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Prostate Cancer
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Posted 10/25/2016 6:13 PM (GMT 0)
This is my first post. I am 72, in generally good health except for CLL (stage zero after 5 years, and spinal stenosis). I eat well, work out/swim twice a week. Father died of PC at 59 in 1963. I have no symptoms of prostate problems. A routine PSA test by my primary care physician showed an increase from 3.86 (June 2015) to 4.62 (June 2016) using the same lab. I was referred to a urologist who performed a DRE. He said my prostate was slightly enlarged, and that an increase of 0.3 in the next PSA test would require a 15 needle transrectal biopsy. He took umbrage at my request for an MRI and/or ultrsound before having a biopsy. I will have another PSA on November 16 when I normally get blood tests for CLL from my oncologist.
Needless to say I have been very anxious about the various diagnostic options and treatments after reading several articles about the unreliability of the PSA as well as the horrific side effects of most treatments.
I am hoping that some of the readers will help me with the following:
1. Is taking Pomi-T effective in lowering PSA or does that just mask the problem?
2. What diagnostic options are available before a transrectal biopsy?
3 .Would a transperineal biopsy prove to be a better option that transrectal?
4. Can anyone provide information about the 3T Multi-Parametric MRI-Blue Laser and the MRI-Fusion?
Posted 10/25/2016 6:49 PM (GMT 0)
I agree with your doctor that an MRI is unneccessary before a first biopsy. about 2/3 of first biopsies are negative anyway, and there is no data demonstrating its usefulness before a first biopsy.

There is a biochemical test called the prostate health index (PHI) that may save you an unnecessary biopsy. You can ask your urologist to order for you at this link:

/www.accureference.com/phi/

Just how big is your prostate? If it is enlarged enough, that may explain your elevated PSA. Did you ask your doctor about Proscar or Avodart? If you take that for several months and it reduces your PSA and your PSA stops rising, that may be all you need. If your PSA doesn't go down while on it, or goes down but rises again, a biopsy is certainly necessary.

A transperineal mapping biopsy would have greater accuracy than a TRUS biopsy, but again, it is a more drastic measure that is only necessary if suspicion remains after a first negative biopsy.
Posted 10/26/2016 1:52 AM (GMT 0)
Welcome to HW.

I can't add much to what Allen said - just wanted to say welcome.

Andrew
Posted 10/26/2016 4:16 AM (GMT 0)
Just adding my welcome and that Allen has a very good read on your next steps. Good luck to you and please keep reporting in.
Posted 10/26/2016 4:52 AM (GMT 0)
Your next step is to do nothing other than continue your fitness regimen...even increase it and enjoy life...there is nothing there...there...I wish you the best...
Posted 10/26/2016 10:55 AM (GMT 0)
Hi, pleased to meet you.

A couple of things here...1) Get the biopsy, but make sure they knock you out for it.

The first uro I went to didn't believe in such things, figured I should just 'man up' and tolerate the pain as he fished around with his implement for 45 minutes. Right until I started to pass out........and he started squealing for the nurse to try and pat my hand and talk at me to keep me conscious. "Quack". I had to pass on a repeat with that idiot.

Second uro knocked me out. No fun to wake up to, but much less painful, though I had to have my son drive me home.

2) The side effects from any and all of the treatments I have experienced thus far are nothing compared to dying of full blown stage 4 metastatic cancer, at least as far as I can tell from here.

3) The equation always balances, there is always a cost to the benefit, there are always some side effects, there is always fear and pain - even if you are not ill and do nothing at all. The trick is not to let your fear prevent you from doing what is necessary.
Posted 10/26/2016 1:33 PM (GMT 0)
Thanks Tall Allen, InTheShop, Michael_T, Bololidat, and Trailguy for your advice and support. You have made me feel welcome and given me a lot to think about. Alex31
Posted 10/26/2016 1:45 PM (GMT 0)
One thing, Alex - Not all of us have trailguy's experience with the biopsy. I was extremely stressed about mine (can you spell terrified?). I discussed it with my uro and he told me that he always uses a complete prostate nerve block for pain. The worst pain was the two injections of lidocaine he did, and that was just a normal injection in an unusual spot. Once that took effect, the 12-core biopsy felt like some tool was tapping me inside 12 times. There was literally no pain after, either. I went out to lunch with my wife. Very little discomfort after, too. No lost time at work or other activities.

Just be aware that there can be some minor bleeding after - in your urine or semen, or with bowel movements. Just scary to see, no danger. For me, the biggest pain in the entire procedure was the supplemental antibiotic injection I got a few days in advance, to go along with the cipro.

Just ask your urologist if he can use a nerve block. If he says "No" I would find another uro.
Posted 10/26/2016 3:45 PM (GMT 0)
Thanks Paxton. I am terrified too. Need to find great urologist on Long Island. Any suggestions?
Posted 10/26/2016 5:32 PM (GMT 0)
I can't offer any suggestions - I'm near Chicago. I'm sure others around here can help, though.

Note, too, that my biopsy was transrectal. I learned at a support group meeting last evening that one of the local centers here does transperineal biopsies under general anesthesia. They do this because their biopsy scheme takes up to 40 cores for complete saturation. I'm not sure how other centers do "common" transperineal biopsies, but I could see from the presentation yesterday that there are areas of the prostate that the transrectal biopsy needles cannot reach, thus they do the transperineal route when they suspect occult cancer that wasn't found via transrectal.
Posted 10/26/2016 9:47 PM (GMT 0)
Most of the time, the standard TRUS (Trans rectal ultrasound) biopsy is done with local numbing. It's unpleasant, to be sure. In a small percentage of cases, there are problems. For me, the worst part was the ultrasound probe...did he lubricate it?

To answer your question about supplements (and we've had this conversation in here often):

Some supplements will lower PSA (saw palmetto is a biggie) and can have some effect on BPH (benign prostate hyperplasia)..old man prostate swelling. There is no evidence out there that any of them have an effect on cancer. None. You're right, they can mask cancer because they keep the PSA lower than it might otherwise be. My Uro told me to double my PSA reading because of the saw palmetto I was on.

Thing is, at 72, you're likely to have measurable prostate cancer. It's just how it is. If it's low grade, then the most likely scenario is that you'll go on watchful waiting and see if it does anything. At your age, that's again the most common scenario.

Best of luck to you.
Posted 10/26/2016 11:47 PM (GMT 0)
I had a transperineal biopsy under general anaesthetic. It was pain free and provided a complete mapping of the prostate. It is regarded as the gold standard for this type of biopsy. Also it has greatly reduced likelihood of infection.

I would highly recommend it.
Posted 10/27/2016 3:06 AM (GMT 0)
Transracial is no joke. I got some cream and two shots that wore off in the middle of the brutal sample testing. Anything other than that preparation would be to your benefit.
Posted 10/27/2016 4:35 PM (GMT 0)
My experience is that the biopsy determined that I had prostate cancer and the URO ordered an MRI as soon as possible. The doctor who did the MRI told me that he could not see anything within the gland since it was full of blood resulting from the biopsy. He just found two affected lymph nodes. A PSMA PET/MRI found two additonal ones later.

Therefore either do the MRI before the biopsy or over two months later.

Provided the cost is of no concern I think the gold standard should be:

a) MRI of the prostate and pelvis (to look for affected lymph nodes)
b) have a PI-RADS evalution of the MRI result
c) if the PI-RADS score is greater than two make the biopsy
d) have a transperineal biopsy under general anaesthetic to avoid infections and pain
e) the needles should be placed into the areas within the gland that looked suspious on the MRI and not according to the standard template.

If the doctors cannot determine cancer after this, you can rely on having none. Chances that they missed it are extremely low.

George
Posted 11/10/2016 5:54 PM (GMT 0)
I just started taking Zyflamend Prostate (just one capsule a day) after reading The Definitive Guide to Prostate Cancer by Dr. Aaron Katz. My PSA score is 4.62, up from 3.86 a year ago. I will retake the PSA test at the end of this month. Any thoughts on the efficacy or downside of Zyflamend?
Thanks.
Alex 131
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