the doctor's notes from when the biopsy was done because ultrasound is used to guide the biopsy.) The amount of PSA is roughly proportional to the volume of the prostate. So you can tell from a comparison if the amount of PSA is rising faster than it should given the size of the prostate, and "excess psa" if there is some, is a call to investigate more thoroughly. In other words the presence of excess PSA is a suggestion that there might be a cancer lurking in there that the biopsies missed. Sometimes that happens.

You have to be careful with this calculation because the volume goes up with the cube of the diameter, and not linearly. If you don't know how to do this, post the size of the prostate and we'll help you with the math.

When the surgery was done in 2012 (it's called TURP, which stands for trans-urethral resection of the prostate) they should have sent a sample of the cells removed to the laboratory to have them checked for cancer. They look at them under the microscope and make an assessment based on the shape of the cells. Talk to the doc and see if they did this. You should be able to get a report from the lab about the cells. If they have kept the slides that they prepared, you can have those slides reviewed by one of the really top-notch labs.

Assuming that the MRI turns out negative it would prudent to keep watch closely, for example PSA's every six months. Pay close attention to the percentage rate of increase from one test to the next. If the rate of rise suddenly increases that would be a sign that something is changing in there, and perhaps a cancer is starting, and would be an indication to do another biopsy.
The rate of rise is slowly increasing. As of July ’13, it was going up at 12% a year. As of April 14th it was going up 19% a year. As of Nov 14, it is going up 29% a year. That is not a good sign. It could well be that the baseline rise of PSA to over ten was due a benign process and now a small cancer has gotten started in there. It bears close watching.

Finally got results of MRI today, and it was negative. Doc says his prostate enlarged again even after having the surgery. Prescribed Finasteride, but I don't like what I have read on it, so having him start a natural supplement for Prostate support. He is not having any urinary symptoms anyway, just the enlarged prostate and high PSA.