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Psa 4.2 and very large prostate with a nodule, 74yo

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Posted 12/24/2019 1:51 AM (GMT 0)
Father in law 74yo has been advised to get a biopsy next year. His psa increased from 3.7 in June to 4.2 in December. Also the ultrasound tech was surprised of how big the prostate is(it has been enlarged for the past 20 years). He is very scared of havjng cancer, but I want to put his mind at ease.

Has anybody had the same results and how did you cope?

At his age what are the chances of it being agressive or resistant to hormonal therapy?
Posted 12/24/2019 1:56 AM (GMT 0)
Sandie, well, at 74, a PSA of 4.2 is not extraordinary, especially with an enlarged prostate. And, a biopsy will probably show that he has PCa--odds are, at his age, that he has measurable cancer...which actually doesn't mean a whole lot. The question will be how much and what grade?

That being said, there are a lot of guys in here who diagnosed with really nasty versions of PCa and who are still here and doing well at 10 years or more. Before biopsy, they could put him on some antibiotics for a while and maybe a drug to shrink his prostate (and make peeing easier), but, biopsy is the only way to diagnose him.

He'll be around a long time.
Posted 12/24/2019 2:22 AM (GMT 0)
Thank you, it is the nodule that was seen that is worrying me. Also he is not in the US or UK so hopefully the treatment he receives is good.
Posted 12/24/2019 3:34 AM (GMT 0)
Sandie - My Dad was around that age, 75-76, when he had brachytherapy seeds and is 92 now. Had Lupron shots a couple years ago to knock down a rising PSA and is still doing fine. It is way too early to worry about aggressiveness or hormone resistant PCa. He just needs to do what needs to be done such as a biopsy to start the evaluation. Odds are that it will be manageable for many years if any PCa is found.
Posted 12/24/2019 10:09 AM (GMT 0)
Sandie, where is he located? There are excellent doctors and facilities all over the world, perhaps we could suggest something if we know where he is.
Posted 12/24/2019 10:16 AM (GMT 0)
He is in Romania, there is robotic surgery performed at some clinics, but I am not sure about the standard of care. From what I have read, it can be lower than Western Europe.
Posted 12/24/2019 2:24 PM (GMT 0)
Sandie - He is at the age where surgery is generally discouraged so will probably be looking at other options if the biopsy comes up with anything that needs attention. At that point, he should be seeing a radiation oncologist or medical oncologist for other options. I would guess that if Romania has robotic surgery equipment, they will have current radiation equipment as well. The key will be going to the best medical centers in Romania for treatment if needed. The standard of care might be better in Germany for example but could be difficult to access if not a citizen or wealthy.
Posted 1/9/2020 9:45 PM (GMT 0)
Update: he went to a renowned urologist and as soon as he saw the ultrasound he said it must be taken out. He is scheduled for prostatectomy next week (he doesn't have other medical conditions so he is fit for surgery). We are pretty worried, as we can't go to the doctor with him. What we know is that besides the 4.2 PSA, the prostate volume is around 200cc which sounds enormous.

What are the chances for it to be just benign BPH?
Posted 1/9/2020 9:48 PM (GMT 0)
RP is routinely performed in men >70 IF they are in otherwise good health. I'm NOT saying the surgery is a=the better option, just that it shouldn't be ruled out simply because of age. There can be reasons RT is not ideal in some patients.

If anyone is interested, I can post links to studies.

Djin
Posted 1/9/2020 10:27 PM (GMT 0)
I am not worried about the surgery in particular, but of the possibility of having extended cancer due to the big size of the prostate. I could not find too much information on the Internet for that volume.
Posted 1/9/2020 10:46 PM (GMT 0)
I see on the Internet there is an inverse relation between prostate size and PCa aggressiveness - the larger the prostate, the smaller chances are for it to be an aggressive type of cancer:

"The results of this study depict an inverse association of prostate volume with the incidence and biological aggressiveness of PCa. "
Posted 1/12/2020 2:54 AM (GMT 0)
No biopsy. Going to remove based on an ultrasound. Is that normal procedure. I'm just asking. I'm new to all of this. I guess they are removing because of size, which does not mean cancer. I'm 75, 73cc prostate and 6 PSA. I've had 3 biopseys and all 3 clean. Prostate surgery is serious surgery. I would think a biopsy would be needed. But I'm not a doctor.
Posted 1/12/2020 12:54 PM (GMT 0)
No it is not normal in the US or most other countries. Without a confirmatory biopsy Medicare, VA, NHS, commercial insurance, etc will not pay for it. And RP is never an emergency that it must be done next week. I think something is amiss here. Prudence says to slow down and do further investigation. Get another opinion. There are many ways to shrink an enlarged prostate. RP is not a routine treatment of BPH.
Posted 1/12/2020 10:40 PM (GMT 0)
Thank you for your advice. I am afraid this lack of communication is common in that country, unless you go private, where the doctors take more time to explain everything in detail. I think they do more tests once he is admitted (except for the biopsy). I will try to direct him to ask more questions on the day, there is not much one can do when living on another continent unfortunately.
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