New and confused

HI V

 

You've come to the right place.  I'm sure you will get many helpful answers here.

 

Ray

Get the Biopsy!!! My Father died from Prostate Cancer at age 74 I was diagnosed at age 51, 10 of 12 cores positive, Brother diagnosed age 46. One other brother had negative biopsy. Get the Biopsy...                   Hero

V, Like you long family history. When I had a PSA jump went to see the URO. He recomended a biopsy and I agreed. Was not real surprised with the positive results.

I made the decision at that point to get it out. The rest is history.

Do the biopsy. Hope it comes back negative if not we will be here to help you through the dance.

Cajun Jeff

Welcome to the forum.

Take a deep breath and realx a little. If you aren't ready for the biopsy, delay it for a month or two. Take that time to read and understand all the implications.

Obviously with your family history, keeping a close watch on this will be important, but you do have time here to make some well informed decsions.

V,
You have a family history of PC, both your psa and PCA3 are high, but just borderline high. These are three red flags that should not be ignored. Get a biopsy and if it comes out negative keep monitoring closely. It is way too early to think about treatments, if and when the time comes you can make a more rational decision about them once you have the facts.
We have all gone through this period and it is far more trying than the treatment itself because you are dealing with the unknown.
JT

ABSOLUTELY GET THE BIOPSY DONE.

I was in your shoes about 8 months ago (read my signature).

The whole purpose of the PCA-3 is to decide whether or not to do the biopsy. I was hoping to avoid a biopsy in the face of an increasing PSA. My PCA-3 test results were worse than yours, but regardless if you do the PCA-3 you should abide by the results.

Mel

Hello to Vam

It’s funny – I also just joined today; well, yesterday and like you, have never participated in any forum before. My husband and I were diagnosed 2 weeks ago and I must admit I'm getting dizzy from the research and decision-making.

The unknown is scary and the only antidote is knowledge. Then again, a little knowledge can be a dangerous thing.

You don’t have to “run” to do anything. Your stats mean that you have time to make an informed decision.

My guess is that most Urologists would NOT recommend a Biopsy based solely on your PSA rise, especially because you’re only 50. But adding in your heredity and PCA3 changes things. Any peeing symptoms? It’s all about statistics. (I wish we had seen a Urologist when the PSA was at 3.0 four years ago at 61 years old but wonder if a biopsy would even have been recommended at that point with virtually no other symptoms?)

That said, here’re some thoughts / suggestions:

1. Keep reading everything – but remember that the internet is both a blessing and curse because there is soooo much there. Keep notes and an organized filing system of some sort.

2. Get 2 more opinions from recommended Urologists within the next 6 – 8 weeks. To get a recommendation call everyone you know who might have some insider knowledge about great docs, good institutions, etc. Call them. They will see you. Take everything your Urologist has in his file on you plus your PSA history plus PCA3 info. Ask for his assistant and he/she will either give you a copy or fax/mail to your consulting docs. He's required by law to do this and you won't be hurting his feelings...you'll never even talk to him to get this stuff.

3. Ask each Urologist (and your 1st Urologist, too) if there is any way to estimate tumor stage* based on your history and your symptoms without doing a biopsy. IE: is there a “nomogram” for pre-biopsy statistics to help determine if you need a biopsy? Read about nomograms and then check out Memorial Sloan Kettering Cancer Center’s site. They have a prostate nomogram-for-dummies you can play with, but only if you’ve had a biopsy and know gleasons, tumor stage probability*, and number of positive and negative nodes. Don't know how well respected it is, to be honest
*tumor stage via the 1997 UICC Ranking of Cancer. UICC = “Int’l Union
Against Cancer”.

4. Ask each doc if there’s any other way than a biopsy to determine if you have cancer and to what degree. Maybe there’re new procedures, etc. Ask that on this site, too

5. Some people might also recommend that you talk to a radiation/chemotherapist doc or 2 and see if THEY think you need a biopsy.

6. If the Urologists’ consensus is that you should have a biopsy, then get one!

7. Relax about the biopsy. They have a scary reputation but have apparently come a long way in the recent past. My Mac thought biopsy-horribleness would be an 8 on a 10 scale and it was only about a 2.5…valium helped.

Good luck. Stay positive and logical. There is nothing I have found that makes me think my guy is going to die from this. Nothing. And all the negatives associated with treatment tend to be better over time with the vast majority of men. Hang out with friends and family. Prostate cancer survival is excellent and getting better all the time.

Best - Paella

Mac’s statistics:
Age 65 - 5'11" Weight 210 BMI 29.1
Overall Heath Condition: Good
No family history
PSA: November 2001 = 1.0 slowly rising to 4.4 in Feb 2010
Biopsy: 04/19/10: Gleason 3 + 4 with 5 of 12 positive (2 at 15%, 1 at 5%,
1 at 25 and 1 at 35). Both lobes involved (right lobe with 1 positive at 5%).
Left Lateral and Left Apex involved with 15% and 35%.
No base involvement

Did the docs do a free psa?  If so, what was the percent free psa?   (Lower percent free psa is more likely to mean prostate cancer, and higher percentages less likely -- as with PCA3, it is another indicator).   Regarding PCA3, there is some debate about what the best cut-point is for that test.  (The usual tension between sensitivity of the test and specificity).  I suspect it is better to look at this test not as generating "positive" or "negative" results, but instead as a  continuum.  Your score is pretty close to the typical cut point.  In other words, it is a little high but not very high.  That is good news because there is evidence that a higher PCA3 test result may correlate with a more aggressive cancer.  And your score is more likely to correlate with a less aggressive cancer - if it is cancer at all.   As others have said here, I would get the biopsy.  It is a low risk procedure and if you don't get the biopsy, the wondering will probably drive you nuts.  IF you do have prostate cancer, you want to find it while it is curable.  The good news is that, given your psa score and your PCA3 results, if you do have prostate cancer, there is a very high likelihood that you have a low grade and readily curable cancer.   Best wishes, Medved  

  medved said... Did the docs do a free psa?  If so, what was the percent free psa?   (Lower percent free psa is more likely to mean prostate cancer, and higher percentages less likely -- as with PCA3, it is another indicator).   Regarding PCA3, there is some debate about what the best cut-point is for that test.  (The usual tension between sensitivity of the test and specificity).  I suspect it is better to look at this test not as generating "positive" or "negative" results, but instead as a  continuum.  Your score is pretty close to the typical cut point.  In other words, it is a little high but not very high.  That is good news because there is evidence that a higher PCA3 test result may correlate with a more aggressive cancer.  And your score is more likely to correlate with a less aggressive cancer - if it is cancer at all.   As others have said here, I would get the biopsy.  It is a low risk procedure and if you don't get the biopsy, the wondering will probably drive you nuts.  IF you do have prostate cancer, you want to find it while it is curable.  The good news is that, given your psa score and your PCA3 results, if you do have prostate cancer, there is a very high likelihood that you have a low grade and readily curable cancer.   Best wishes, Medved     Funny enough.... I never new too much about a free psa percentage until I got here.... I called my doctor today and said that the lab doesn't break it down that way.... my URO will be doing all my PSA testing from this point forward. I will make sure I ask him so that I can get those numbers also. THANKS!

medved said...
<lab doesn't break it down that way....>

Nearly any lab (certainly any of the major labs) will do a free psa test, but the doctor has to request it. It is relatively common for docs not to order free psa percentage unless total psa is at least 4 ng/ml. However, there is evidence to support the use of free psa percentage at lower total psa levels too (I have seen a study supporting the validity of free psa percentage with total psa as low as 2.5 ng/ml).

Best wishes,

Thank you again MED..... I wish I would have know this. I will definetly request the staff at the doctor's office do this next round.

Hi Vam:

I'm late to the party on this one but I do agree with most of the other posters that a biopsy is in order.  Some biopsy issues that you should discuss with your uro before you get to the procedure date:

1.  How many samples will he take?  There have been a couple of posters of late that had as few as 6 samples.  That's not good....12 is pretty common, but 16 is more state of the art.

2.  What is his/her thought on comfort during the biopsy?  Some men find that its "no big deal" but others have found the pain excruciating.  I had IV anesthesia so it was a piece of cake for me.  You might want to think about the comfort issue and address it with your doc.

Good luck and let us know what you find out.

Tudpock

Thanks again to all..... I must admit once again, I'm glad I joined this group.... so much info and so much to learn. Not to put another thought in my head, cause Lord know I have enough.... looking at some of the "signatures" here, I almost wonder if maybe I should have looked into a biopsy a while back. Some of you guys have such a low PSA and still were DX'd with PCa. I watched mine for 10 years with no radical changes until the last 22 months with a 1.05 jump.