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Upcoming biopsy on 7.2 PSA count

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Posted 3/30/2018 6:38 AM (GMT 0)
Hello out there, my name is Doug and I'm worried like hell about my upcoming biopsy this coming Monday afternoon. I'm 76 years of age, and have a history of a long survival rate in my family and therefore the procedure is being conducted. Had a biopsy when I was 70 when PSA count was about 3.6 and everything was benign. This higher count in this short of time has me worried.

Of course I am hoping for the better, and can excuse myself out of this club. But just would like to hear some reassuring words from survivors of prostate cancer, and what procedures had been done to prolong your longevity.

Someone had told me that if it is cancerous, to stay away from the 'seed' procedure, whatever that is. I'll be looking forward to anybody who writes back to me. Thanks in advance for your support. ------ Doug W
Posted 3/30/2018 9:38 AM (GMT 0)
Doug stay with what you know, you have a psa of 7.2 period. Even if you have to join the club there are many treatments that the 15-year survival rate is >90%. Many things cause PSA to rise, so you just have to wait and see. Hang in there. Denis
Posted 3/30/2018 1:18 PM (GMT 0)
Hi Doug. I'm guessing about 99% of men in their 70s and 80s have prostate cancer to some degree. Depending on the velocity of your PSA (the rate of increase), you might not need to do anything. If you do have some aggressive cancer cells for this biopsy you are probably a better radiation candidate based on your age than surgery.

Radiation can basically be two types - you lie on a platform and a machine irradiates your pelvic area or radioactive 'seeds' are inserted in the prostate area. This is called brachytherapy. This is an oversimplification but is gives you the basic idea.

And of course, PSA isn't an indicator of prostate cancer.
Posted 3/30/2018 2:21 PM (GMT 0)
Doug:

Even if the biopsy is positive, you may qualify for Active Surveillance, because many prostate cancers are slow growing and not in any way life threatening. If you qualify for that, while you may need some future MRIs and/or biopsies, you won't need any treatment such as surgery or radiation.
Posted 3/30/2018 2:27 PM (GMT 0)
Hello Doug and welcome. First of all, good luck on the biopsy. Hopefully it will show nothing and your stay with us will be brief. That PSA count is not terribly high especially if you have an enlarged prostate or an infection.

In any case, there are lots of options for cure even if you get diagnosed. And don't be too swayed by "someone" who told you to stay away from seeds. That might be a good option for you depending on your diagnosis, prostate size, personal wishes, etc. But we are getting ahead of ourselves...if you do have cancer we can and will help you get through this. There are LOTS of knowledgeable folks here you can provide you with great advice.

Jim
Posted 3/30/2018 5:51 PM (GMT 0)
Welcome Doug.
First, yup, you may have prostate cancer. But you may not. It could just be an enlarged prostate, common in men in their 70's. Or it could be prostatitis.
So don't jump to conclusions.

Second, even if you do have pc, the odds at age 76, that you'll die of it, are slim. To none.
So don't jump offa bridge

Hang in there, and stick around. We've all been there, it will be fine either way

Finally, check out this chart for age adjusted PSA normal ranges. Yeah, you PSA is a little high, but not as far out of the normal range as you might think....

PSA levels chart
Age-Specific Reference Ranges for Serum PSA
Age Range (Years) Asian Americans African Americans Caucasians
40 to 49 0 to 2.0 ng/mL 0 to 2.0 ng/mL 0 to 2.5 ng/mL
50 to 59 0 to 3.0 ng/mL 0 to 4.0 ng/mL 0 to 3.5 ng/mL
60 to 69 0 to 4.0 ng/mL 0 to 4.5 ng/mL 0 to 4.5 ng/mL
70 to 79 0 to 5.0 ng/mL. 0 to 5.5 ng/mL 0 to 6 ng/mL
Posted 3/30/2018 10:43 PM (GMT 0)
Ditto Prato, Doug...

That's been a while since your last biopsy. Doesn't mean a thing as far as agressiveness goes....and that's even if ya got it.
Posted 4/2/2018 5:30 PM (GMT 0)
Thanks to all who responded. I have 4 hours to go until the procedure. But, first off comes the enema, 1 1/2 hours until the fleet comes in. The wife said that she doesn't care to assist me, so I'm on my own. I feel like a pervert sticking something up my behind, especially knowing someone (wife) is in the other room knowing what is going on. Oh well, I wish that was all I had to worry about. Thankfully it's beautiful weather here in Arizona, maybe that will calm me down. For those who are interested, I'll share the results of the biopsy, once I hear back from my doctor (Dr. Amy Schlaiffer).

Post Edited (DougW) : 4/2/2018 11:38:08 AM (GMT-6)

Posted 4/2/2018 6:03 PM (GMT 0)
The whole biopsy process is annoying and undignified. Most tolerate the procedure just fine.

Keep us updated on your progress and we'll have lots of things to say about your results (some might even be helpful ;) ).

Hang in there,
Andrew
Posted 4/12/2018 9:35 PM (GMT 0)
DougW.....I read this thread with interest and have been watching to see the results of your biopsy. Surely, since your biopsy was on April 2, you have the results??? Considering your angst that comes through loud and clear in this thread, I hope you will avail yourself of information from the wealth of experience and knowledge of the members here. If you do nothing beyond reading and developing a broader perspective about whatever it is that you might be facing, you will be the better for it and will be better prepared to advocate for yourself. I wish you the best.
Posted 4/17/2018 12:37 AM (GMT 0)
Strange that they had me wait two weeks before they brought me back in. Well, it wasn't good news, but I guess they could have told me worse news like it was a fast moving cancer. I don't understand all the jibberish that goes with the diagnostix. All that I mainly am concern about is where it reads Right Apex: ADENOCARCINOMA; Gleason Score 7 (4+3); Grade Group3: 20% 2 of 3 cores involved. Right Mid: ADENOCARCINOMA; Gleason Score 6 (3+3); Grade Group 1; 85% of the needle core tissue involved by tumor; 1 of 2 cores involved.

Everything else of the 16 biopsy samples they took is benign. She gave me a lot of options from taking castasterone pills and injections, surgery, radiation, and periodic check ups to where they keep track of it and occasionally take more biopsies. I am to see her again in three weeks to give her my decision. I thought at first about the surgery which actually is robotic prostatectomy done through a machine where they enter in several places in the stomach to remove the cancer. She talked me out of that. Then I thought about the castaterone pills, and she said that the side effects are not pleasing with hot flashes, weight gain, and mood swings. My wife asked her, "If this was your father or grandfather what would you suggest?" The doctor replied, "I would have him do radiation." I have paperwork in which to see a radiologist to see what he has to say.

In the meantime I am asking all those out there what they think I should do. Again, I have three weeks in which I am to report back to my urologist, Dr. Amy Schlaiffer. I have a history of longevity in my family and would love to live another 15 years plus, with my aunt living to 96, uncle to 98, and great grandfather to 104. I feel a lot younger than the 76 years that i've aged.
Posted 4/17/2018 12:59 AM (GMT 0)
Hi Doug and so sorry to hear about your diagnosis. That said, with a diagnosis like yours you have every chance of doing well. It sounds like your uro has broken your options into 1) surgery, 2) radiation, 3) ADT (cutting off your testosterone) and 4) Active Surveillance, in which you're monitored instead of being actively treated.

Typically, you wouldn't have AS with a Gleason score of 4+3, but it would be worth your while to get a second opinion on your biopsy slides to make sure that the score is really 4+3. If it were to be downgraded to 3+3, your risk level would be pretty low and that might be a possibility. It's unlikely, but worth a shot since it's the only treatment without side effects.

ADT would mean "controlling" your PCa, as opposed to "curing" it. Given your goal of another 15 years, plus the side effects that she mentioned, that may not be what you want to do. At age 76, you'd be pushing the upper age limits for surgery, although it would be a possibility. Still, it sounds like she talked you out of that route.

That leaves you with radiation. There are several types of radiation and you might have to talk to a several different radiation oncologists for each type. Sometimes for more aggressive cancers, they use ADT in conjunction with the radiation. That's another good reason to get the second opinion on your biopsy slides to make sure you know what you're dealing with.

Also, you have lots of time to make a decision. Your next appointment may be in three weeks, but you certainly don't have to decide what to do by then. I suggest you spend the time up until then trying to get as smart as you can about PCa and your options. Hopefully we can help with that!
Posted 4/17/2018 1:13 AM (GMT 0)
Thanks for your reply, Michael. Just hearing the news only a couple of hours ago, I am still a little shaken and as you mentioned; I have plenty of time to weigh all the options. I'll keep all of you posted as to my decision. Right now I'm just going to sit and absorb. ~ Doug
Posted 4/17/2018 1:56 AM (GMT 0)
Take some time to adjust and let your emotions cool a bit. Then learn all you can about this.

Radiation is a good choice. You've got a choice of Brachy or beam. SBRT is a current beam method that seems to be working well with fewer side effects. HDR Brachy is getting good reports too.

Get a referral to a good RO and see what they say.

The good news is your case is very treatable with every chance for a cure.

Andrew
Posted 4/17/2018 2:58 AM (GMT 0)
Hi DougW-

I'm sorry to hear this diagnosis, but hopefully it can be cured.

One of the worst questions to ask a doctor is what he would do if it was him (or his father). This is a decision that only you can make for yourself. No other person in the world can do the self-assessment to decide this. Surgery is not necessarily off the table, but depends on what comorbidities you may have. But I agree that because side effects increase with age, it may not be your best option. Hormone therapy for the rest of your life is certainly an option, especially if you are diabetic or have heart disease. Please fill in the following - it will tell you the probability that prostate cancer will kill you in 15 years if you do absolutely nothing:

/webcore.mskcc.org/survey/surveyform.aspx?&preview=true&excelsurveylistid=4

You are near Phoenix, right? Maybe you can see John Kresl at the Phoenix CyberKnife Center. I don't really know who offers either kind of brachytherapy in the area.
Posted 4/17/2018 12:08 PM (GMT 0)
Doug if you are in the Phoenix area you could also check out the Mayo Clinic System they have a pretty good reputation and I sure appreciated the team approach they take


Larry
Posted 4/17/2018 2:23 PM (GMT 0)
Hey DougW.....Sorry for your diagnosis and that you have the misfortune of joining all of us here because of it. However, you have options to study and time to make an informed decision with your unique set of circumstances. Each case is unique but there are always many similarities with other folks and I would simply urge you to read extensively from the posts in this forum to learn about the process that others have chosen and how all has worked out for them before making any decision for yourself. Many of the guys here are significantly younger than you but not all. I will be 71 in four months and I was treated last July. Treatment choices do vary at least to some degree dependent upon age. The most critical issue in my opinion at this juncture for a person in your situation and at your age is to make sure you are familiar with the benefits and drawbacks (side effects) of all viable treatments for you and how each might impact your life going forward. One thing I learned early on is that treatment specialists tend to push their specialty and generally don't have a high degree of expertise outside that specialty. That means it is necessary to discuss treatment with a number of different physicians in order to get the best information out there. Also, if you have the ability, it might be worthwhile for you to travel for access to a particular Dr. that you are comfortable with for such an important process. You are your most important advocate and finding a good fit with a Dr. is crucial for you. Don't be hesitant to critically assess a Dr. and their staff. For example, the Dr. that I selected (recommended by TA here) was 250 miles from me but after meeting with her and her staff, I would have traveled cross country to be treated by her and her team. Developing that confidence early on gave me the peace of mind going through all the testing and subsequent treatment, that I was doing the right thing for me, no matter the end result. Ultimately, only you can decide what is best for you. Do your homework and then proceed with clarity that with your diagnosis, there is a substantial likelihood for cure with reasonably minor life altering side effects. I wish you the best in whatever you choose to do.
Posted 4/17/2018 3:00 PM (GMT 0)
Thanks to all for their support and interests. I certainly have a lot of options to choose. I still have one biopsy to wait on and that is the DNA testing where they took samples from my cheeks on the inside of my mouth. The Dr. said that these results may take up to 3 weeks, so I only have another week to wait on that. According to her, this will tell me if any of the cancer cells have spread to the lymph nodes or other organs. I am optimistic that all is well with that.

The two options that I am most leaning toward are Robotic Radiosurgery System such as Cyberknife or the castasterone pills. The latter side effects worry me a bit. Not worried about mood swings, hot flashes, low energy, or weight gain. But, I was wondering if this will effect other parts of my body. My man-boobs are already large enough and don't care to add any increase. So if somebody out their can tell me if this is one of the side effects, I would appreciate it.

Perhaps I could do the pills and if the side effects are not to my liking then I can switch to the radiosurgery. What I really need to do is see what my insurance will cover. I am with CIGNA who only has operations in Maricopa County in the Phoenix area. I live 40 miles out of that county and travel into the Phoenix area as is for any of my medical issues.

As mentioned, I am open to all options and wish to hear from as many people as possible with similar issues. Thanks once again ~ Doug
Posted 4/17/2018 6:14 PM (GMT 0)
I assume you mean Casodex. Yes, gynecomastia is one of its most common side effects, but it is easily preventable if you take 10 mg tamoxifen every day with it.

What did the nomogram tell you?
Posted 4/18/2018 2:48 AM (GMT 0)
Hi Allen, I wish I new what is meant by a nomogram; completely in the fog. As mentioned in one of my previous blogs, my PSA was 7.2 and had a reading of 4+3 (7) in my right apex 20% and 3+3 (6) in my mid-right apex 85%. I don't know all the diagnostix readings and what is most tangible as far as what is asked by members of this club, but would be more than obliged to provide if given more info on what to look for on my paperwork.
Posted 4/18/2018 7:14 AM (GMT 0)
I gave you the link to it in my previous post. Just click on it and answer the questions:

/webcore.mskcc.org/survey/surveyform.aspx?&preview=true&excelsurveylistid=4
Posted 4/18/2018 10:32 AM (GMT 0)
Yeah, I clicked on that WebCore website and took the test. I showed that in 10 years with my prostate cancer and other health issues (which I have little of), 7 out of 100 people will die of prostate cancer within 10 years. 54 out of 100 would die of other illnesses. This leaves the other 39 to live beyond 10 years. At 15 years it decreased to only 11 out of 100 would live those additional years. The other factors as far as dying of prostate cancer or other illnesses; who cares at that point just knowing the odds already of living another 15 years. And that is what I am pushing for at my current age.

Of course, all this can change once I hear back from my urologist on the results of my DNA swabbing. Naturally, I hope it is negative and am constantly in prayer that this is the case.

I noticed at the bottom od everybody's blog, are the results of their testings, dates, plus age at that time. How does one enter that info so it shows up each time you wish to post a message?
Posted 4/18/2018 3:09 PM (GMT 0)
There may be an easier way Doug but just click on your name.. Member profile appears. Click on "my profile". Then click on "edit profile". At the bottom is a box called "signature". Fill in all the info you want in that space and click "update". From then on the info will appear at the bottom of your posts. Be aware there are character limitations.
Posted 4/18/2018 7:04 PM (GMT 0)
It's from Memorial Sloan Kettering. So does knowing that you have a 7% chance of dying of PC in the next ten years if you do nothing to treat it (and probably similar for 15 years) make you want to give up on pursuing curative treatment, or does it make you want to take a shot at that extra 7%? Only you can decide.
Posted 4/19/2018 2:22 PM (GMT 0)
After going back and reading a lot of the personal blogs in healingwell, I consider myself very fortunate in finding my cancer at an early stage. So many people in here that are much younger than I am and who have much worst conditions: I can only say that my heart goes out to them. And, they are the ones trying to console me. I feel truly blessed to know a group like this who care, when they are the ones who really need prayers. Thanks again to all those in this club, I feel rejoiced but somewhat shameful for excepting others offerings.
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