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call from doctor about biopsy...

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Posted 12/4/2009 5:51 AM (GMT 0)
 

 On 1/14/09 I signed up on this forum and had several questions concerning a very fast rise in my PSA level.  A very brief history which shows why I have become much more aggressive concerning what doctors tell me.

PSA test about a year ago 9.4.  Doctor said no cancer, your problem is prostatitias.  Started meds. for one month.  After a month the doctor called and said I think that you may have cancer, psa level now 11.4.  Did 12 needle biopsy.  No cancer found.  Started more meds.  Six months later another PSA test came back 15.9.  Doctor started more meds for a month, psa now came back 20.  Doctor told me that he would just about bet that I didn't have cancer but a bad case of prostitatias.

I finally said enough is enough and made an appoinment at the Mayo Clinc in Phoenix.  Doctor did an exam and said that prostate felt fine and that meds. were all that I needed.  I told him that I wanted to know why the psa was so high.  He finally agreed to the flow test, blader scope and and another biopsy, 18 core this time.  Blader scope showed a very enlarged prostate (front part) and infection at the blader opening.  These folks are fast, they did everything in one afternoon, with the biopsy reports within 48 hours.

I finally received a call about five hours ago that he found cancer in one area of the prostate.   While in shock, I did ask about the gleason score (thanks to this forum I had some idea what it means)  He said 3+3=6.  I didn't think to ask about anything else at that time.  He did indicate that he thought my high psa could be caused by the enlarged prostate.  What got me on this is that everyone who has checked my prostate always said it was not enlarged and felt fine, while the upper part was indeed inlarged.

He said that the cancer score was low but he was concerned about the high psa levels.  He indicated a bone scan and ct could be done.  My question is:  At what psa level will these tests show if the cancer has spread?  That is my next main concern.  If I knew the cancer was confined to the prostate I would have it removed as soon as possible.

Any thoughts or suggestions would be appreciated.

Bob

Posted 12/4/2009 6:58 AM (GMT 0)
Wow, a tough journey and you haven't even gone anywhere yet. It is not too surprising that a DRE didn't catch the front part of the prostate since the doc only gets to feel the back. (Yeah, I know it feels like he wraps his whole fist around it)

So where are you? A PSA of 20, one core out of 18 (or out of 30) positive and an enlarged prostate. You don't say how old you are and that gets to be an issue since all prostates grow with age. No matter what your age you have a lot of time and a lot of choices.

You need to get your doctors to lay out your options. For example, use hormone therapy to shrink the prostate and then use seeds. and of course surgery is also a possible choice. You have already embarked on a path of learning and asking questions and that will see you through -- this da*med PC can act in so many different ways that each appearance is its own puzzle
Posted 12/4/2009 7:02 AM (GMT 0)
You would not be able to have the prostate removed till about 4 to 6 weeks after the biopsy so you do not have to rush to do anything as for worrying about the doctors checking the prostate I had 3 doctors check mine the first one checked it at three different times and found nothing the second found 2 lumps and the third only 1 lump
Posted 12/4/2009 11:26 AM (GMT 0)
Hey Twotall
You'll see my stats are close to yours. When my first PSA came back at 17 my GP put me in Cipro - obviously a case of protatitis as he, too, did not feel anything - "maybe a little firmness". A few weeks later the PSA was 22. Oops!
Biopsy, 6 weeks delay to let it heal, DaVinci, and 4 months later the PSA is 0.04. Alive and well in wet underpants.
Jeff
Posted 12/4/2009 3:23 PM (GMT 0)
Well, as unsettling as it is to hear the doctor say "You have cancer", there is some relief in knowing what is going on.

If there is good news, the G 6 is certainly better than 7 ,8, or 9. Now you can set about figuring out what to do.

Good luck. Sorry you are joining us, but you are in good company here.

Goodlife
Posted 12/4/2009 4:03 PM (GMT 0)
Doctors - can't live with 'em, can't live without 'em.

After much experience, I now believe that the best technique for dealing with anyone in a white coat is to follow Ronald Reagan's advice: "Trust but verify."

Zen9

Posted 12/4/2009 4:47 PM (GMT 0)
Zen- exactly my mantra on this forum, all experts????
Posted 12/4/2009 5:09 PM (GMT 0)
Twotall,
Most doctors know very little about PC and how to diagnose and stage it. You've already experienced this with conflicting opinions. I went through 10 years of this before I found a couple of doctors that really understand how this disease works and were skilled enough to provide a correct diagonosis.
Dr Lee in Rochester Mi, Dr Scholz in Marina Del Rey Ca, Dr Bahn in Ventura Ca,
Stephen Strum in Ashland Ore, Dr Myers in Earlysville Va. are all well qualified to evaluate you. There are certaintly others, but these are the best.
Right now you have a very high PSA with a very high velocity that puts you into a very high risk catagory, and you don't know what's causing it. Seeking treatment without knowing the exact cause is just asking for an unfavorable outcome. If you just had a G6 with a low PSA that would be one thing; but your PSA and PSA velocity suggest you need the help of a specialist to really understand what is causing it.

JohnT
Posted 12/4/2009 5:43 PM (GMT 0)
John T has a good list of leading experts. There are others (including both urologists and oncologists) who I would personally put in the same category in terms of CaP expertise, so you have some options depending on, among other things, your geography, financial resources, insurance, etc. Some I would add to the list are: Scardino and Scher at MSK, Logothetis at MD Andersen, Sartor at Tulane, Carter, Partin and Eisenberger at Hopkins, Klein at Cleveland Clinic.
Posted 12/4/2009 11:59 PM (GMT 0)
TO TALL,

My uncle had a PSA of 246 6 yrs ago and the cancer hadn't spread .To this day I have never heard of a score that high.

Charlie
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