Looking for feedback.

Hello. I'm hoping for some feedback from those with experience.

I'm a 40 years old. I was diagnosed with bph 4 years ago, having a 6cm enlarged prostate at the time. I have been on finasteride since that time. I have had several psa tests, most showing a range of 0.3 to 0.7 raw score. So doubled due to finasteride 0.6 to 1.4. Additionally, my father died from prostate cancer in his mid 50s and I have a history of exposure to radiation.

My most recent psa came back at 3.11 in March 2017. The previous was 0.37 in July 2015. Doubled due to finasteride 6.22 March 2017 0.74 July 2015.

My current primary care is through the VA. My primary care doc didn't even mention the latest result to me, I'm guessing because they are a Nurse Practitioner, who's typical patient is over the age of 60.

Currently I'm looking to schedule an appointment with a civilian urologist.

I'm obviously concerned that my psa has gone up nearly tenfold in less than 2 years. Especially given my history.

It has been nearly impossible to locate any reference ranges for people my age. As I know it is fairly rare to have prostate cancer at my age. But, over the past year, my urinary problems have worsened, and I've maintained an elevated sed rate(which I know is an unspecific indicator of inflammation), and extreme fatigue. However, when looking at the evidence and my history I'm a little scared to be honest.

Am I doing the right thing searching out an independent urologist? Or, am I overreacting?

First, PC rarely has symptoms at your age or PSA number. The urinary problems are more likely due to the BPH. I don't know much about radiation exposure affecting the prostate - possible, but I've not heard of that (other body parts would make more sense to me, but I'm not an expert).

Still, it's possible as Todd points out.

Getting an eval outside the VA is good and likely you'll get better information. In any case a second opinion is always the right thing to do. It is a little scary - especially with family history.

Even if the worst is true, the good news will be that you caught it early and have plenty of treatment options and every reason to expect a good outcome.

Get to that URO and find someone who will take the time needed to figure out what's going on.
Andrew

You should have results back within about a week.
Side effects: dull ache in the area of the prostate, blood in your semen and perhaps in your urine. These will go away relatively soon.
Some guys request tranquilizers or being put into "twilight" for the procedure. Depends on your pain tolerance and anxiety level.
For me, it wasn't a big deal.
Take care and good luck through the process

I agree with the above. The anticipation of the biopsy was much worse than the procedure. I was given a local and it was uncomfortable but pain free. I had my results in a few days.

Good to see you found a doc at the VA that is helping you.

Hi, Zom - I'm happy to meet you, but sorry you had to come here to find us. From your mention of the VA, I presume you're a veteran. In that case, thank you very much for your service to our country. I've known quite a few folks who received their medical care through the VA, and I am glad that it is there for you. (This is NOT a political comment. My daughter used to work in the VA hospital system. It thrills me to see the younger generation feel so much support for their elders.)

Anyway, a few comments about biopsy. I feared my prostate biopsy more than I did open-heart surgery. I don't know why, but I do know I was totally wrong in that fear. One thing to ask the urologist for is a complete nerve-block for the procedure. To do this, they inject lidocaine directly into the nerves in the prostate. It sounds gruesome, but you hardly feel the two little tiny needles, but after that you only hear the biopsy tool, you don't feel it. My biopsy took all of 15 minutes, and right afterward I took my wife out for lunch. I did have some "full" feeling in the perineal area for a day or so, but I had no blood in my urine or stool. I did have the "slasher-movie semen" for a month or 6 weeks. A little bit of blood in your semen will look like you've been slashed from stem to stern, but you won't feel any different, and it will pass.

If all is well with your biopsy and your PSA rise is due to other factors, another procedure to look into for urinary issues may be the Urolift. This is a device that is inserted into the prostate that widens the path for the urethra through the prostate, reducing the obstruction to urination. I see posters for the device in my uro's office, but I have no idea if the VA can offer it.

At any rate, please don't panic and rush to the OR for prostatectomy. Get your biopsy results, then research what they mean. Come on back here and tell us about it. There may be multiple options for you, depending upon what, if any, cancer shows in the report.

Biopsy done today. Results in a week.
I will likely require another biopsy though. They only got 5 cores. They got all the cores on right, but only 1 on left and stopped because my blood pressure dropped to 80/40. I've been on finasteride for over 4 years and my prostate is still big. So I guess that why they wanted more cores.
They still sent it to the lab and told me if it comes back positive then I may be able to just start treatment. But, if it's negative, they will do another biopsy, but under general anesthesia so I can be more closely monitored.
It was my understanding that I will need another biopsy regardless since they need samples from all over the prostate to properly stage it. Maybe you guys with more experience would know about that?
Anyway I'll update in about a week. Thanks for all the info you guys share on the board here.

How many cores did they plan to sample? In recent years, 12 has been the standard, with up to 4 additional if they are doing an MRI fusion biopsy.

You should ask why they were planning to take less than 12 cores, especially if you have a large prostate. The more of your prostate that is sampled, the better confidence you can have in the pathology report.