Urologist 99% sure of PCA B4 Biopsy

Hello Husker and welcome. Sorry you have to be here but we hope your stay is short. If not, we are here to help and support you.

Your two-minute diagnosis is odd to say the least. Other members may have other choice words about your urologist. There is no way to be 99% sure about prostate cancer without a biopsy and certainly not with a normal DRE. Your difficulty urinating is probably due to your enlarged prostate and not to anything cancer related. Prostate cancer is generally seen after a gradual rise in PSA rather than a spike. Spikes are normally caused by prostatitis/infection. That's not to say that yours wasn't gradual over the last year but there is no way to know. Also an enlarged prostate puts out more PSA than a smaller one so your PSA readings may be in line with your prostate size.

One thing you might consider before you get a biopsy is a second opinion from a less diagnosis happy urologist. Many urologists will prescribe a course of antibiotics to see if the PSA drops before subjecting the patient to a biopsy.

Yeah, maybe you have prostate cancer and maybe not. PSA is not a cancer test rather a warning light that something is wrong. So you might want to check out what else might be wrong before undergoing the biopsy.

Good luck.

Jim

Thank you both for the fast reply. He really set me back on my heels with boom you have it diagnosis so talking to someone kind of in the same boat is relieving. The doctor did a urine test looking for infection. I was able to read the results of that test online last evening. It said "no growth in 24 hours" so I'm guessing it was negative. I'll let you know via this post, any definite news or results.

HimHusker,
Sorry to see you here but hopefully your stay will be short. Did this urologist see a sign hanging over your head that said prostate cancer below? Time to search out another urologist. As others have already said, prostatitis is more in line with what you describe. Before you let anyone start poking around, get on a course of antibiotics.
BUT FIRST........find another urologist and get another opinion.

Husker,
I went to my first Uro meeting with a PSA of 21. The Uro did a DRE and felt large nodules on both sides of my prostate. He said I probably have PCa, which I did. But this is a waaaay different scenario than you have. It doesn’t seem that your Uro made his statement based on any obvious evidence.

I think you would be doing a disservice to yourself if you didn’t get a second opinion before submitting to the biopsy.

Welcome to HW.

That's a fast DX and a doc who would scare me. Still there are worse things than a biopsy.

You might consider getting a second opinion.
Andrew

I think it would make sense to consult with a second urologist before having the biopsy. I don't like doctors who deliver such a serious diagnosis so cavalierly. Most biopsies are routine and uneventful but occasionally they are not, so it makes sense to rule out other explanations for your PSA rise before submitting to anesthesia.

That 50% of biopsies are negative is indicative that too many are performed on men that probably do not have PCa.. My urologist must see very sure signs of high probability of PCa before subjecting a person to a biopsy. As such he reports his positive rate is over 90%. Even in my case with PSA 59 and a large nodule felt he said PCa is very likely and we should do a biopsy. He is diligent in determining the reason for the high and/or rising PSA, but in most cases does not rush to a biopsy until other determinations and treatments are pursued.

Ar friend in Florida had a PSA rise for which his GP prescribed meds. The PSA reduced from 10 to 5 in 90 days and he was referred to a very high volume PCa surgeon. Upon a 5 minute exam the surgeon said you have cancer and I can cure you like the thousands I have also cured before and we will do a biopsy today. My friend said not so fast and declined a biopsy that day. The doc said he couldn't leave the clinic without signing a hold harmless declaration and he had to threaten to call the police if he wasn't allowed to leave and did not sign the from. My urologist provided several referrals and my friend is now being treated for the usual BPH and prostatitis and his PSA is lower but bouncing around. He may find at some time that he has PCa and perhaps it nay need treatment, but the urologist is not ready to do a biopsy on a man with a slightly high PSA and unremarkable DRE.

I, like others, suggest you find a new urologist. Best that the person specializes in prostate and male issues and is well experienced treating the usual prostate issues.

And just because biopsies are routine and frequently performed doesn't mean they should be done frivolously. They do have risk with a significant number of men having infections. Plus they are downright a pain in the rear.

Rob, some clarification regarding your definition of PSA. It is merely a protein produced by prostatic cells. Most men do not have any type of inflamation or disease yet produce normal amounts of PSA.

What the PSA measure alerts us to is excessive expression that can have many different causes including inflamation and diseases like cancer. When PSA is excessive and/or trending upward that is when we go looking for the cause. While not a test for any of these conditions it is an indicator of something going on that may adversely affect us. And of course we know that prostate enlargement is normal as men age and a larger prostate will express more PSA even in the absence of inflamation and or disease. Hence the age-based increasing ranges of normal PSA that are used.

Prostate cancer cells most always express PSA at a greater rate than normal prostate cells until the PCa cells become so mutated as to be very unlike prostate cells and then may produce little or no PSA. It is generally held that a normal prostate expresses PSA at an average rate of .066 per cc of volume. But a cancerous G3 grade expresses PSA at a rate of about 3-4 per cc of volume. As the G grades go up the PSA expression generally reduces. In my case the docs estimated that based on my prostate size, PSA, biopsy core sample and Gleason grades that I had a tumor load of approximately 19cc.

We too often see men with advanced stage disease with rapidly increasing PSA into the hundreds and thousands indicating an ever increasing amount of cancer and usually confirmed by various scans. But, we also see men that have advanced terminal disease with little or no PSA because their cancer has so mutated to forms like small cell that produce little or no PSA but are just as lethal with similarly increasing tumor loads. A good friend died after a seven year fight due to small cell in his lungs and very large growths in his abdominal lymph nodes. His PSA never went above 5.
.
Once the prostate is removed the only reason for PSA expression is that there are prostate cancer cells somewhere. No prostate means no infection, no inflamation, no BPH, no bike riding or sexual activity cause, no enlargement, no other way to express PSA. So for those men it is indeed a cancer test. If the PSA is going up it is due to the PCa. To much the same extent it is also a test for most men whose prostate has been fully radiated but not removed. While prostatitus and BPH may be possible in radiated men, both are rare. Since some prostatic tissue may still be functioning these men are allowed a bit more PSA expression than those that had surgery. For men that have had focal treatment like HIFU, NanoKnife, etc. since there is much of the prostate unaffected then all the increasing PSA causes can be present and must be considered in the ongoing management and potential treatment.

OHHusker said...
I am obviously hoping he's wrong and that may be the Androgel or something else is causing the rise to 4.0. We shall see.

I would be more inclined to think that the T-gel was the culprit if you were new to it. I have been using T-gel for the past 6 years, also will need it for life. When I started on the gel, we saw my PSA rise from around 1.7 to around 3.5, then stabilize. Some years later, it again rose, this time to almost 5.7. At that point we chose biopsy, and the rest is history.

That said, although external T can cause PSA to rise, it does not, in and of itself, cause PCa -- especially if your T is being managed well and your T levels are in the normal range. I've had the input of a well-known specialist as well as my uro and RO regarding management of my T and PCa. I have remained on the gel before diagnosis, during treatment and now, after treatment. (Knock on wood. . . ) All is going as it should. So, if you need supplemental/replacement T, don't let them take it away from you without doing all your homework to see if you need to stop it. Even if you do have PCa (and we don't know yet), if it is favorable or favorable intermediate risk, they shouldn't need to stop it. I can go into tons of detail as to why I feel that way, IF you ever need to know.

I'll be around.

I will just jump in on top of the pile.
A second opinion and forget this urologist.
There are too many things that could drive that PSA without it being PCa.

Roger

To suggest further testing of the PSA and even a biopsy is one thing but to tell someone that it is 99% sure you have cancer is another. Which school of fortune telling did the Uro attend.

Roger

My first abnormal PSA was 5.2. I went to the urologist at that point and he had me retest what amounted to 3 times, (two of these with additional fPSA included) over the next 12 months before settling on a biopsy. To this day my PSA fluctuates. It's a difficult decision. For the record, I had normal DRE.