PSA 18, 3 negative biopsies

I'm posting for my 74 year old neighbor, Julian, who is computerless and needs some advice. His first ever PSA test was 5, about four to 5 years ago. Starting rising about two plus years ago to it's present level of 18. Actually went down a point about 9 months ago but came back up, went through the antiobitic regime, no evidence of infection, DRE normal, normal prostate size. He has had three biopsies and a CT scan in the last 18 months, all negative. His urologist doesn't have any answers, and is confident that he mapped the biopsies to cover his whole prostate, (not sure if those were his exact words). He wants Julian to take a regimen of Finasteride 5mg, he didn't go into detail why (maybe a good question on his next visit).

Julian is a very healthy, active guy. Vegetarian, walks 4-5 miles per day.has a huge organic garden, and expects to live a long time. Both parents lived into their mid 90's on a daily regimen of biscuits, bacon, and cigarettes (I think his Dad quit smoking in his 70's).

Does anybody have any experience with these kind of numbers and results?
Any experience with the Fenasteride?
If a tumor is eventually found (you would assume it would be small and slow growing), any opinions about treatment options considering his expected longevity?

Thanks for any response or opinions!

WG,

Thanks for the reply.

Don't think any of these circumstances are issues. Hope to hear from others with 3 plus biopsies and their outcomes. Anybody out there who has had PSA this high and multiple negative biopsies, and PC was never found?

Bill

There are two possible causes, psa leak or a transition zone tumor.
The most probable is a TZ tumor which 99% of urologists are unable to biopsy properly.

The best method of DX is an MP -MRI with a 3T. The other option is a color Doppler ultrasound, but only by someone like Dr Bahn in Ventura Ca.
See my history as I went through the exact same thing over a 10 year period with 13 negative biopsies and MRIs.
Finasteride will reduce any psa due to BPH but will not affect psa produced by cancer.

TZ tumors are usually not dangerous as they are contained around a lot of prostate tissue.

I would think that at age 74 and after three biopsys that found nothing, maybe we just don't know everything about PSA levels. A low PSA does not mean that you're cancer free either. In his case, if Pca is so hard to find, perhaps he should give it a rest. How aggressive must one try to be in obtaining a diagnosis? How aggressive would the tumor be at this stage of his life. He seems to have done enough and perhaps enough has been done. Maybe he should just go on with his life.

Thanks clanda,
He has certainly expressed serious interest in that choice, and I don't think it would necessarily be a bad one, watchful waiting until something dramatic may change his mind.

 

I, too, had a TZ tumor that 3 TRUS biopsies missed. The cancer was finally found incidentally when I underwent a TURP to relieve BPH. Although my PSA grew steadily over a period of 13 years from 3.4 to 9.6, the volume of cancer finally found was very low and the Gleason score was 6. It appears that TZ tumors can generate higher PSA scores even with a GS6.

It took 8 biopsy's over a 5-year period before cancer was found . Theres a book by Pat Walsh from John Hopkins were he states Prostate cancer is different then most cancers in that it grows like clovers in a field of grass. Which can make it hard to find, I had a nurse tell me, except that youll have a biopsy once a year until they find the cancer and it will be early or a small cancer. Thats exactly how it played out for me. Good luck!!!