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Posted 4/24/2023 9:21 PM (GMT 0)
Saw a urologist today. Had another PSA (10 days post my last one) prior to my visit this afternoon. PSA went down from a 8.2 to a 7. Urologist did a DRE and said it was normal. I am going for a MRI this week and he said he will look at the results from there. He said at this point unless there is something on the MRI he would rather follow the PSA retest path rather than getting a biopsy. Make sense?
Posted 4/25/2023 3:18 AM (GMT 0)
Sounds like a good plan. A biopsy is not risk free but not to be feared either if the data supports it. A MRI and steady PSA testing will yield clues on what to do next. Unfortunately, MRI’s and biopsies can miss PCA lesions so you just have to deal with an imperfect system working with the prostate and PCa.
Posted 4/25/2023 2:49 PM (GMT 0)
I think for now, your urologist has a good plan. Generally speaking, and assuming both tests were at the same lab, PSA doesnt fall in the presence of cancer, only in the presence of prostatities. Of course there are always exceptions so you need to stay vigilant.
Posted 4/25/2023 3:15 PM (GMT 0)
Pratoman,
Is a PSA that drops from a 8 to a 7 in 10 days really a drop or just two samples that are both high?
Thanks
Posted 4/25/2023 3:29 PM (GMT 0)
Both, that is why MRI and another PSA test or two should tell the story. The 8 vs. 7 can be within a normal variance or something getting better. No way to hurry this process up much to solve the puzzle.
Posted 4/25/2023 5:27 PM (GMT 0)
What Mumbo said
Posted 4/27/2023 2:04 AM (GMT 0)
PiRad 3.
Rad who I know says it was close to a 2.
Time to go to the urologist for a biopsy I guess.
Posted 4/27/2023 2:17 AM (GMT 0)
The fact that something shows up on the MRI with the higher PSA values tends to push you in the biopsy direction. Chat with the urologist again and see what direction it goes. Waiting for another PSA should not hurt either. You don’t have to hurry anything but at some point, you will want to know the answer.
Posted 4/27/2023 2:45 PM (GMT 0)
I am a little concerned the urologist wants to wait a couple months for another PSA. Do you think I should push for the biopsy?
Thanks
Posted 4/27/2023 9:22 PM (GMT 0)
We all want to know, in absolutes. In this case, if it was me, emotions aside, i would go along with the doc. A couple months wont make a difference, and your PSA did drop. Biopsy is usually not a tough procedure, but like any procedure it doesn't come with zero risk. Take a deep breath and do another PSA first. If you want to tell the Dr 6 weeks instead of a couple months, i'm sure he'd go along with it.
Posted 4/27/2023 9:46 PM (GMT 0)
Did your urologist suggest the "couple of months" PSA before or after reviewing the MRI results?

It is mainly a mental problem at this point as the need to know is strong once you suspect something. In my layman's opinion, your "condition" will not be substantially different in 30 days vs. 60 days given the slow growing nature PCa but the anxiety of waiting may be troubling at this point. I would suggest contacting your urologist and asking if a 30 day PSA test could be done instead of 60 days (couple of months) as you are anxious to see where this is going. Most urologists understand the anxiety associated with possible PCa and will try to be accommodating but want to get the data necessary also to make a decision.

On the flip side, the further out the PSA test is, the more helpful the result is to compare with the other values. Sort of a balancing act, one week is too short and 6 months is too long so what do you pick?
Posted 4/28/2023 2:20 PM (GMT 0)
Thanks to everyone. It is interesting that resolution or determination of one’s status is not immediate like in the ulcerative colitis world. My urologist wants to get a 3 month and 6 month PSA. I will make it monthly.
Just out of interest who is the top pca surgeon in North America?
Will report back when I know more.
Your forum is very good compared to other health issues on healing well.
Posted 4/28/2023 4:20 PM (GMT 0)

Hugo18 said...
Thanks to everyone. It is interesting that resolution or determination of one’s status is not immediate like in the ulcerative colitis world. My urologist wants to get a 3 month and 6 month PSA. I will make it monthly.
Just out of interest who is the top pca surgeon in North America?
Will report back when I know more.
Your forum is very good compared to other health issues on healing well.

There are so many good surgeons in the U.S. with great reputations. Two that come to mind in NY are Tewari, at Mount Sinai, and Eastman at MSKCC. Depends on your location, if you share others will likely chime in who know surgeons in their area who are tops.

IMO the best surgeon in America is the one that inspires, in you, the most confidence
Posted 4/28/2023 9:49 PM (GMT 0)
Some things are being ignored or glossed over.
First, as was mentioned briefly, PSAs from PC tend to show small steady increases when done say quarterly.

Large spikes tend to be (but of course not always) prostatitis or an infection, often with no symptoms.


I am surprised that no doctor or HW poster suggested: do 14 days of a good antibiotic and then test PSA again.

Mel
Posted 4/29/2023 1:53 PM (GMT 0)
You asked who is the best surgeon in the US. If you opt for surgery, it is good to have it done relatively close to home because it is major surgery with a lengthy recovery. After two nights in the hospital I had an hour drive, and it was the worst driving experience in my life. If you fly across the country, you should probably plan to recover about a week before flying home. Since you asked about surgery, I'd like to advise you to investigate all treatment options, including radiation. Since there is a good probability you have PC, it would benefit you a lot to learn in advance about the different treatments available so that when you meet with doctors you will know what they are saying.
Posted 6/1/2023 10:40 PM (GMT 0)
Had another PSA and it is even more elevated now a month later at 8.5. I am seeing the top urologist in my neck of the woods in Canada. Not in panic but want to get informed about my options. Where would you recommend that I go? Obviously, i need to wait for the biopsy. I presume that tells me what options I will have in front of me. I know that everyone has the same concerns but my sex life is probably the most predominant one. Is there a surgeon or a technique out there that is particularly nerve sparing and could lead to better results? I know that I am way ahead of myself on this but it can't hurt to prepare. Thanks again.
Posted 6/3/2023 2:25 AM (GMT 0)
Don’t know the details about Canada’s system but it seems that the Vancouver Prostate Centre in BC has a good reputation in western CA. May be others depending on where your live.
Posted 8/24/2023 9:46 PM (GMT 0)
I am going next week to John Hopkins for a perineal biopsy. Anything i should be focused on asking the urologist prior to the procedure? Considering I am returning to Canada following the procedure would I get the results from him verbally days later? Thanks
Posted 8/25/2023 12:24 AM (GMT 0)
Hi Hugo. Just a personal opinion, but I think your biopsy is overdue by years. Was your high PSA previously investigated? Was prostatitis ruled out? I don't understand why your docs have waited so long futzing around with what is obviously a high PSA, as your own thread title says.

A PIRADS 3 (intermediate risk of cancer; gray area) should be investigated, but frankly, a biopsy is usually recommended for biopsy-naive man even when no lesions are identified on the MRI if there reason to suspect cancer.

What was the size estimate for your prostate? Please keep us posted.

All the best,

Djin
Posted 8/25/2023 2:18 AM (GMT 0)
My prostate size is approximately 33cc volume. My PSA was at 3 years ago. I didn’t have another PSA test since 2020. Really my fault not my doctors.
Posted 8/25/2023 5:12 PM (GMT 0)
It's a slow-growing disease and to some degree is what it is if you see what I mean: time is not the main driver. How are your urinary symptoms? Good I imagine with that pocket-sized prostate! Mine were awful (BPH) so I had no option but to have surgery. Surgery is often-enough (and in my case) followed by radiation as IMO not to be seen as definitive: IMO you should definitely look at radiation: it is a BREEZE compared to surgery. Having said that, is it nice facing old age with no prostate: YESSIR. Am I finally "trifecta"? With the grace of Gd. So, horses and courses. No right answers. Good luck: I'm not worried about you.
Posted 8/25/2023 7:09 PM (GMT 0)
Hi Hugo, I’m glad you opted for the perineal biopsy. It’s the best and safest diagnostic tool for PCa and John Hopkins is a great facility. Based on your testing to date the data suggests PCa is likely. The good news is there are many ways of treating it. Surgery is not the only option and in many situations not the best option. The best option is always an informed one. This is a great place to collect information that will help you make a fully informed choice when the time comes.

I suggest another good starting place are videos by Dr. Mark Scholz. Dr. Scholz is a board certified oncologist focused on PCa. He has a lot of experience treating patients whose initial treatment failed. Urologist focus on surgery and are not typically up to date on radiation options. Radiation is not for everyone and neither is surgery. Every treatment has risk of unwanted side effects. It’s important to understand those risks and select the treatment option best for your personal situation.

Memorial Sloan Kettering has a very good explanation for their “Precise” treatment which is the same as or similar to SBRT. PCRI.org is another sound source of information.

You’ve selected a great option for your biopsy. If treatment becomes necessary I always recommend seeking out the best treatment team available.

Best wishes and keep posting as we learn from one another’s experiences. Terry
Posted 8/25/2023 8:42 PM (GMT 0)
Thanks for the feedback. I am aware that I most likely have PCa. Crazy that I have to go to John Hopkins for a biopsy but we simply don’t have a perineal method for biopsy anywhere in Canada. I am sure I can use the urologist in Baltimore as one guide for what options he recommends. I have a hell of a time with my ulcerative colitis the last 5 years so the notion of wrapping my head around another ailment doesn’t excite me but I am ready for it. How long does it take to get biopsy results?
Posted 8/25/2023 10:34 PM (GMT 0)
Hugo, From my personal experience I would expect biopsy results to be returned within a day or two. In my case I got my results back over the phone; however, the earliest date I could get with my urologist was six weeks later. Those six weeks proved a blessing allowing me time to research my options. I was a low volume Gleason six for which many treatments would offer a cure.

For my situation radiation in any several forms offered a high cure rate with the lowest risks of sexual or urinary side effects. I chose SBRT since it was only five radiation treatments instead of EBRT with forty-five. It was not offered locally in the Pittsburgh area so I did have to travel to Cleveland Clinic for treatment. We made a total of eight trips to CCI and I believe we met people from Canada at each visit. Terry
Posted 9/1/2023 11:33 PM (GMT 0)
Had my biopsy today. Excellent urologist at John Hopkins. Was much easier than I anticipated.
He says after looking at the ultrasound and MRI images while doing the biopsy he felt the areas of concern didn’t look suspicious to him. I presume he can’t really determine that via biopsy, but rather wanted to reassure me on a long weekend. Will update when results come out. Thanks for everyone’s assistance.
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