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Posted 7/11/2007 2:40 AM (GMT 0)

Hi Everyone,

 

I need your opinion about my father.  He is 75 years of age. His Urologist recently performed a DRE and said that it didn't feel right and that my dad needs a biopsy.  My father has an enlarged prostate (I don't know the size but I was told that it's very large) and he's been on Proscar for the last 8 years.  His psa level is 4.0 and has been pretty much stable with the exception of several years ago it jumped to a 16 and then slowly went back down to 4.  The Urologist said it was probably an inflammation of some sort and didn’t do a biopsy.

 

My dad went for a second opinion to a very well known Urologist in Manhattan.  He examined my father and said that he did feel something during the DRE but thinks it could be an inflammation.  His advice was not to do a biopsy for now and see if the psa goes up within the next 6 months.  He also said that since his prostate is so large that he wouldn’t be a candidate for seeds or radiation. 

 

What do you think of this wait and see approach at this point?  What do you think my dad should do at this time?

 

Thank you.

 

AEG

 

Posted 7/11/2007 3:06 AM (GMT 0)

I think you were given good advice.  I believe in the PSA numbers and believe me if he has prostate cancer in an advanced form the PSA numbers will rise and then do the biopsy and find out what treatment options are available according to the biopsy results.

 

Posted 7/11/2007 3:50 PM (GMT 0)
I just wanted to add that Proscar can artificially lower the psa by 50%.

AEG
Posted 7/12/2007 5:00 PM (GMT 0)
Hi AEG,
Your dads PSA is maintaining a steady number and Proscar is considered an androgen blockade that can help keep it there. Proscar and Avodart lower dihydrotestosterone in men, the most most potent cancer food, and that is not artificially lowing the PSA but rather attacking prostate cancer cells if they exist, and they also treat BHP or enlarged prostate. The book by Dr. Myers goes into in depth detail on the strategic use of these drugs. At 75 and staying steady, and otherwise healthy, watchful waiting is not bad advice. For me the comfort zone would have pushed me to request the biopsy anyway. Another push to biopsy would be if he experiences symptoms of PCa and they make him uncomfortable during urination, unable to empty bladder, etc. And remember, he has control of when to do a biopsy, not his doctors. He already has the 4.0ng gray area so insurance, or medicare should cover it. Not too sure about seeds or radiation though. Probably true to some extent but if he is maintaining the PSA number for some more years then if it does start to rise, radiation and HT might not be a bad alternative to surgery depending on his health. While radiation may not kill all his cancer, with HT it may keep it in check. You can always second opinion that.

If you are asking my vote, consider a prostiscint and MRI scan to see if there is more information that can help you decide to consider biopsy or further treatment.

Tony
Posted 7/13/2007 11:53 AM (GMT 0)
Hi AEG,
Since you asked, here's my $0.02 worth. If they were asking him to perform surgery, I'd say by all means wait. But the biopsy is not that big a deal, and should give him an affirmative answer. I never showed any symptoms of PCa, and my tumor was not palpable right up to surgery. I personally would go crazy waiting and wondering: Will my PSA go up? Is the cancer there and growing? Was that really something he felt during the DRE? Am I decreasing my survival odds by waiting? All of these things would whirl in my mind 24/7. It's never an easy decision. Whatever you decide, I'm thinking of you and you Dad.
Best,
Mike
Posted 7/13/2007 12:21 PM (GMT 0)
A biopsy gives you the most definitive answer. 

I was so bummed when I found out, but I still recognize that it is better to know and be taking action than not to know and have it get worse.

The biopsy is truly an easy procedure to endure.  I chose to take as much sedation as they were willing to give.  Fact is, I don't remember a thing of the procedure, even though the doc told me I would.

 

Posted 7/14/2007 11:54 PM (GMT 0)
hi,

yeah I would agree that doing a biopsy would be minimally invasive.

unless he has some health condition or something that is making them hesitant to do that?

and from our experience, your PSA score does need to be multiplied by a factor from being on proscar or avodart.  But, we were on avodart for only about 4 months after diagnosis but pre-surgery.  And it went down from 3.7 to 1.9.  (but doc multiplied it to about 3.4).

I am not sure though if being on it as long as your dad and having pretty stable PSA's would mean it has stabilized?  But anyway, is there any disadvantage in his case in getting a biopsy?

Tanya

 

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