High PSA velocity, no cancer

Selmer and LT-TX
Thanks for the fast responce, very much appreciated. (LT-TX let me know if this is not the way to start a new thread.) Selmer, your caring advice is appreciated and is also reposted.

Here is my history.
I am another no cancer (per biopsy), but high psa velocity person. Rarely have Symtoms (great diifficulty with urination start, high urges, and long time finish 3- 5 minutes). However, they are brought on by heavy lifting (ex, lift and drag logs to clear land for 3 hours). Age is 66. Father and Uncle had prostate cancer at 75, PSA = 4.5, father had Lupron for a couple of months was taken off it and the PSA droped and the cancer shrunk and remained dormant, died at 78 from heart attack. Uncle had radio active distruction of his prostate and is 82 and living.
PSA History 11/2008 = 9.5, 5/2008 bisopsy showed no cancer for 12 cores, 5/2008 = 6.2, 4/2007=4.5, 3/2006 = 3
DRE normal, No measure of free PSA was done, Small volume prostrate, no density measure
11/2008 - Uro gave 7 days of broad spectrum antiibotics (levenquin ??) to eradicate any urinary infection that would impact PSA

My internet has me second guessing my urologist, who is not that communicative. (He would not discuss odds, LT strategy, etc)
Please add your pros and cons to the following:

1 - If high (>9), he will want to do another biopsy. Do you know of any other reliable tests AMAS, ECPA, protate MRI, ....
(I was pushing for an AMAS test via Oncolab and wanted to know his recommendation, cost to me $165 instead of a ..........biopsy, this is praised by some doctors and considered worthless by others, .... my uro-doc never heard of it....he also ........... does not measure free PSA, ....why not? his answer is we don't do that??)
2 - I read that if the PSA is high, one should be on 30 days of antibiotics because unrinary infections are difficult and timely to ..........eradicate. Please comment. ( If high I think uro-doc should employ 30 days of antibiotics, and find a more reliable test ..........other than biopsy)
3 - What are the odds of me getting protrate cancer in the future with this high velocity PSA?
4 - Is my uro-doc OK?
5 - John Hopkins sends me email on latest break-thus, but they want to sell books to us in order to get that information. Do you know where else I can get latest breakthur information such as the diet we should be on.


From Selmer:
You seem to indicate you already had a biopsy. When was that and what were the results? What is your age?
Did the same urologist do that? [no cancer, 66, same uro-doc]

If you don't communicate well with your urologist, and you think it is his fault, then you should get one you can put faith in. On the other hand, perhaps you just feel he isn't saying what you want to hear. [ might get a new one, if he wants an immediate biopsy. Based on your statement below, I think 6 more months need to pass before the next biopsy to allow normal PSA settling to occur ]

Some doctors give 7 days of antibiotics, some 14 and some 30. Realize that most prostatitis is non-bacterial and the antibiotics don't affect it very much if at all.

Having said all of the above, and being a person who normally looks for a way to avoid unnecessary biopsies, your PSA numbers appear to be on a steady and increasing march. If its not caused by some other reason then you need another biopsy. Looks like the velocity is taking off.
Again, how many biopsies and when did you have them previously?

After you get your next PSA back.....see what it is........then if needed get a quick second opinion, and make a decision. Lots of first time biopsies, like you apparently had, can easily miss cancer. Think of the cancer, if it exists, like some olives in a loaf of bread. You stick 12 probes into a loaf of bread, and you could easily miss even several olives. Some people go from zero positive cores on the first biopsy to perhaps 4 of 12 on the second biopsy. Hit or miss.

Good luck, but I suspect your PSA isn't gonna drop back below the prior 6/2 reading from May, 2008.
Let us know.......and if its back to 6.2 or below, perhaps you could request a free-PSA from another urologist, although you may well find him/her suggesting you do the biopsy anyway.

Selmer

Hello Worker and welcome again. Glad you made your own post so many others will read and respond.

Couple of notes here...you are in the higher risk category of getting prostate cancer based on a father and uncle having prostate cancer than most of the general public. Age is another factor, in that the older you get the more likely it will be present. The good news is that if it is found it might be the indolent type where treatment may not be necessary or treatment can be delayed. But first things first. So far the first biopsy was negative..that is good news...but the high PSA is of concern in my opinion. I would follow the treatment plan by your doctor of using the antibotics first...but I am willing to bet that another biopsy will be in order. It isn't uncommon from what I have read that sometimes several biopsies are done before the cancer was detected. Generally PCa is multi-focal meaning there isn't just one big mass, but several smaller sized masses and that makes it hard to pinpoint with a biopsy needle. You may also talk with your doctor about performing a saturated biopsy which will utilize sometimes 40 or more core samples thus giving a pretty good overall sampling rate. As far as your doctor...hmmm...only you can decide that one. I want a doctor that is straight forward and not sugar coat anything...and just my luck those type doctors usually have the worst bedside manners. One thing for sure, you will need to be very proactive with your health and if you have any questions about anything, seek a second opinion. None of the doctors I have were offended by seeking a second opinion and actually they endorsed getting second medical opinions. I am sure you doctor will be the same way.

"free PSA" and "PSA density calculations"  are done to determine the amount of PSA being produced by benign causes or by an enlarged prostate producing more PSA, however elevated PSA due to natural causes is usually a more gradual process over some years.

If you have another biopsy, it would be logical under the circumstances to employ the "transperineal" biopsy method.

Worker,

I had a similar case with rising PSA for 10 years, I had 13 biopsies and an MRI all negative. I saw 5 different uroligists at major universities and they said keep getting biopsies every year. I finally found a prostate oncologist that knew what he was doing and sent me to a radioligist that does targeted biopsies with color doppler ultra sound. He found a large tumor that everyone else had missed for the past 10 years.

Transition zone tumors are very difficult to discover by biopsies or MRI. 25% of all cancers are in the transition zone so normal biopsies won't pick them up because most urologists only biopsy the perphril zone.

There are a number of causes for a rising PSA. PSA leakage, which normally levels off somewhere along the line. Prostate Cancer. BPH from an enlarged prostate. Infection which can be cured by Cipro. The biopsy should have picked up any infection.

Some recommendations.

Have a PSA3 urine test. It's a new exotic test that is more accurate than free PSA in determining cancer. Find a doctor that uses color doppler, I think there are only 3 in the US. Start with Dr Bahn in Ventura ca, www.pioa.org he's done over 1400 biopsies using color doppler and has exceptional skills.

As for diet, read "The China Study" by Cambell, you can get it on Amazon for about $13

Hope this helps. Good luck.

JohnT

Selmer,
Updated the profile with medicine and blood test stats. I appreciate the info. and I will be reading your recommendations.

Thankyou,
Worker

A couple more thoughts for those with rising PSAs:
If your doctor is not charting PSA Velocity, PSAV, PSA density, PSAD, and PSA doubling time, PSADT, then you should get another doctor who can. According to Dr Strum he has never seen a patient in 25 years of practice with a PSADT of 12 than was not eventually diagonosed with PC.
JohnT

Hi John T,
Thanks for your information,I am so worry for my PSA velocity ,suddenly jump in a 2 months,I feel nothing wrong for my selfself,I don't belelive when my doctor told me my psa result.
I am on antibiotics medication for 4 weeks,and see what is the PSA will be.It the PSA still high then I will go for my second biopsy.I am very worry why my PSA can doublt in 2 months from 5.6 to 12.56 .if any one can give me some reson. I will go the see my doctor 24 feb 2009 for anyother psa test.

my history
4/08 PSA=4.00
Biopsy No cancer
11/08 PSA=5.60
1/09 PSA=12.56

Hi John,

After reading your email,It make me felt much better,I hope sudden increase so much is sign of infection not cancer.I hope more friend have this experence to let me know.Now i just wait for 2 weeks for any other psa test.
My question is the rapidily cancer in postate,will it possible increase psa leave doublt in two months?