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Newbie Question: First PSA ; should I get a Biopsy?

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Posted 10/27/2008 4:36 PM (GMT 0)
Just a another great set of thank you to you all;

I am hoping to have another PSA test by the end of the week so I can keep my Biopsy appt next Monday;  If I cannot get that maybe the Biopsy will be delayed until I do that; 

Again thanks!

Posted 10/27/2008 4:40 PM (GMT 0)
Scotty,

I will chime in here also...Get the biopsy...only way to know for certain. Anxiety and worry grows alot faster than cancer does. The waiting is hard, but even harder when you don't know. Until then take your time to read as you have been doing and make the best decision for yourself...but don't forget the anxiety and worry of your loved ones. Honestly...I did the biopsy for the relief of my wife, not for me. With my low PSA I had only a 25% chance of having cancer and I wasn't going to bother until she insisted that I go through with the biopsy for her peace of mind. My wife knows more than I do. I listen very carefully to her now.
Posted 10/28/2008 12:10 AM (GMT 0)
My URO (Dr Mene) spoke with me today;  and I am going in tomorrow for a duplicate PSA test  (10 days later);  Biospy still scheduled for Monday.
Posted 10/28/2008 12:01 PM (GMT 0)
One more point; Actually my date for my PSA was 7 days ago (10/21/08);  wow; 5 days feels like 5 months!;  anyway;  another PSA test scheduled for today; not sure if one week can show a change?  any thought?
Posted 10/28/2008 1:00 PM (GMT 0)
I am going for another post RRP PSA test today myself. Your test should show very little difference if any from your last test, but that being said these PSA tests are for our peace of mind. In your case you are struggling with the validity of it all, and I think for that reason another test will be helpful. If nothing else it will show you whether or not the last test was authentic. So much of this is a mental battle to make right decisions and find a comfort level with those decisions. I wish you the very best!

RB

Age 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
Posted 10/29/2008 2:36 PM (GMT 0)

Wow; PSA today  2.6;  Still went up from one week agao  (when was 5.9);  Uro still wants Biopsy; but maybe it is on the way down further??  Maybe I should take Cipro for a few weeks and wait on test?  Thoughts?

Posted 10/29/2008 2:37 PM (GMT 0)
Wow; PSA today 2.6; Still went up from one YEAR ago (when was 1.38); but down from last week... Uro still wants Biopsy; but maybe it is on the way down further?? Maybe I should take Cipro for a few weeks and wait on test? Thoughts?
Posted 10/29/2008 2:59 PM (GMT 0)
Yep, still elevated but this goes to show ya...protocols are made for a reason : >)
Posted 10/29/2008 6:16 PM (GMT 0)
I am new to board and need to seek some insight. I have been "fighting" an irratic PSA started as a 4.8. Doc put me on cipro went up to a 5.6. Rechecked after a couple of weeks and went down to a 3.?. All ok. Had a Life exam and they checked the PSA in August 5.1, they did a recheck and this month dropped to a 4.5 but checked the Free psa and that came in at a 7. I have only had a DRE. Was scheduled with the urologist and cancelled when psa went within normal. I am going back to Doc today to discuss results of Life Exam. They refused coverage (obviously). Any ideas or experience with these wacky numbers. I know the Free PSA doesn't look too favorable but need a heads up. And some opinions Thanks
Posted 10/29/2008 6:19 PM (GMT 0)
Oh I forgot to put that I am just shy of 50

Posted 10/29/2008 6:59 PM (GMT 0)

Wow; I am pretty new here too; but I can tell you that there is not normal PSA and perhaps you should get a Biopsy at some point;  My Uro does not hold much faith in the fPSA test as an infection would produce the same results;  judging from your PSA goin up and down then there must be some type of Prostatis or something.  From what I read seems like 2 weeks is not enough to cure the infection; did you stay on it just 2 weeks?  It might have sent PSA down, but maybe infection came back?  All this is difficult; at some point a biopsy is needed, unless the PSA gets under 2.5

Posted 10/29/2008 7:10 PM (GMT 0)
If I remember I was on the cipro long enought to tear my stomach up. Indigestion burning etc. In reading the other posts it sure seems that I am going to be sent for the biopsy. If it is an infection it sure is resistent. We changed from the cipro to another med and I stayed on that for quite awhile until the PSA was in the 3's. I was trying to avoid the biopsy but doesn't look like I can. At only 50 (almost) I sure hope it is only a prostatitis. I was going to have a retest of the PSA next month but I guess with the Life exam this will be sped up. I  know the sexual activity will  increase the PSA and I avoided that knowing the test was coming so it is definitely something. Thanks for the reply. It is good to know there is a support platform like this

Posted 10/29/2008 8:23 PM (GMT 0)
I will have to agree with Selmer. But the waiting another month for a repeat test is going to be nerve racking. But it is better than getting a biopsy when it isn't necessary. Just follow your own instincts with the advice of your doctor. Personally, I wouldn't wait...too dang hard having this hanging over my head. We each are different in that regard.
Posted 10/30/2008 1:41 AM (GMT 0)
HRD:

Sounds like you need to see a urologist for sure. Take some time and find a good, experienced one in your area. Family docs are fine but you really should get some more expert advice.
Posted 10/30/2008 8:12 PM (GMT 0)
Selmer,

Thanks for your thoughtful post;  With my PSA going up then down  I am hopeful that is is 'itis, but from what i read 'itis and PCa together can be there;  I guess today I am happy as I feel I am back in the position of everyone else (in that I always have a chance of this thing); My Uro suggested that if I wanted to wait for another PSA test that I should at least take the Antibotics, which from what what you said, which I have also read, is that it may not do anything anyway; but as long as I am waiting why not?  I did ask about taking IBuprofin for it as well and he said no, that taking both does not help according to what he has read;  hmmm, not sure I can see the reason in that; so I plan to take 2 Ibuprofin each morning for the next two weeks as well.  But you were right in waiting for a variety of reasons, especially if I do have a Biopsy at some point; it would be important to get some idea of my real PSA;  My think on PSA (and I am no Doctor); is that your lowest PSA is your baseline and any fluctuations upwards is probably 'itis; but even at 2.6 or even at 2.0  you might wonder, because as we all know anyone can have this and the Biopsy can be positive for even PSA at 1.5;  I agree that you dont want to find really slow PCa as that maybe you would have aggressive treatment for no reason; but I am not sure, which is why I think a PSA velocity is very important; but again, I am not sure why mine changed so much; and how common that is.  That said the PSA seems like a great test to help people after surgery, but before surgury, the 'itis makes it difficult. 

Posted 10/30/2008 8:33 PM (GMT 0)
Scotty,

Selmer has his own reasons for his self-advised treatment and that is absolutely his right to do just that. Sometimes it is in our best interest to follow our own path. As long as the outcome is borne of informed consent and what we're willing to accept, good or bad, then each to his/her own I say. What is right for one is not necessarily right for another. Why any young man would risk dying of a terribly painful disease instead of seeking a simple diagnosis and potentially avoiding unimaginable bone pain is beyond my comprehension but, we all have our reasons. Unless a man is in his late years, I see every reason in the world to avoid advanced disease by catching PCa in those early stages. A drip and some ED beats the alternative. If someone said don't worry, PCa is a painless death, I could see the justification in doing nothing. IT ISN'T..... At least seek a diagnosis so you can make an informed decision. Good Luck to you.

Swim
Posted 10/30/2008 8:39 PM (GMT 0)
Scotty...double check with your doctor about the IBuprofin. I don't think you are suppose to take it before a biopsy for at least two weeks. There are several things you shouldn't take because they may interfere with the healing process. I know my uro wouldn't allow it, along with Celebrex, asprin etc.
Posted 10/30/2008 8:47 PM (GMT 0)
Hi Scotty:

I have been reading your thread with interest and decided I might as well weigh in also. I'm struck by a couple of things:

1. Sounds like you don't have much faith in your urologist. Maybe you should consider finding a new one. I just had a lack of confidence in the first urologist I found, then took the time to find one in which I now have a lot of faith.

2. Certainly PSA results before treatment are not perfect. However, they are indicators and, translated by an experienced uro, can help us to seek proper treatment.

3. I disagree with you and Selmer re not wanting to find early slow growing prostate cancer. That, of course, doesn't mean I am right...it's just my personal and non-medical opinion. My thinking is this: If you DO find that you have PCa, you can decide what treatment, if any, to choose. There is a school of thought for "watchful waiting", even for younger men for early stage slow growth cancers. There is currently a study using watchful waiting patients going on at Johns Hopkins; there are probably others. Anyway, my point is that if you don't know - one way or another - then your only basic choice is watchful waiting. If you DO know, you can choose from among many options. For me, it was important to know as I prefer to make my own choices given my options...but, of course, not all men feel that way.

Anyway, those are my thoughts. Good luck and we'll look forward to hearing how you progress.
Posted 10/31/2008 8:37 PM (GMT 0)
Correct, if my PSA test in two weeks is near 1.38;  then I would not have a Biopsy; but if it stays at 2.6 I would, as 1.38 -> 2.6 in 9 months is a clear signal for Biopsy and possible PCa.  Of course other factors can keep the PSA at 2.6 but in my opinion, unless my PSA goes back to baseline there is concern.  That being said; I could opt to wait again another 2 weeks or 2 months and see if it goes down as 'itis is not easy to clear up.  But at some point you run the risk of it either being 'itis or PCa, and from statistics you cannot disregard the PCa factor, especially if it goes up quickly.  I have read that PCA velocity is as important as Gleason score to indicate how bad it is, howeverm since 'itis and PCa can be combined it is very important to get good baselines.  So for both reasons, I think many PSA tests over time is best, but even then it may be either PCa or 'itis; and then even after a Biopsy; one need to consider that somethings the second biopsy catches what the first misses.

Posted 10/31/2008 9:43 PM (GMT 0)
Scotty,

Just follow through with the experience of your Physician and ignore bad advise. You have a PSA that has "changed" over time, period. Any change could mean cancer no matter what spin we put on it. Cipro is a drug used to treat prostatitis as well as a pre/post biopsy medication so what the heck? I see no reason to suspect your Physician has led you in the wrong direction but, I can read with my own eyes that there are lay-person's who might be trying. Paul (DH) had cancer with a PSA of 2.7. Do yourself a favor and seek a proper diagnosis just as you have planned. A couple of weeks to a couple of months shouldn't make a difference but don't put off a biopsy any longer than that...just in case that 5.9 was reflective of a real cancer. Size and PSA do matter. In otherwords, the size of a prostate and the PSA, tumor location, in addition to the Gleason score, all have meaning. Get the answer and move forward one way or another.

Swim
Posted 11/1/2008 3:36 PM (GMT 0)
Selmer,

Scotty had several ABNORMAL test results over the last year (as have you). None of them have been 0. A couple months delayis likely quite safe but, don't forget, the most lethal grades don't necessarily have much of a PSA!! Take my husband's partner for example. His father, Gleason 10, no PSA and dead at 62! Please stop with the I'm afraid of the truth therefore everyone should be too routine. Your body, your decision.

As for Paul, he did delay his diagnosis by 5 months and his PSA was low. The largest tumor was 2.5cm in diameter. That's plenty large enough to have been advanced stage in a man with a smaller prostate. Thank goodness for a slightly enlargened organ! 3 more areas were very small but one was in the apex. Again, location location, location!! Only a diagnosis could have given us the information Paul needed to make a sound decision concerning his health. He took Cipro at my suggestion since it does follow protocol.
Posted 11/1/2008 4:09 PM (GMT 0)
Swim,

Not sure what you meant by PSA of zero;  is that even possible?  My Doctor stated that if the PSA comes down to the normal level (I am assuming here he means 1.38 or something very near it) he would not want to do a Biopsy, even after I suggested to him I would want a Biopsy.

Posted 11/1/2008 6:25 PM (GMT 0)
ScottyMo,

How old are you? Do you know the size of your prostate? Has a free PSA been done at all? Can your Dr. rule out cancer at this stage? If not...a biopsy is still indicated. Keep in mind, most PSA elevations are NOT cancer. A free PSA may be the best guess test before a biopsy.
Posted 11/1/2008 9:55 PM (GMT 0)
Swim, I should add myage, 52, to my signature.  My Dr suggested against a fPSA, which surprised me, but I didnt discuss further with him directly; however, after my own research a fPSA does not disinquish between 'itis or cancer so I am not sure it is helpful as , again from my research, most PCa also has 'itis so fPSA may not be helpful, although that being said I would think I would what to know all the figures at least so I would have all numbers in case at some point they would be more meaningful,.I am not sure what I am saying, except that if fPSA points to a more aggressive PCa and also points to 'itis, I can understand my Dr's point, although he just said that he believes fPSA not to be helpful.  From what I said above he may be right, although I would think that if  it is PCa and one can tell there is no 'itis then it would be useful indicator.  Either way retesting and Biopsy are the only tools we have at this time to find this disease and if found to help determine best treatment.  If I were recommending to anyone, I would recommend a Biopsy when in doubt, but I am waiting as I hope my personal PSA continues to come down to the 138 level, again if it does not, it may be that the 'itis or it may be be PCA, and then I would opt for a Biopsy for sure.  Some might argue waiting yet again and retest in weeks or months, I would probably go for the Biopsy at that point.   If it turns out to be PCa my first instinct would be surgery, but others have had success with other treatments, but I dont want to get ahead of myself.  If it goes down to 1.38  or 1.4 or perhaps even 1.5  I will wait 3 months and test again.  If it goes down again, lets say to 1.9 or 2.0; that is where I will be confused again.  So basically at this point

If next PSA stays 2.6 (or higher)  - Biospy

If next PSA goes down to 1.9 or 2.0  - Confused, may wait or may take biopsy

If next PSA goes down to original 1.38 or 1.4 -  take another PSA 4-6 months

Age 52:

 

Posted 11/1/2008 9:57 PM (GMT 0)
Hey Scotty,

Just get the biopsy. It ain't that bigga deal....

Jim
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