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Can Someone Please Help With This Screwball History?

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Prostate Cancer
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Posted 5/1/2015 7:16 PM (GMT 0)
OK. I'll TRY to get this right but it's confusing, even for me and I'm living it.

I just turned 69. about three months ago I went for a routine physical. My PSA was 8.3, up substantially from the 2011 test of 1.23. I developed BPH in the interim so my MD put me on a 14 day CIPRO regimen. It helped. Hardly wake up to urinate at all during the night anymore. Retest during the last days of the CIPRO treatment was 7.67. MD recommended I see a urologist. Urologist did a DRE (Negative) but said I had cancer and wants to do a biopsy. He was quite plain that he'd then recommend an operation to remove same. Seems hell-bent on having already made up his mind about that. Meanwhile, I insisted on a Free PSA. PSA battery came back two days ago as 14% free which is marginal BUT the PSA had dropped to 6.29. Best I can find is that my chances of having PC are about 28%

So - - - - I'm torn. Has anyone had similar results and what did you do? Not too thrilled about the possibility of sepsis as a result of the biopsy. Asked for an ultrasound first but Uro said as long as I had the US probe there I might as well get the biopsy done.

Thoughts?

Thanks!
Posted 5/1/2015 7:35 PM (GMT 0)
Welcome to our world, sorry you need to be here.

Frankly, I'd be looking for another URO. You doc seems to be making a lot of leaps on little data.

Just looking at PSA history isn't definitive for PC, it is suspect for sure, but the fact that you had a drop after cipro suggests there may have been an active infection - prostatitis. Often a rapidly rising PSA is caused by infection. PC tends to rise slowly, but there are exceptions to everything. prostatitis is known to be difficult to treat. If your PSA is dropping, prostatitis seems the more likely cause of the elevated PSA.

But then I am not a doctor just random guy on the internet.

He is right about the ultra-sound - it's just one small step from biopsy. A biopsy might be prudent right now, just know for sure. If PC is found, don't let this guy just start cutting - weigh your options and get a second opinion.

In fact that might just be the thing to do now, find another URO and get a second opinion on needing a biopsy vs. another round of cipro to see if it's stubborn case of prostatitis.

Hang in there and keep us updated,
Andrew
Posted 5/1/2015 7:38 PM (GMT 0)
PSA is simply not reliable. Mine has bounced "all over the place" in my PCP's words, over the past twenty years. Infections, or trauma from a biopsy can cause big spikes.

My suggestion is that you have a 3T multi-parametric MRI, which can provide a good sense of whether there is cancer in your prostate. It won't hurt you, and it will provide confidence that you are being properly treated, or even if any treatment is necessary.
Posted 5/1/2015 7:44 PM (GMT 0)
The urologist sounds too aggresive. He should not diagnose cancer without a biopsy. Even if you had prostate cancer, it could be indolent requiring only surveillance, or could possibly be treated with radiation or focal ablation.
I would find a urologist at a larger hospital. Good luck and there is no rush.
Posted 5/1/2015 8:41 PM (GMT 0)
Frankly, this Uro sounds like one of those that the recent prostate cancer screening guidelines was aimed at. Diagnosing cancer based only on PSA????? Especially with a negative DRE????? Run, do not walk, to a major academic medical center and get into the Urology group. When you get a name, google is your friend.

PSA is not, repeat, is NOT A CANCER TEST.

Now, I've gotten that off my chest. F4Driver, in a more relaxed tone, this is nothing to mess around with. Where are you located? I'm sure someone can aim you somewhere nearby to find competent care. Good docs are all over. So, unfortunately, are poor ones.
Posted 5/1/2015 8:59 PM (GMT 0)
This Uro is the type that gives PSA screening a bad name. Your PSA rose what, 7 points in 5 years if I read it right. That is not fast at all. My PSA has been yoyoing 10-20 points for the last two years, in fact it just went from a 160 to a 150 in the past two weeks. I would definitely get a new Uro and have a biopsy as you problem do have some issue that only a biopsy can clear up. The danger of sepsis is overrated and can be mitigated by getting the best Uro you can find. If I ever saw a better candidate for Active Awareness, AW, it would be the same history as yours. Given your age, 69, and the very slow growth of PC I would opt for that as the treatments will all mess with your life something fierce. . . . . Q
Posted 5/1/2015 9:27 PM (GMT 0)
I agree with others; get another doctor as he is not acting in your best interest. If you have BPH then what is the estimated size of your prostate. Psa density should be used for all patients with BPH, and anything greater than 1.5 should be an area of concern. A normal prostate is 25cc so a psa reading of 3.7 would be in a normal range. if your enlarged prostate is 50cc than a psa reading of 7.5 would be within reasonable range. Are you taking anything for BPH like Proscar or Adovart? If so a new psa baseline would be established and any increases from that baseline are most likely due to cancer and not BPH. Cipro is used for infection and would not affect BPH.
Posted 5/1/2015 10:03 PM (GMT 0)
Not to repeat what everyone else pretty much said, but how on earth can a urologist definitively state that you have cancer, without any data other than a PSA test and a NEGATIVE DRE. That's unconsciounable, in my opinion.

Find a real Uro.
Oh, and welcome to the forum, hope you are just visiting
Posted 5/2/2015 10:35 AM (GMT 0)
Thanks guys! I've come to the generally same conclusions. As you can imagine I'm getting lots of resistance from the Uro on this. I live in NEPA, Wilkes-Barre area. Any suggestions for a good Uro or venue for a second opinion? I have no desire to suffer the consequences of a removal as I'm still using the equipment fairly often. When I mention density or other tests I get treated like I landed from Mars. In good health otherwise.
Posted 5/2/2015 10:52 AM (GMT 0)
F4, all I can say, is that I traveled 2 hrs by car to find my team. How far are you from Philadelphia? I don't know, but I'm sure there are good ones there. Further afield there is JH in Baltimore...
Posted 5/2/2015 11:11 AM (GMT 0)
F4, looking at the map, you might be closer to NYC than you are to Philly....am I right? Lots of good folks there.
Posted 5/2/2015 11:40 AM (GMT 0)
Thanks Hal.

Not exactly sure of the path I want to take. Read your story. Requested a 3T multi-parametric MRI as well as a density. We'll see how it goes with the Drs. Frankly at my age I'm loathe to do anything no matter what the diagnosis.
Posted 5/2/2015 12:22 PM (GMT 0)
Get a second opinion SOON!

Get a second URO SOONER!

.
Posted 5/2/2015 7:24 PM (GMT 0)
F4, true. At your age, if you came out at a G6 with 3 or fewer cores (out of 12), you'd have a strong argument to nothing. Now, that would require you to have a biopsy. For most men, a biopsy is a minor unpleasantness. It's not painless, and not without it's anxiety, but in the end, it's not any worse than a filling.
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