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Posted 4/21/2015 11:52 PM (GMT 0)
First of all, Thanks for a great message board. Seems there are many knowledgeable posters here. I wish there was a MB like this for COPD!

As for the COPD I am in the severe stage of this progressive disease. I can get around OK, don't need oxygen, and I am able to live a mostly normal life. I exercise almost everyday. Routine physical in Oct 2014 showed bloodwork OK. Other than COPD am in good health.
I am 65 years young and had my PSA tested two times in the last six months:

Oct 2014 PSA = 5.2
March 2015 PSA = 7.5
DRE both times were negitive

Same lab for both tests. First DRE was from Primary Doc and second was from Uro Doc who wants me to have a TRUS biopsy.
I am not looking forward to the biopsy but will go through with it if it can shed some light on the subject. I would like to hear opinions or any comments that may help with biopsy decision and follow up treatment if any. Doc says an operation may be ruled out because of COPD.

I should also mention that I take inhaled corticosteroids (very small amount) to help with the COPD. To further complicate matters I do have a pacemaker but it doesn't pace much at all. My cardio problem may have resolved itself and the pacemaker may be removed soon. It may not make a difference as I can't seem to find any MRI machines in this neck of the woods. I have entered a clinical trial to place metal rods in my lungs, they act more or less like "stents". They should open my airways enough for breathing almost back to normal, but have the downside of ruling out MRI in the future.


Bob
Posted 4/22/2015 12:07 AM (GMT 0)
Take the truss biopsy and find out if you have Pca. If you do there are curative treatments that can bypass the copd and pace maker issue. Of course a cure is a nebulous term that may not shed the light they are known for. Welcome to the minefield of Pca? In the meantime keep your faith, Pca may be the least of the issues you have to deal with. What is your age and are you a beetles or elvis type ? Just trying to add a dash of levity to your situation , which is probably not as bad as you think…so dream,dream,dream….and feel the trombone vibrations…. it is not Gabriels trumpet…..
Posted 4/22/2015 12:18 AM (GMT 0)
The TRUS biopsy is unpleasant but not a big deal. It takes all of 10 minutes for a typical 12 core biopsy. The worst part for me was the antibiotic shot in the butt. THAT hurt for a month or more. Once you get the biopsy report, fill us in on the results and we can tell you what we know about the next steps.
Posted 4/22/2015 12:59 AM (GMT 0)
Given your other conditions I suggest you take a balanced approach to the possibility of prostate cancer. Has your doctor tried treating you for an infection or tried to determine if it is BPH? Your life expectancy will have to be carefully considered to help determine to what extent, if at all, you embark on PCa treatment, if it is cancer.
Posted 4/22/2015 3:26 AM (GMT 0)
Welcome to HW
sorry you need to be here,
but it's a good place to be.

A biopsy is prudent
although you might have
a simple infection.

You might have BPH or an infection
PC is possible, but not for sure

Even if the worst is true
Hope is there
as you have options
Active Surveillance,
Beam Radiation
both could be used.
Posted 4/22/2015 4:14 AM (GMT 0)
It sounds like they are going to do a "template" or "blind" biopsy, which is typical of an initial sampling.

However, if it is negative, or "suspicious", and your psa goes higher, I would suggest that they do a 3Telsa MRI before doing more "needle in haystack" biopsies. If the 3T MRI finds areas that are possibly cancerous, then they could do a "fusion" biopsy targeting those specific areas.

But, you could just have BPH, so don't be too concerned about jumping ahead in your mind at this point.
Posted 4/23/2015 4:00 AM (GMT 0)
Sorry for late reply. Thank you to logoslidat, halbert, JNF, InTheShop, and ASAdvocate. I appreciate your responses, and already feel better about this.

Both DRE came back as normal. At least Docs said "OK" so I guess that means negative which means they couldn't feel anything different or unusual. Is it still possible I could have infection or BPH?
Any hints about PSA rise? I will report back on biopsy report in the next few weeks.

Age 65
Oct 2014 PSA 5.2, DRE negative
March 2015 PSA 7.5, DRE negative

Bob
Posted 4/23/2015 12:08 PM (GMT 0)
Bob,

Sadly, one doesn't get a lot of specific information from a DRE, even the more expert kind one gets from the highly educated (and usually surprisingly strong) finger of a urologist. A positive result is a risk factor but there are a lot of non-cancerous conditions (cysts, calcifications, etc.) that will produce a similar-feeling lump and a negative result simply means the doctor didn't feel anything which doesn't mean that there isn't anything there.

Since the "H" in BPH stands for "Hypertrophy" (over-growth) the doctor can at least feel how big the gland is and if it feels big to him that can be a mildly good sign since a larger gland can produce more PSA but that is a somewhat mild reassurance. It is nearly impossible for your doctor to evaluate an infection from a DRE. The swelling can make it feel larger but not otherwise unusual.

So, basically, with your two normal DREs you can be glad they weren't abnormal but shouldn't think that a normal DRE ever rules out anything.
Posted 4/23/2015 4:51 PM (GMT 0)
hi Bob,
I didn't notice in this thread if you've been asked if you had sext he night or two before your second PSA, that can cause a spike. Perhaps a round of Antibiotics and another sex free and bike free PSA will give you a more definitive PSA . . . Q
Posted 4/23/2015 5:08 PM (GMT 0)
Thanks for response Peter, Quincy, and Allen. Lots of info for me. It seems from your response and other posts I have read here that if PCa is not found first time, or two or three times later, that you just keep on digging. (pun intended)

Will PSA results guide need to Bx. I take that an increasing PSA means more Bx in future. Any way around this?

I live in Central Jersey. Anyone care to recommend to good PCa Doc that accepts medicare? I have found in dealing with COPD that you may be better off with a specialist. Also anyone know of place for MRI prostate in the area (including NYC and PA).

I am really glad I found this MB. So much great info and neat sense of humor.

Bob

Post Edited (Bob007) : 4/23/2015 11:12:39 AM (GMT-6)

Posted 4/23/2015 5:10 PM (GMT 0)
That fairly rapid increase in PSA is usually indicative of prostatitis. You might ask your doctor for a course of antibiotics to see if it brings down your PSA before proceeding to a biopsy. If your prostate were "lumpy" I would suggest you go ahead with a biopsy, but since it's normal, it may not be necessary.

I agree with JNF that your "serious" COPD takes precedence here. PC is usually a very slowly growing cancer, often taking 20 or more years until it becomes lethal. It is also symptomless for much of that time, while treatments can have very troubling symptoms. This is a discussion you should have with your pulmonologist who can better assess it along with any other comorbidities you may have.

- Allen
Posted 4/23/2015 5:29 PM (GMT 0)
Hi again Bob,
On your question of " will additional PSA results guide to more Bx?". Not very often is my answer, after you have gone through all the other variables like Prostatis, sex, bike riding, etc. you will end up with a pretty definite PSA result. If you then practice Active Awareness, AW, for say six months or so and your numbers continue to rise then find a good UROLOGIST and get your biopsy. That's the gold standard for PCa in my book.

As others have written, your COPD takes precedence at this stage but maintaining AW is, unfortunately, now also on your list of medical issues . . . Q
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