Anxious

Hi.

A year ago I challenged my GP on why I hadn't had a PSA yet. Where I come from (not Canada where I live) you'd be getting PSA tests by this age (45). Based on an enlarged prostate found under DRE, she humoured me and my PSA came back at 2.9 and free % 15%.

She didn't want to send me to a urologist because "anything under 4 is normal". I challenged her on that because I'd already read lots of urologist use a lower cut-off for my age. I won the battle and got shipped off to a urologist.

The urologist wanted to take a wait-and-see approach and ordered a PSA and free PSA test 1-year into the future. I've just done these tests and now have a PSA of 5.2 and a free % of 7%.

So, I'm a little anxious and don't see the urologist for a few weeks. Does this sound like anyone else's story to PCa?

Also, am I right in thinking that aggressive PCa is more likely in younger men? I am also right in thinking that treatment tends to be aggressive due to the potential to save life expectancy (versus someone older who might not die from having a tumour for a number of years).

Thanks in advance.

Doesn't the free % help filter out benign rather than cancerous outcome?

Geekything said...
Doesn't the free % help filter out benign rather than cancerous outcome?

It helps. It's better than PSA alone, but it's still not very good. Prostatitis and BPH still affect it. PHI is better, but its far from the screening tool we'd want. If you can't get PHI in Canada, you can take finasteride for a few months to see if that affects the PSA. If it keeps going up while on finasteride, it's a good sign that a biopsy is warranted.

I'd be anxious too in your shoes. At age 45 a PSA of 2.9 and free PSA of 15 warranted further consultation with a urologist. A year later your PSA has almost doubled and your free PSA is half; worrisome numbers for sure. The enlarged prostate determined by the GP could certainly be a contributing cause, as could prostatitis. I assume you haven't seen the Uro yet, only gotten the PSA results. When you do, ask about having a mp-MRI. More men are having one in cases like yours before having a blind biopsy. The MRI will give you an accurate measurement of your prostate, report any finding of prostatitis and, most importantly, determine if any cancer is seen that is worth doing a biopsy. If nothing is found on the MRI then you have more assurance that your condition is benign or caused by low level indolent cancer, not worth knowing and worrying about. If the radiologist thinks a biopsy is in order you'll get a fusion, targeted biopsy rather than random.

I will only tell you my experience......my case was a bit out of the ordinary. This is not intended to cause more anxiety although it probably will and I apologise if it does.
If you look at my signature you will see that my PSA was 3.42 with a %fPSA of 7.6. I am older than you and was Dx at 59yrs. My DRE was somewhat inconclusive as I had 3 different opinions from 3 Ds. My PCP thought he felt a hard ridge and firmness on one side. The other 2 weren't sure. All 3 drs thought that I was in the standard range and didn't think a biopsy was necessary. One dr. did state that if I wanted one, he would order it. After posting my situation here on HW I received many responses. I balanced those responses and more guys said they thought a biopsy was called for . Some said wait, others weren't sure. I decided to ask for the biopsy.

When I got to the appointment for the Bx, the uro that performs them in the group I see asked why I was having it done.... to him my PSA was normal. I persisted and he told me he would give me one if I wanted. (Like I was only there to experieince the thrill of it all) His words were" Ok.......if you want one...I'll give you one.
I will tell you ...I felt like most everyone thought I was crazy.

My Bx came back G9 with 8 of 12 cores cancer..... exactly 2 yrs ago yesterday.

So..... That is my story...... You are the one in charge of you health. You are the one that must be your advocate.
I followed my gut. I did research and asked a lot of questions.

So here you are, in much the same boat I found myself in. I can't and won't tell you what you should do about getting a biopsy. You now know a bit about my expereince .........take from it what you will.


I will tell you.....Stay on this. Take what suggestions that have already been given and those that will follow. Be your own Advocate.


I wish you the best going forward. It might be something very minor but you want to be sure.


Battle On Brothers!


The Artistic One - Mark

Am I right in thinking that my good bloodwork, lack of white cells in my urine, and lack of culture of my urine start to rule out prostatitis? Is the next step massage (boy am I not looking forward to that) and possibly imaging?

Saw my urologist this morning. Given my age, he is quite concerned about the latest PSA levels, especially that my free PSA % has halved in a year and my total PSA has more-or-less doubled. He acknowledged my prostate was slightly enlarged.

He said best case scenario is this is a "blip" and that I could go back to the vicinity of my last total PSA of 2.9 (still outside the reference range for my age) and then he'd definitely be less concerned.

I have my biopsy on August 15th. He explained the risks in detail (gave me stats). It was refreshing to have a doctor not downplay the risks of a procedure.

Artist Mark said...
Thanks for the update. Keep moving forward and keep us up to date on the Biopsy.
For me the Bx was uncomfortable and not painful after the first needle poke to numb things. Didn't last very long and I didn't have any issues following aside from the blood in urine and semen that didn't last past the first day and the first ejaculation.

I am really not looking forward to the Bx. Dumb question, the anesthetic goes into the prostate?

Am I being over anxious taking a pair of adult diapers for afterwards?

You should ask for a "periprostatic nerve block" or a "pelvic plexus nerve block." The anesthetic is injected into specific nerves that your doctor can find using the ultrasound probe. They will block all sensation in the prostate, and leave you awake and alert.

You may see some blood spots in your poop and in your urine at first, but that should disappear quickly. You will have blood in your semen for several weeks. It looks scarier than it is. You won't need diapers at all - who told you that?

Maybe you will observe some blood in the bathroom activities for a few days, but not in your clothes. In the rare case you observe significant rectal bleeding look for inmediate medical assistance. Semen will show strange and variable colors for as long as a month. Nothing permanent to be sure. Above all, you will need urgent medical help if you have moderate or high fever a few days after, but this is also rare. Usually, a prostate biopsy is not such a big event as most people fear and it does not require important adjustments in your daily activities.

The rectal bleeding, if any, is minuscule, and is nothing to worry about. I never had any myself, and I had 3 biopsies.

convertible68 is right.

I too had a couple ejaculations that looked like a cheap ketchup and lots of it! They didn't concern me at all but I did 'enjoy' the experience! The next few looked like a cheap chocolate milk like liquid.

I took my cipro as instructed but failed with delivering the morning enema. Having had a BM a couple hours before, I had no ill effects. I was however very concerned about the entire procedure beforehand.

Afterwards, I did have cramping for a few hours after the biopsy but after a walk that quickly dissipated.

While having the wife along is great for moral support, do not for a minute believe that this will be anything but a quick, annoying few minutes. After my biopsy, I took my wife out to lunch, then went back to work for the afternoon. With the proper nerve block, as TA mentions, it is a big non-issue.

One thing to ask your uro about -- mine routinely does a rectal swab a week or so in advance of the procedure. Lab analysis of the swab allows them to know if your body harbors any (benign) critters that would be immune to the Cipro. If you do (as I did) have any Cipro-resistant bacteria in your system, they can give you a supplemental shot of an appropriate antibiotic.

Just an anecdote - I had that antibiotic shot a couple of days before my biopsy, and the shot hurt worse than the biopsy itself did.

Hang in there. The biopsy is just something that has to be done to get the answers we need.