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Posted 6/24/2009 2:57 AM (GMT 0)

I’m hopeful that I’m physically fine, but my anxiety is getting the best of me.  52 years old. 

PSA 1.8 2001, 1.7 2003,

1.7 2005, 2.17 2006, concern with DRE, did a biopsy – anxiety for a week , results were great – no cancer.

6/07 DRE no concerns, PSA 1.51

6/08 DRE no concerns - didn't do a PSA - Not sure why.

6/09 DRE no concerns, PSA  2.47.

Just received the card in the mail today with PSA at 2.47, marked “Abnormal” and recommending a retest in six months.  When I saw the Urologist about a week ago, he seemed convinced there was no problem.  I’m trying to think positive, but am very concerned I have prostate cancer.  Any advice?

 

 

Post Edited (arkclk) : 6/23/2009 9:26:06 PM (GMT-6)

Posted 6/24/2009 3:49 AM (GMT 0)
Take a deep breath, do some more reading on this forum, including some of the websites refeerenced in the beginning of the forum page.

Prostate cancer is a slow growing cancer, even if you do have it, but 2.47 does not sound like a need to panic and worry yet. Six months seems like a long time, but it really isn't. Your next PSA will be more important to see the rate of change if any.

You might also read the thread entitled Observations... Prostate cancer is not the end of the world. Early detection, competent medical advice and treatment, and a little prayer once in a while results in very high cure rates for this disease.

Best of luck !
Posted 6/24/2009 3:58 AM (GMT 0)
I agree...deep breath. read about it. Doc will probably want to test again down the road and see if it rises fast. there are numerous reasons a psa can rise w/o cancer.

Posted 6/24/2009 3:59 AM (GMT 0)
A course of antibiotics may help rule out inflamation. Ultra-sound may show the size of the prostate to correlate with 2.47 PSA. If nothing explains the PSA and its rise, I would not wait six month, but retest after three. My perspective may be warped, but I was lulled into a false sense of security by my doc and five negative PSA tests.
Posted 6/24/2009 5:24 AM (GMT 0)

Welcome to the forum!

In looking at your history, your PSA has gone up and down in intervening years.  For example, from 2.1 down to 1.5.   At your age, a PSA in the 2 range is often considered normal by medical professionals.  Every doctor is different.  Your doctor may wish to work with you to seek for other signs of concern.  

In my case, I had a PSA of 4.3 after being tested only six months earlier giving a 2.1.  So there was a concern about the steep rise in a very short period of time.

No need to worry now... Just follow the doctor's advice to get more information about your condition.

Kind regards,

Posted 6/24/2009 11:38 AM (GMT 0)
Thanks for the responses. I'm somehow convinced that having PC would be the end of the world, even though I've learned from many posts on this forum that you guys have made it and are continuing to make great progress. Still the anxiety of the "unknown" really seems to bother me. I'm traditionally a "worry" type of person and this news just really hit me hard. I'm hopeful I can put this out of my mind, but I may make another appt. with my Dr. to see if he has any advice on this. I'm hopeful he will say that this is only a precaution, that there's probably nothing more than a mild inflamation, and that PSA results can vary periodically. Thanks again to everyone who has responded. This helps more than you know. When I woke up a 4:00 in the morning and couldn't sleep, I got on the forum and was pleasantly surprised with the responses. THANKS
Posted 6/24/2009 2:08 PM (GMT 0)
If it were me with your stats, I would re-test the PSA with the same lab in 90 days, not six months, if there were any rise at all, I would want another biopsy.

We hope you never need to be here, and certainly understand any fear and worry. Yes, we that have PC deal with it, and learn to live with it, and its side effects, it is a life changing malady at the least, but it doesn't make it any easier. We do the best we can.

I just don't think I would wait a full six month to that next check point.

David in SC
Posted 6/24/2009 2:43 PM (GMT 0)
In the past year there have been two major studies published which suggest that, especially in America, prostate cancer is over diagnosed and over treated. Part of this is due to much better PSA testing and more conscientious screening by physicians.

Many doctors believe that, if a man lives long enough, he will develop prostate cancer. Thus the problem can be seen as trying to evaluate whether each particular man is at risk of having his life shortened or his quality of life reduced by failing to treat his PC.

What your doctors are doing is called Watchful Waiting. This is medically recognized as a legitimate treatment. It is most definitely not the equivalent of “close your eyes and hope it goes away.” Among cancers, PC is very slow moving and so for many men watchful waiting is all the treatment that they will need in their entire lifetime. The people in this forum tend to be the exceptions. It may well be that your doctors will never find you exceptional enough.

Worry about PC? Yes, but how much do you worry about having a heart attack or a stroke or for that matter getting hit by a truck? So, watch your diet and exercise, don’t smoke, look both ways when crossing streets, and do watchful waiting – all in their proper proportion.
Posted 6/24/2009 3:36 PM (GMT 0)
Make sure you check your family history for PC.
Posted 6/24/2009 6:28 PM (GMT 0)
geezer,

PC is not always slow moving, that is part of the myth of PC, is that it is the "good" cancer to get because it moves so slow and most men survive it. That line of thinking is only a half truth at best. I don't think us Americans are over diagnosed for PC, I, for one, am thankful where there is enough public awareness to the subject of PC. I wonder if any of the people that make up these studies have had PC or someone close to them with it. Early detection is always best with most diseases, especially cancers, so doing regular DRE and PSA at an even earlier age makes good sense to me. Once you have a Gleason of 7 or higher, your window of opportunity for a cure or at least to have it contained to the prostate grow slimmer by the time. Watchful Waiting is a good option if one meets the proper criteria for it. But some people, and we have to admit this is true, keep themselves in various forms of denialism in their lives, especially when it comes to medical matters. What they don't know won't hurt them kind of thinking. Got a good friend local to me, done business together for 16 years now, won't get his PSA tested, even though his father died of it and two uncles on his father's side, and knowing what I have been going through. He is 62 btw, and he may or may not be fine, but he won't get it checked, I have even offered to pay for the test. I suppose my last statement will be subjective at best, but knowing is always better than not knowing in my opinion.

David in SC
Posted 6/24/2009 7:39 PM (GMT 0)
Dear artclk:

While your PSA level would typically be ok for a man your age, I can certainly understand worrying.  Question:  Did you by any chance have sex in the 48 hours prior to the latest PSA test?  That can cause a spike...

In any case, given that you are an admitted worrier, count me in with Geebra and David.  That is, split the difference and have a PSA test in 3 months rather than 6.  Hopefully that will give you some peace of mind, especailly if there is no further rise...

Tudpock

Posted 6/24/2009 9:30 PM (GMT 0)

Research age specific PSA. My understanding is that for a man in his 50's the PSA should  average 0.9 if there is no inflamation, enlargement, cancer, etc. This is taken from Dr Catalona's website:

"Rather than consider the PSA range in terms of "normal or abnormal," it is more useful to consider it as a means of assessing the risk that prostate cancer would be found on a biopsy.

For instance, regardless of age, if a man has a perfectly healthy prostate gland (without inflammation, benign enlargement or cancer) the PSA should be very low - certainly less than 2. Our studies showed than the median PSA level is 0.7 for men in their 40s, 0.9 for men in their 50s and 1.4 for men in their 60s.

If there is cancer, inflammation, or benign enlargement, or a combination of these conditions, the PSA level will be higher.

If the PSA is in the 2.5-4 range, the chances of finding cancer on biopsy are about 25%. If the PSA is 4-10, the chances of finding cancer are 35-40%. If the PSA is higher than 10, the chances of finding cancer are about 60%."


Post Edited (Squirm) : 6/24/2009 3:34:22 PM (GMT-6)

Posted 6/24/2009 10:10 PM (GMT 0)
arkclk,

Need to add just one more tidbit to the already astounding information and recommendations given. You also need to know what the doubling time of your PSA is. If if it doubling at a high rate (regardless of the PSA level), there is more cause for concern than just the PSA level by itself. BTW, I punched your stats into the nomogram and your doubling time is around 23.9 years. Which would put you somewhere around 75 years old before your PSA doubles from the level it is now. Hopefully that will ease your mind some. But the caveat is that PSA levels will change and sometimes rapidly from one test to the next, which is the reason for yearly testing. PSA and the PSA velocity or doubling time put together make a better picture rather than PSA alone.

Just keep checking the PSA regularly and follow your doctors recommendations as mentioned.
Posted 6/24/2009 10:37 PM (GMT 0)
At 52 my PSA went from 1.9 to 2.85 in one year. Urologist insisted on biopsy, first one was suspicious for cancer but not diagnostic, had to repeat in 4 months. This time it was definately prostate cancer in 2/12 cores, gleason 3+3=6 score. I think you should retest in 3 months. Although a lot of prostate cancers with gleason scores of 6 or less are slow growing, how do you know without a biopsy you don't have a  more aggressive cancer with a gleason score of 7,8,or 9? Just because the PSA isn't rising that fast right now doesn't necessarily mean its slow growing. I would insist on repeat in 3 months, maybe I too am just paranoid about the big C. 
Posted 6/25/2009 12:26 AM (GMT 0)
Thanks to everyone who has taken the time to respond. This is a great forum, and while I hope not to have too much in common with each of you, should I find bad news, this is where I will turn first.

Geezer99 - thanks for the great perspective. I did wonder about posting my question in this forum because there are probably people like me who have had a few PSA tests, a biopsy, and everything turned out well and they didn't join this forum. Therefore, I did wonder if the responses would be more focused on the possibility of cancer when it could be something much less severe. I'll try not to worry (but this is one of my bad habits), have already made an appointment with my urologist for next Tuesday, and I'll see if we can schedule a follow up PSA sooner rather than later.

THANKS again for all the support.
Posted 6/25/2009 1:29 AM (GMT 0)
artclk,

we are thrilled here when a new friend to the group finds out they don't need to be here. that is the best possible news you can give us. hope all goes well for you in the future.

david in sc
Posted 6/25/2009 1:35 AM (GMT 0)
Just my two cents worth on urgency.

I had a PSA of 4.3 and a Gleason score of 3+3=6 from the biopsy, which suggested encapsulated cancer.  After all that testing was over, I had second-opinions from several health care professionals.   This was June of 2007.  Each professional agreed that there was need to hurry on deciding on my options, but did say have some kind of treatment before the end of the year. 

In my opinion, since there was no hurry for my treatment according to several doctors, there may be no hurry for you to get re-tested. 

Having said that, you should do what makes you most comfortable.  You are in the driver's seat!

I wish you all the best,

Posted 6/25/2009 3:28 AM (GMT 0)
Hi arlclk,

I know what it's like to have anxieties over doctor visits and lab tests.  I worry and lose sleep about things I have no control over, too.  Or is it just an active mind wanting to be sure that every thought is in the proper perspective?

As for worrying about having PC, that part is over for me.  Getting an early diagnosis didn't give me any time to worry about negative biopsies or other prostate health issues.

My PSA over 2.3 got me an appointment with the Urologist.  My family doc's DRE was of no concern, the Urologist's DRE was "mmm maybe". There wasn't a lot of concern to pursue treatment right away after the biopsy.  Post-surgery pathology was an upgrade from gleason 6 to 7 and the cancer was right up to but had not invaded the capsule.  I think that it was good that I did not wait any longer for the biopsy or surgery. 

You are wise to keep watching this, but keep yourself occupied with other important things in life.

Best wishes for you to never have cancer.

Dan

Posted 6/25/2009 3:45 AM (GMT 0)
Purgatory,

Wouldn't you agree that slow or fast in cancer talk is relative ? What I mean is, it is not uncommon to have a freind or acquantance diagnosed with lung, liver or brain cancer and have them die within a few months.

On the other hand, we see men on this forum who have had cancer diagnosed in early and advanced stages, and still have good results in terms of time. I think time is why some refer to PC as slow growing. Even a Gleason 9, which is agressive, grows at a relatively slow rate compared to dome of the other vital organ cancers.

Even arkclk has a retest in 3 months, most uros will still take 3 more months before any action is taken. I am not sure we should be causing men to panic that if they don't get retested quickly,, all is lost. Your post on observations made that abundantly clear.

Just a thought ....
Posted 6/26/2009 2:13 PM (GMT 0)
The first rule is
Don't Panic
The second rule is
Don't Panic
I'll let you guess the third rule...

What you have here is a lot of guys who have decided to take positive action against PC. On this board we have seen examples of advanced cases which were discovered and treated later than they should have been and we very much do not want that to happen to anyone else. Our mantra is "learn and be proactive" but I would suggest that "proactive" doesn't mean rushing into either tests or treatment. It means understanding and weighing the information you get from this board and from your doctors and then making your choices.

Anyway, one of your choices is to follow the three rules above.
Posted 6/30/2009 10:30 PM (GMT 0)
Well thanks again for all the help and support.  This is a great forum, although I'm still hopeful that I will not be joining the club.  Saw my Doctor today and we agreed to just go ahead with a biopsy.  I think I convinced him (with input from some of you) that we might as well find out now rather than waiting 3 or 6 months.  I used the argument that the PSA is at 2.47 today and if it goes to 3.0 in December, we will end up with a biopsy, so let's go for it now.  Obviously, I wanted him to say that through the DRE he was sure it wasn't cancer, but he couldn't do that and so that's where we are.  Since today is Tuesday and they only do the biopsys on Tuesdays, I have to wait a week, then wait for the results.  Again, you have been great in helping me through this, and I'm not sure I've hit the hard part yet.  Thanks so much.

Posted 6/30/2009 10:57 PM (GMT 0)
Greetings, arkclk.  I think you and your doc have made a wise decision.  Even though a biopsy doesn't always find the cancer they usually do.  Better to know what you are facing and hopefully everything will be great and you won't have cancer.  If you do we are here for you.  Here's hoping for a good report in a couple of weeks - please keep us posted.  David

Posted 7/1/2009 12:29 AM (GMT 0)
Art,
I think you made a wise decision with your dr. After many years of nice DRE's that came up clean, it was the 3 biopsies that finally found the cancer. I think you being pro-active at this point is a good thing and an example to others.

David in SC
Posted 7/1/2009 1:26 AM (GMT 0)
Hey arkclk,

Good plan. You'll obtain good information from the biopsy that you don't have today.

Your friends will be here to support you when you get the results.

Barry
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