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Wildly fluctuating PSAs; just finished 3rd biopsy

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Posted 1/24/2015 2:37 PM (GMT 0)
Please see the diagnostic data below. I got first PSA at annual physical then went to Uro when it was over 10. Uro gave new PSA, plus Free, Plus PHI which came back as shown. He ordered a biopsy which came back as shown. Seems he should have given me a course of antibiotics instead of Bx….His tests for infection though were negative. Now after 2 biopsies, I got them to do an updated PSA (6 weeks post second Bx) and it comes in at 2.5 with freePSA of 12%. Do not have results of 3rd Bx yet but will post when in. My uro who did 2nd and 3rd Bx says the third "lesion" does not look suspicious to him and his radiology team (it was graded suspicious 4/5 by a radiology second opinion). If the 3rd Bx is negative what am I to do? Some docs say treat; some say active surveillance. I'm thinking wait 90 days and get new "clean" PSA and T3 MRI and go from there. I was all set to treat with IGRT until this last PSA score. This has been going on now for 4 months. Any thoughts or input would be greatly appreciated.


_____________
PSA: 2012: 2.0; 9/24/14; 10.4; 10/7/14: 12.7 (Free 6%) (PHI: 36); 1/21/15: 2.5 (Free 12%)
First Bx: 10/14/14: 3 0f 12 positive, 5%, 10%,20% all Gleason 3+3 (confirmed by JH)
2nd Bx: 12/10/14: MRI guided, 2 lesions identified; each lesion Bx 3x, plus 12 random all benign, 1 with PINs
3 Bx 1/23/15: Bx's another "suspicious" spot ID'd by another radiologist as a precaution; no results yet
Pet scan, T3 MRI; CT all negative for extracapsular involvement.
Posted 1/24/2015 6:07 PM (GMT 0)
It's likely that there may be some PC in there somewhere if you riddle his poor prostate with biopsy cores, but if there is, it is obviously too little and of such low grade that it is not worth treating. This kind of insignificant, indolent PC is what we all wish for if we're going to have any, and has been shown to not require treatment. I can't imagine any ethical doctor treating a negative biopsy - they take an oath to do no harm. Finasteride or Proscar may prevent any GS6 from cropping up in the future.

Wildly fluctuating PSAs do not indicate PC, and most prostatitis will not respond to antibiotics.

- Allen
Posted 1/24/2015 6:12 PM (GMT 0)
Sounds like run of the mill low risk PC. Keep monitoring until there is something significant to treat if ever.
Posted 1/24/2015 6:33 PM (GMT 0)
Thanks for the responses guys! I've been living with that over 10 PSA since this started in September. It has make me think there is something bad lurking that had not been found. I don't have results yet from Bx #3 but I ordered the recent PSA which came in at 2.5 and even shocked me. I will post the third biopsy results when I get them. Meantime, I have developed a huge herniated disk at L2-3 which is impinging on femoral nerve and causing constant pain 24/7 and see no option but surgery (next Tuesday)...
Posted 1/25/2015 2:54 AM (GMT 0)
Did you have sex and ejaculate within 48 hours of blood draw?
Did you have the DRE and then have the doc send you down the hallway to have your blood drawn?

Either one will artificially raise the PSA. If you answered "yes" to the second, schedule a follow up appointment with the doc and use that time to kick him in the nuts. He is either incompetent or trying to drum up business. I'm not sure which is worse.

Good luck,
Jeff
Posted 1/25/2015 11:48 AM (GMT 0)
No to the sex question; but yes to the DRE before taking the blood draw for the first PSA at 10.4. The second PSA at 12.7 was all done properly at urologist's office. What could explain the drop down to 2.5 except infection at the time of the first two which were about 2 weeks apart??? I've been taking a lot of off the shelf immune system supplements, etc and pom juice. Lots friends have been praying. Any other thoughts out there?

Now it seems I should just wait 90 days, get a new PSA and maybe a T3 MRI once the gland is totally healed from all these biopsies. Thoughts on that?`
Posted 1/25/2015 12:48 PM (GMT 0)
Yep, infection/inflammation can cause high PSA and very low free PSA, two numbers that freaked me out when I was 45. 3 subsequent biopsies only found some inflammation. We tried a round of Cipro (IIRC), and then took low dose aspirin ever since. My PSA dropped over time down below two and stayed there for 3 or more years. No PCa until my current diagnosis 10 years later (sigh).

Infections in the prostate are notoriously difficult to clear up, too. Something about the way blood flows through there makes it hard for the antibiotics to get to the trouble spots. PCa also doesn't cause highly varying PSA levels. It's more of a steady rise (exponential at some rate, if you're into math).

I think you can take your finger off the panic button for a while. The G6 from the first biopsy is quite low risk. It can grow, but virtually never metastasizes. Those horses may fill the barn and spill into the corral, but they don't run off into the fields!

By the way, have you considered a second opinion on the first biopsy's slides? It's not impossible, but is unusual, for a positive one to be followed by negative ones like that. They are rather hit-or-miss affairs though. Boy, though if Johns-Hopkins confirmed the biopsy results that seems quite inarguable. PCa can be like a few BBs scattered through the gland; it's "multifocal", appearing often as multiple small tumors. Easy to miss with a biopsy needle.

So that's the murky twilight zone of PCa!

Jerry
Posted 1/25/2015 2:30 PM (GMT 0)

Tall one, you said...
I can't imagine any ethical doctor treating a negative biopsy - they take an oath to do no harm.

Mine did. My first, second and fourth (final) biopsies were all negative and my third biopsy caught only one core with a tiny bit of GS 6(3+3) or GS 7(3+4) depending on which pathologist you choose to believe. I am the Ghost of Active Surveillance Anxiety. I see the virtues of AS and I try not to let my chains rattle... But, occasionally... BOO!

Nuttinhoney,

As others have told you your recent PSA drop is consistent with an occult prostate infection and should be reassuring that your now-you-see-it-now-you-dont Gleason 6 cancer isn't somehow off to the races. Your plan to wait three months are retest seems sensible -- three more months of AS. And I sympathize with your dilemma: if a suspected infection forces you to discount your PSA then the AS lifestyle can seem like an endless procession of men in white coats waiting in line to poke things up your behind -- a bit like being a straight guy trapped in a medically-themed gay p0rn0 film.
Posted 1/25/2015 4:25 PM (GMT 0)
Nuttinhoney,

Wait.... I am trying to calm down..... putting a sock in my mouth and biting down..... ARRRRGHHH!!!! I CAN'T STAND IT!!!

HE GAVE YOU A DRE AND SENT YOU TO HAVE YOUR BLOOD DRAWN?!?!?! AAAAAARRRRRRGGGGHHHH!

HIS NUTS SHOULD BE IN HONEY - COVERED IN RED ANTS!!!!

OK... Breathe in... breath out... in... out...
OK... It's out of my system.... Whew...

Please wait 3 months and have another PSA done. Refrain from sex and any other prostate stimulation for 48 hours before the blood draw. I'd even skip bicycle riding.
If you want consistent results you should be as consistent as possible. Control the variables you can control.

May you have a roaring case of prostatitis that Cipro will cure.
Good luck,
Jeff
Posted 1/25/2015 5:48 PM (GMT 0)
Everyone on here has their own personal agonizing experience with this awful disease. So, at the risk of belaboring my situation, I'm gonna impose on your patience a bit because I think you will understand. First of all, I know I'm lucky to have what I have and not worse (of course, 3rd Bx results are not back yet). If the 3rd comes back G6 or worse, I think I would go ahead and get treatment…probably IGRT although UCLA said before the 2nd Bx they would treat me HDR mono therapy. With now much lower PSA, I think I would go with IGRT. If the 3rd is negative, I'm thinking I would do AS for 90 days and do every diet related, etc thing I can find to counteract what was found in the 1st Bx..since that is still there and should not be ignored. Can't really see past that...

Post Edited (nuttinhoney) : 1/25/2015 11:15:22 AM (GMT-7)

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