Some kind of journey

I found you guys by accident and the advice has been very rational and calming. I am 57, and went to the MD in July for an unrelated issue. They were "selling" various tests and I asked for a PSA. I told them my Dad had an advanced PC case found by accident @67 which he has been battling for 20 years. He had proton beam. My results came back at 3.0 I got a letter saying it was a bit high and come back in one year. Around December starting having BPH type symptions - slower stream mostly off and on. I drink 2 pots of weak black tea- read the Scottish study :( switched to weak coffee. A co worker, tea guy also, died of PC recently. Anyhow went back in early Feb for another PSA- 4.51. My MD called and they said get in quickly to the Urologist. DRE was negative, she said that was reassuring but was otherwise totally deadpan. She said you need a 12 core biopsy in a month which has given me ample time to read journal articles. I am at a loss for what to expect. I have had a bit of mild bilateral hip pain for two years which resolves with stretching before a walk.

7/15 PSA 3.0
12/15 BPH symptoms
2/15 PSA 4.51, negative DRE
3/15 12 core biopsy scheduled

Norsk, the biopsy isn't that bad. They'll probably give you some Cipro to take the night before and the morning of, and will have you do an enema to clean things out. The day of, they'll give you another shot of antibiotic in the butt, then you'll have the biopsy. It's unpleasant...they stick an ultrasound probe up your butt to image things, then they take a needle gun and take the samples.

You'll bleed a little from your butt, you'll pass some clots and blood in your urine for a while, and your semen will be reddish/black for a month or so. That's about it. Do what they tell you to do to keep things clean, and you'll be fine. Usually the results take about a week.

When you get them, let us know and we'll help interpret them.

Thanks everybody. This was helpful.

Went for the ultrasound guided biopsy today. Not bad. Friendly folks. She said mine was 43cc, so "matched the model perfectly" and was smiling. She saw nothing interesting on her new hi def screen. Nobody is saying anything yet but the body language was encouraging. Results in a week.

Post Edited (Norsk11) : 3/17/2016 5:36:50 AM (GMT-6)

Got the biopsy results- all normal. She wants me back in 6 months for another PSA. She says they are getting a new MRI device of some kind. If my PSA stays steady I am likely OK if it goes up they have to keep hunting.

After smiling at the slogan out here that a falling PSA (esp. ~4) is usually not cancer away I went. The annual biometric exercise at work led me back to the lab for cholesterol tests so added in a PSA. It was 4.1. Moments after reading the results online the Urologist's office called. They said I needed a MRI prostate scan- they have a shiny new piece of equipment. The last time they got excited about "PSA velocity" this time it was a "slow steady PSA rise" - sigh. Is PCa in my future- yep. Is this the day- I think not- my numbers match an enlarged prostate /BPH case nicely. I think I would not be happy with another needle biopsy but this new kind seems expensive but not dangerous.

7/15 PSA 3.0
12/15 BPH symptoms
2/16 PSA 4.51, negative DRE
3/16 12 core biopsy - negative, ultrasound clear, 43 cc
5/16 PSA 2.99
9/16 PSA 3.2, Negative DRE
9/17 PSA 4.1 BPH symptoms

Post Edited (Norsk11) : 9/19/2017 5:03:56 AM (GMT-6)

Norsk-

If you don't want to commit to an mpMRI/US fusion biopsy yet, you can get a Prostate Health Index (PHI) blood test and a PCA3 urine test. Both should be covered by insurance after a first negative biopsy. They are somewhat more prognostic than just a PSA test.

Veldig bra. Utmerket.

Pohaku53 highlights an important point...I probably assumed you understood your mpMRI results already, but whether you do or not, it probably is worth repeating/highlighting because there will undoubtedly be others who stumble across this thread in the future who might misinterpret. He's a more complete answer...


Hey, at age 58 (?right), you probably do* have some prostate cancer...despite the negative biopsy you had last year (2016). Your mpMRI is specifically intended to look only for possible areas of high-grade prostate cancer—the type that might actually warrant an aggressive treatment. Having low-grade PC is not really very newsworthy. The wonderful news from your report was in the last sentence: "Clinically significant cancer is unlikely to be present." You've taken a valuable step forward in helping to separate the (likely) clinically insignificant PC (which you probably have, even though your random biopsy was negative) from the likelihood of any clinically significant PC (which would otherwise prompt likely treatment).

Hope that helps!

• This is based on multiple autopsy studies of men of all ages who died accidental deaths. Starting at about age 40, the percent likelihood of men having at least some "detectable" amount of PC was roughly equal to their age. So by the time a man hits 50, he's about 50% likely to have detectable PC. At age 70, the likelihood is 70%. The important take-away from this study is the clear understanding that just having PC doesn't mean that treatment is needed. The counterparts who didn't die of accidents, who probably are walking around with PC at the same percentages, mostly will never know they have it and it will never affect them in their lives...because PC is most frequently indolent.

There's an "old saying" from the PC world that comes to mind: the harder one looks for PC, the more likely one is to find it. Of course, that is a direct outcome of the autopsy study combined with today's more advanced imaging techniques which can find smaller-and-smaller, and less-and-less-significant minuscule amounts of PC...the type which used to be ignored to no determent. Your next steps? If I were you, I'd ask about treatments for your BPH. And if you prefer tea over coffee, go back to the tea. Lastly, stretch before you go for long walks; you aren't as young as you used to be.

Post Edited (NKinney) : 9/27/2017 11:18:02 AM (GMT-6)

Tall Allen said...
Norsk-

mpMRI reports are highly dependent on the experience of the radiologist who read it. PIRADS 2 is an excellent finding, if it is true.

This is an underappreciated point. Reading prostate MRIs is difficult and takes additional training and experience. As with other skill dependent services (like surgery and radiation oncology), it is worth inquiring about the qualifications of the radiologist reading the scan. Ideally you would want a radiologist that subspecializes in body reads (as opposed to a generalist or a musculoskeletal or neuro subspecialist), who has had additional training, and who reads a substantial number of scans on a regular basis. Most mpMRIs are performed on 3T machines, although a 1.5T machine can be used with the right coil. Endorectal coils which were once commonly used are now infrequently used, especially with 3T machines.

I just got another PSA result- 3.9. I am not feeling any panic and think yearly tests are better for the moment. This lowish PSA merry go round + BHP is annoying. If it pops up to 5 or 6- then I'm ready for a biopsy. We do need a better blood test. I will see the Urologist Monday. I did find a study that recent sexual activity can send the PSA result up .5 to a full point- a word to the wise.

I am a big fan of my Urologist. We agreed I have BPH or inflammation. He did say he likes to see PSA scores for guys in their 50's "closer to two and not four". He says my prostate is not "giant" and there may be some leakage going on. He says a one year follow up (+DRE) is fine. I did ask for and got six month PSA tests. The DRE was fine. I asked about PHI and PCA3. He said "What do I do with the result? If it is high, do I do a 50 core biopsy and hope we find it? We just did an mpMRI- these are expensive. What if we miss it on biopsy and find a low grade spot? If we find a low grade spot, we would just watch it anyhow." He says if the PSA trends up again, he would do another mpMRI, first, to try to target a spot to biopsy.

Post Edited (Norsk11) : 4/9/2018 11:52:58 AM (GMT-6)

Please listen to Tall Allen.

IMHO
He is the most knowledgeable and up to date guy on this forum.

Yes...Skol!