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PSA levels before biopsy-any chance it's not cancer?

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Posted 1/24/2009 12:20 PM (GMT 0)
Hello everyone.

I am a new member today.

My psa levels went as follows:

2006- 3.1

2007- 3.2

2008- 2.6

2009- 4.7

I have had a DRE and nothing is abnormal. Urine test shows no infections.

I am scheduled for a biopsy in 10 days.

From what I can get from the internet, my chances of NOT having prostate cancer is slim. 

Any thoughts or experiences that you can share would be greatly appreciated.

Thanks,

Honker

 

Posted 1/24/2009 12:33 PM (GMT 0)
Dr. Strum says psa velocity and doubling times are red flags for (further tests),.A Psa number by itself is not PCa specific...maybe if seen with psa of 1000 or more, then probably could say it is specific.

Your urine test for possible prostatitis?....who knows if that is totally accurate for such, alot of time this cannot even be diagnosed for patients.

There is a new urine test called PCA3 that can be accurate for detecting some level of PCa being envolved. Talk to your uro-doc or google Dr. Bostwick or www.bostwicklaboratories.com
to read about it.

You could go and get the fPsa testing- not totally definitive of course, but via percentages of unbound prostate specific antigens, it can be measured to show possible likely hood, uro-doc could get that for you, too. The lower percentages measured are very likely for PCa....i.e. say 20% or less...is very likely to be because of PCa.

You could put off biopsies for a little while if you wish to see the results of these tests, first. turn
If you get biopsies ask for local anesthetic to avoid some pain from this. Realize PCa is a wild world and full of inconsistencies etc.

My uro-doc did not mention anesthetic for biopsies, of course he did alot things incorrectly after I took time to investigate more....he got fired later and his cash cow for Lupron had left the building. (lol)

Posted 1/24/2009 1:31 PM (GMT 0)

Dear Honker:

Welcome to the forum.  Hopefully, it is NOT PCa but the cautious approach with those changes is to have a biopsy.  My PSA history was not unlike yours, a biopsy was suggested and, unfortunately, the news was not good.  However, you should hope for the best but go ahead with the biopsy in my opinion.

One other thing, if I may, is to suggest anesthsia with your biopsy.  This subject has been discussed before on this forum.  Those of us who has the procedure under anesthesia (mine was IV) describe it as "mildly uncomfortable", "uneventful" or "no big deal".  Those phrases have also been used by those who were biopsed w/o anesthesia but...some men have described it as "seriously painful" or "very uncomfortable".  So...my two cents is to advise anesthesia...

Tudpock

Posted 1/24/2009 1:43 PM (GMT 0)
My biopsy was done with a local injection of anesthetics. No pain at all. Did have some strange sensations when the needle gun went click, but no discomfort. My B-I-L had me frightened to death over the biopsy (he had several over the years) and his urologist didn't use any anesthetics. My doctor said his doctor was in error for not using anything.
Posted 1/24/2009 1:50 PM (GMT 0)
Hello and welcome Honker,

Zufas above is correct, it's your PSA velocity that gives the concern for the biopsy. If you look at my psa stats, you can see how i ended up here. it still doesn't mean you have cancer, and this 1st biopsy may or may not cancer. if it comes back "clean" and your psa continues to rise over time, you could probably count on another biopsy.

as far as pain with the biopsy, pretty subjective thing. i have 3 done over 15 months. 2 without any thing for pain, and 1 with local pain shots. the shots that administer the pain shots hurt me more and made me come out of my skin then without the pain med. so i told my dr on the 3rd one, give it to me straight. for me, the biopsies are unnatural, degrading and unpleasant, but not a terrible experience.

keep us posted on your situation

david in sc
Posted 1/24/2009 4:26 PM (GMT 0)
Hi Honker,
There is a chance that what you have is not PCa, but there is becomeing no chance for that biopsy to be skipped. I managed to get through the biopsy experience pretty well. It is different for everybody, but I think most do really well.

Welcome to HealigWell. This is the best site I found on the web for caring and compassionate support for prostate cancer. Feel free to stay with us for questions and advice. While I hope you are here without cancer, there are things you will see that we all have here. Sharing is the number one thing you will find here. Good luck in the coming weeks. Stay positive!

Tony
Posted 1/24/2009 4:38 PM (GMT 0)

Honker said...
Hello everyone.
I am a new member today.

My psa levels went as follows:

2006- 3.1

2007- 3.2

2008- 2.6

2009- 4.7

I have had a DRE and nothing is abnormal. Urine test shows no infections.

I am scheduled for a biopsy in 10 days.

From what I can get from the internet, my chances of NOT having prostate cancer is slim.

Any thoughts or experiences that you can share would be greatly appreciated.

Thanks,

Honker

With this monster you never know. My PSA was 2.3 and a golf buddy's was 4.7. I also had a suspicious DRE. Bottom line was my biopsy was positive while his was negative. So yes there's a chance you don't have PCa. If you don't you'll still need to monitor your psa. As far as those who need to be sedated for a common biopsy I believe are primarily the same guys who can't stand any needles. With a little lidocaine my first biopsy while a little uncomfortable was no big deal. The saturation biopsy you are required to be sedated. good luck...
Posted 1/24/2009 4:43 PM (GMT 0)
Thanks everyone for the quick, thorough, and positive responses. I will stay with this forum until i get a diagnosis.
Honker
Posted 1/24/2009 7:58 PM (GMT 0)
Welcome Honker,

Sorry you had to research this, but I think you have found a good resource for a sounding board.

I am like the others that think there is reason to believe it is a benign process just as easily as cancer. You did not mention symptoms, are you having any? Free PSA has already been suggested and I think it is a good suggestion. There is also a urine test that not all urologists use it is called PCA3 and must be done in conjuction with a DRE. The studies I have seen on it indicate it is a very good screen to detect the presence of cancer within the prostate.

I had the biopsy with just a little lydocaine rubbed on the area and it was more shocking to my sensibilies than painful. You can go that route, ask for an oral pain med or even go outpatient and IV sedation if you prefer.

I think there is still reason to hope that it is not cancer. Please let us know. Scott
Posted 1/24/2009 10:23 PM (GMT 0)
Thanks Selmer.
What a thoughtful and thorough response.
I am 60 years old.
You bring up many things that i have not considered.
I don't even know what prostatitis is.
I understand about the manipulation of the prostate causing some elevation in psa. My blood work was done as a routine yearly checkup (no DRE) on Jan 9, 2009. I got the results on Jan 13. I met with the urologist on Jan 20. She checked my prostate (DRE) at that time and said it was normal feeling. She did a urine sample that day, which i got the following day with normal results.
She wants to do a biopsy right away.
Sincerely,
Honker
Posted 1/24/2009 11:07 PM (GMT 0)
Hi Honker,

I was in a very similar situation myself, except I had a known history or protatitis symptoms. I recently had a spike of my PSA and was very worried. I waited until I had minimal prostatitis symptoms and retested and was quite surprised that my PSA dropped down to what I consider my baseline. I recently saw a second urologist who agrees with this (and did a better job of finding my previous PSA records including a 2005 reading which helped establish my baseline). I would think from what you said that your baseline is around 3.0 and your recent PSA rise is certainly something to consider. My personal opinion (I am NOT a physician) is waiting a week or two and having another PSA test is likely a low risk step. If your PSA goes back to baseline you may then want to just keep an eye on it and avoid the biopsy "right away". Also you can get a second Urologist opinion.

HOWEVER, I am not a physician and these are highly individual decisions between you and your physician. If you and your physician are worried then perhaps the biopsy is the way to go.

Best of luck and keep us informed.
Rich
Posted 1/25/2009 1:52 AM (GMT 0)
It helps if you take a vicodine before your biopsy. There is no problem with bleeding and it sure helps the pain. I agree with everyone else, get a free psa and a psa3. If they are in normal range then skip the biopsy.
JohnT
Posted 1/25/2009 2:11 AM (GMT 0)
Hey John T, what is it with the big blank area after each of your posts. wink
Honker, it is PCA3 and unlike PSA which is not conclusive for cancer it is. I would have one post haste.

Best wishes. Scott
Posted 1/25/2009 3:11 AM (GMT 0)

Dear Honker:

Respectfully, I disagree with both Selmer and Rich.  To me, knowledge is power.  PSA fluctuation as well as velocity is a possible indication of PCa.  A biopsy is a low risk and reasonably accurate way of knowing whether or not you have cancer.  I agree with your doc and would think having a biopsy and receiving the accompanying KNOWLEDGE is the way to go.  Once done you can then make decisions you feel are appropriate.  Without the biopsy, you are choosing "watchful waiting" without very good information.  Anyway, that's my opinion....

Tudpock

P.S.  My personal experience was low velocity with some flucuation and a PSA not terribly high for my age.  Frankly, I didn't want to do a biopsy but fought the urge to just keep doing PSA tests and went ahead with the biopsy.  The results were PCa...and not that I was happy with the results but I was happy knowing that my cancer was found early and that I had multiple options for treatment and cure.

Posted 1/25/2009 3:54 AM (GMT 0)
Tudpock
I am so confused. But I like your pragmatic attitude. I DO want to know if it is cancer (I guess it is called PCa). I am learning so much. I will probably? go through with the biopsy and go from there. The various points of view are what's nice about this forum. I know it is my choice, but at least I have a choice.
Thanks my friend.
Regards,
Honker
Posted 1/25/2009 4:15 AM (GMT 0)
Tudpock, I agree with your thinking here. Watchful waiting without a biopsy is more like wishful thinking to me, again no disrepect to other views. the results of the biopsy once it finds the cancer is a fact in front of you, a beginning point to start dealing with PC. On rare occasions , the post pathology will show less involvement then the biopsy, but think how many times the tumor grade, the gleason, etc increase after pathology when they have the entire gland and other parts to examine. Then there are times when the biopsy and post pathology match exactly. Mine was the classic example, no symptons, no prior prostate ailments, just a steadly and quickly rising PSA.

David in SC
Posted 1/25/2009 4:28 AM (GMT 0)
Thank you all for the responses and advice.
Honker
Posted 1/25/2009 5:02 AM (GMT 0)
two stories as briefly as I can make them:  MY psa Jan 2006-1, my psa Jan 2007 4.5.  Biopsy found one out of 10 samples barely cancerous.  I elected to have surgery and due to family emergencies I put if off until 10/4/2007.  Post surgery I was told that the prostate was"full of really bad cancer".  I was also told that radiation and chemo would not have helped and without surgery I would not have had five years.  Because the doctor did not know the extent of the cancer he spared the nerves and my psa is now undetectable.  I expect to win the lottery any day now.  Second story, and this is according to my uncle, his psa several years ago was around 1,000.  He never had surgery and did hormone therapy.  He was recently told that he does not have and apparently never had prostate cancer.  Sounds unbelievable, but that's what I was told.
Posted 1/25/2009 7:51 AM (GMT 0)
This is why this is such a useful forum. You will hear all sides and will obtain alot of information, both anecdotal and based on published research. Obviously you will need to make your own decisions based on as much information as you can get -- PCa is still not an exacting science in both diagnosis (PSA is prostate specific, not cancer specific, and biopsies can be falsely negative) and treatment choice is complex. Your doctor's recommendation for a biopsy is based entirely on a rise on one PSA test value. My point is that if this is not a legitimate value, why subject yourself to a biopsy when it's simple to wait a week or two and check your PSA. If the 4.7 is real then a biopsy seems logical, if it is 3.0 than there may be no need for a biopsy. That's what 2 different urologists told me. But that's my particular case. Regardless, when you get a bump in PSA you need to investigate. Also whatever you decide, and if you do have PCa, you can find support here.
Posted 1/25/2009 10:01 AM (GMT 0)
You guys are great. I will keep you all updated as to my decisions and results. If and when I have a PCa diagnosis, I will need your help even more. Dealing with this, along with other health issues, is difficult. I'm sure that you all have similar concerns. With this forum, I am keenly aware that I am not alone.
Thanks,
Honker
Posted 1/25/2009 7:11 PM (GMT 0)
Honker,

I had normal DRE's and had an abnormal but stable PSA 4.6 / 8% free psa. I had been putting off having a biopsy and then the PSA shot up to 5.65 / 4% free psa. That was my wake-up call. Glad now I had the biopsy, and feeling very lucky. Best of luck to you.
Posted 1/25/2009 7:36 PM (GMT 0)
Honker - Any history of PCa in your family?

My experience with the biopsy was absolutely no pain (local anesthetic given during biopsy) during biopsy. Some discomfort while sitting later in the day after anesthetic wore off. You may want to plan on taking the day off work and relaxing after the biopsy. I planned on going back to work but my plans changed after an hour or so passed by.
Posted 1/25/2009 7:44 PM (GMT 0)
Tom, I agree with you there, my were all timed for late in the afternoon, and when they were over, I was able to drive home. On my 3rd one, which was barely 6 weeks from the second, I had one of my sons with me to drive home. The leather seats in my car are nice, but hard as rocks
Posted 1/25/2009 8:32 PM (GMT 0)
Dear sandstorm and tobmeister.
Both of your cenarios sound like something I might be looking at.
I'm glad for both of you that things are looking good.
My family history of PCa is not good. My father died of brain cancer (never had a psa test). All three of his brothers have PCa now. My cousin (my father's sister's son) , my age, has PCa now.
Believe me, I have been saying my prayers.
Honker
Posted 1/25/2009 8:39 PM (GMT 0)
Selmer your point is good, but as always, in dealing with PC, there never is any consistent guaranteed way of doing anything at any point, way too many variations of the same stories and process, just at this site alone.
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