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Posted 1/8/2016 7:27 PM (GMT 0)
My history:
48 years old

PSA 2.6 in November 2012
12 core Biopsy negative January 2013

PSA 4.26 June 2014
Free PSA 10% June 2014
20 core biopsy negative August 2014 (though there was evidence of HGPIN in one area)

PSA 4.57 February 2015
Free PSA 7% February 2015
MRI Fusion biopsy (one area right base equivocal for cancer in MRI biopsied), negative for cancer.

September 2015 PSA steady at 4.55

Jan 2016
Had PSA test as part of regular physical (though same lab) PSA 7.06
Urologist wants to do another MRI. Biopsy if any suspicious areas found.

This is getting so frustrating. The waiting, anxiety, relief cycle every year is wearing me out. I know I've been very fortunate until now with negative biopsies but why can't I stop thinking that there is something there they just aren't finding? Am I crazy to feel that that is possible even after all of the tests? I'm a generally optimistic person but something feels off here.
Posted 1/8/2016 7:50 PM (GMT 0)
I may be incorrect, but a prostate biopsy is just not capable of gathering samples from all areas of the prostate. Please, someone correct me if I'm wrong.

Standard prostate biopsies are random and the urologist will do his / her best to obtain samplings from all suspicious areas of the prostate, but there’s no guarantee that a biopsy will hit the cancer, especially if it's a small one.
Posted 1/8/2016 11:20 PM (GMT 0)
The biopsy is a best guess shot in the dark. Think about an orange and you need to place a straw through it to find a bad spot. You might get lucky and hit it. I got lucky on the 24 poke and they found cancer in 1 spot and it was only in 5% of the core sample. Good luck and please doing what you think is best for you.
Posted 1/9/2016 12:08 AM (GMT 0)
Todd, did you ever ask for a saturation biopsy?
Posted 1/9/2016 1:12 AM (GMT 0)
I have not requested a saturation biopsy though I may suggest that. Each time I go through this, I feel like it must be the last time but clearly I am wrong. I thought my last MRI would be pretty definitive but this technology is so new I think they are essentially learning as they go.
Posted 1/9/2016 1:36 AM (GMT 0)
I feel for you ToddW. I was in the same boat for a year... biopsies, cipro, biopsies, MRI all negative with PSA rising and PSA Free % going down to 5%. I finally went to Dr Duke Bahn in Ventura for a Color Doppler Ultrasound. He found the lesion hiding up in the transition zone near the apex. Would not be found by MRI. The Doppler Radar lights up the blood flow and was easy to see compared to the MRI. Glad he found it as it was a G9 hiding in there. My insurance at the time would not pay for it so I paid out of pocket and I am glad I did. I don't know if you are capable of a test like that but you can look him up on the internet. Again, I did that because of the rising PSA and dropping PSA Free%. Good luck. Keep us up to date. -JR
Posted 1/9/2016 12:16 PM (GMT 0)
Thank you for the information, CaliJR. I'm sorry that your results weren't better but I'm glad you took the bull by the horns and got the answers you needed. My MRI last year did show a suspicious lesion and that lesion was supposedly sampled in the biopsy but in any event my continually rising PSA numbers and falling free PSA is a big concern for me.

I will talk to my doctor about the color Doppler ultrasound if we get nowhere with the MRI (which is scheduled for the 20th)

I wish you all the very best with your treatment. Thank you again for the information.
Posted 1/10/2016 5:10 AM (GMT 0)
Todd
As maddening as it is, I commend you for staying on top of this. I hope there is another explanation for the rise in PSA, but since cancers in younger are usually aggressive, you are wise IMO to stay after it! Good luck, Todd.
Beth n Gary
Posted 1/10/2016 3:46 PM (GMT 0)
Thank you, Beth and Gary. I know my frustration is just a drop in the bucket compared to many people here and I also understand that this can be a long road. It's good, however to have to his place to express my fears and find wonderful support. I'm worried but know I'm in the best hands with my doctor at The Cleveland Clinic. I know he's doing the very best he can and so will I. Thank you for writing.
Posted 1/10/2016 8:42 PM (GMT 0)
Todd, good luck on the suspicious condition. I've learned how complex PC can be from this site. I learn something new with each posting. Cali's comment on Color Doppler Ultrasound usage to find what could not be found is eye opening.

Have you thought about the current non-intrusive gene/biomarker science being utilized for PC. There are several urine tests (PCA3, MiPS, etc.) that can identify PC cancer existence and in some cases the Type (Aggressive vs non-aggressive). Although not a 100% black & white, they can help when poking around (biopsy) fails to return a cancer detection for the PSA number. Couldn't hurt to ask your doc about them.
___________________________________________________________________________

OCTOBER 2015
Age: 59
PSA: 3.0 elevated to 3.5 in (6) months
3T-MRI: (1) lesion identified
Fusion Biopsy Results: Lesion cores benign, additional (12) cores = (1) positive, cancer <5%
Pathology Summary: Grade 1 (GS6:3+3), 2nd pathology verification
Cancer DNA Profile: DNA risk status unknown (cancer tissue to small to test, <1mm)
Clinical Stage: T1c
Other Health Conditions: Diabetes Type II (DX 2000), on meds & insulin

PC Treatment: "Active Surveillance"
Risk: Undetected Cancer Progression
Risk Likelihood: LOW

My Story: https://www.healingwell.com/community/default.aspx?f=35&m=3528051

Post Edited (NewDay) : 1/10/2016 2:23:02 PM (GMT-7)

Posted 1/10/2016 8:57 PM (GMT 0)
Thanks, NewDay. The PCA3 test was mentioned to me as a possibility on this forum between my last two biopsies......but I am always so grateful after getting a negative biopsy I just run like hell with the good news and enjoy the next six months. I'll be honest, the trajectory of both the PSA and the %free PSA has me a little spooked this time. And it apparently spooked my urologist enough to bring me in two months early for the MRI. I need to open up a dialogue with him after this MRI. I'm pretty worried this time and the back and forth is exhausting to me and my family. Thank you for taking the time to respond and for your suggestions.
Posted 1/10/2016 9:07 PM (GMT 0)
Hang in there guy. Remember, if you feel there is a risk, drive yourself to keep digging and turn every stone.

Catching PC early and identifying the Type for appropriate treatment, can and will save your life, don't deny yourself that chance.

A few biomarker links:
http://www.pca3.org/
http://www.mcancer.org/prostate-cancer/screening

Post Edited (NewDay) : 1/10/2016 2:18:29 PM (GMT-7)

Posted 1/10/2016 9:17 PM (GMT 0)
Thanks again. The MRI is on the 20th so I don't have long to wait. I'm curious to see if the lesion that was there last spring is still present. If that, or another, is there we do another biopsy. If not I'll feel much better but will still keep a close eye and suggest the PCA3
Posted 1/10/2016 10:39 PM (GMT 0)
How many samples were taken in '15?

If I was gonna poke again based on an MRI I'd want more than just a couple of pokes at a suspicious looking spot.

I think I'd want the whole gland tested again. I'd want 12.

Good luck.
Posted 1/10/2016 11:04 PM (GMT 0)
I believe they took 12 samples last spring. Three of the suspicious lesion and 9 in other areas of the prostate..

I'm fairly certain that, even with the MRI as guidance, the protocol is to sample the entire prostate in a biopsy following the MRI. Just to be as certain as possible.
Posted 1/11/2016 12:09 AM (GMT 0)
I can certainly understand your frustration, but I also don't think there's anything super-alarming here. (Caveat: I'm just some guy on the internet, not a doctor.) If I were you, I'd want to cycle through your options in the least invasive order you can. First, I'd want to retest the PSA since Jan 2016 is an outlier. Did your uro give you any antibiotics in case an infection was causing the spike? I do think the other PSA-type tests suggested can be good since PSA itself is not a great test for cancer.

BTW, do you have a family history of PC? I'm wondering since you had a biopsy at age 45 (which is somewhat young) with a PSA of only 2.6 (if I'm reading your history correctly). I'm wondering if there is an underlying issue that I'm missing.

Good luck to you--I know this can't be fun for you, but I also think there's a decent chance you keep coming back negative since there's nothing for them to find.
Posted 1/11/2016 1:05 AM (GMT 0)
The 3Tesla mpMRI with contrast dye is about 98 percent accurate in finding spots suspicious for PCa, and a targeted fusion biopsy using those images is your best bet at determining what your situation is.

Have the MRI, hopefully with those features, and the path report and any subsequent biopsy should answer your questions, and hopefully be negative for cancer.

If those tests are still not determinate...well, that's the world of Active Surveillance, and hoping and fearing while maybe, maybe not hearing bad news, at least not this year.
Posted 1/11/2016 1:31 AM (GMT 0)
98%... I'll bet not overall. Maybe for some guys who are really good at a relatively new technology...maybe
Posted 1/11/2016 1:52 AM (GMT 0)
To answer some of your questions.

I have been treated repeatedly with antibiotics with no effect on PSA numbers. The original 2.6 was biopsied by my first urologist because it was just above the cut off for my age. I do not have a family history of prostate cancer.

I have been seeing my current urologist every six months for the last two years. He checks both PSA and % free PSA each visit. The MRI guided biopsy done last year was done because of a suspicious lesion found on the MRI. It was the first MRI guided biopsy for the technician working the equipment and while my urologist was training her I wondered about the accuracy of the sampling during that procedure.

That said, I trust my urologist and have a good relationship with him....but I am just as glad not to have to see him for six months after every round of good news. I'm hopeful that this will likewise be a false alarm but I am trying to fortify myself with information and questions to ask him in any outcome. It makes me feel like I'm doing something to take control of a situation over which I feel like I have little control. You all are great. I appreciate all of your input.
Posted 1/11/2016 5:56 AM (GMT 0)
ToddW

I'm pretty much a newbie here (Robotic RP in November 15) but I'll share something with you that may help you ask some more useful questions.

I'm 69. After my PSA started creeping up (again) last Sept my Uro suggested an MRI. That was mainly because I told him I would be on an extended trip this year and away from Australia for 7 months.
When I said I'd have the MRI done locally he strongly urged me to have it at one of two places (near Brisbane) as the MRI Machinery is the latest and the operators had been specifically trained on PC detection, so that's what I did. They found a lesion and so I had a robotic/DaVinci perineal biopsy which confirmed PC (3+4).

The MRI results and imagery were used (accessed online I believe) to guide that robotic biopsy.

So, its my understanding but please validate this with your medical resources that :
1. there have been significant advances in MRI hardware and software within the last two years
2. that the results of such an MRI when used with robotic technology can increase the likelihood of an accurate biopsy.

That's my layman's understanding.

Good luck

Hugh
Posted 1/11/2016 1:29 PM (GMT 0)
Thank you, Hugh.....

My first MRI was done at the downtown Cleveland Clinic building and the biopsy (guided by the MRI images) was performed at a suburban satellite office. I was told by the nurse that they no longer do the fusion biopsies at the satellite office since my urologist was the only one using the equipment. They would do the biopsy itself at the main Cleveland Clinic building if they find anything on the MRI this time. I should have asked what that lesion might have been if it was not cancer since it was flagged as being suspicious the first time around (at least suspicious enough to warrant a biopsy). When a doctor tells you you don't have cancer though, the questions all fall out of your head and you're just so grateful.....until the next time you have to go through it. Thank you for your information. It's very helpful.
Posted 1/11/2016 3:28 PM (GMT 0)
LOL I hear you , Todd. Yes, no, maybe, I don't know, can you repeat the question? I'm in similar position
one year ago, PSA6.6..biopsy 3 of 12 G 3-3, > 5 % of sample. 3 months..PSA 8.0...uh oh...3 more months PSA 7,0 now what? I about ready to say screw it let's just do something. :) PSA coming up this week .I've got to learn that mindful thinking or this is going to put me in the nut house. :)
Posted 1/11/2016 5:28 PM (GMT 0)
Todd,
I know exactly how you feel as I was on the same roller coaster for 10 years, 13 biopsies with psa increasing every year to 40.
In my case the tumor was in a spot that couldn't be reached with a trans rectal biopsy, but was finally spotted by advanced imaging.
Since you already have had advanced imaging and since your psa is low there is a very high probability of not having cancer. A friend has a psa of 10 and has been seeing Dr Scholz in Marina Del Rey for years with no sign of cancer.
You are doing exactly what you should be doing with monitoring, some of the newer tests offered by Bostwick Labs could also help.
The two best MDs, Medical Detectives, are Dr Stephen Strum and Mark Scholz. A consult with either could shed some light on your issue.
Posted 1/11/2016 6:26 PM (GMT 0)
I think there are only a couple of places in the US where you can go for Color Doppler ultrasound of the prostate. IIRC, it is always out of pocket.

Marina Del Ray, CA - Duke Bahn, Mark Sholz, et al ( uncertain of how or if they are related)

Dattoli - Sarasota, Fla

Sperling NYC

If there are others, I can't recall them at the moment.

The 3T mp MRI I had a Duke came back with negative findings for cancer, but showed nodules that were consistent with previous prostatitis. ( I just looked but couldn't find report for actual wording.)

Cancer, by it's nature (my understanding, anyhow) increases blood flow to cancerous areas to feed the cancer. Increased blood flow to suspicious areas is a marker for cancer. When they put the contrast in during your MRI, it shows variations in blood flow (wording?)

That is what Color Doppler Ultrasound is also good at showing.

Also, a Tall poster here at HW that I greatly respect said he thought PCA3 a poor test.

If I were you, and were close to someone specializing in prostate Color Doppler Ultrasound, that would be a step I would take prior to a full mapping transperineal biopsy (saturation).

If the CDUS is clear, then I would only consider doing the mapping biopsy if PSA numbers increasingly worsen
Posted 1/12/2016 5:59 PM (GMT 0)
With all that many of you have been through with diagnosis and treatment (and waiting, waiting, waiting) I feel a bit silly for my worry. This is the only place to go for really sane, comprehensive information and support. It feels a little bit like screaming into the darkness but here people actually answer, and kindly. This is a terrifying process, you know that. I recently lost two people very close to me to cancer and they described it as the loneliest disease in the world because everyone has their own individual experience with it. My experience feels like just a scratch compared to many of you who have been through so much. What you all are for each other is remarkable and I thank you for your kindness in giving me some peace of mind and some very solid information. Please never stop doing what you are doing here. It is important. Thank you.

Todd
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