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High PSa What next

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Prostate Cancer
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Posted 9/19/2013 3:36 PM (GMT 0)
MY PSA  has slowly risen from 3. to 8.14 in feb..  I just had it done again  it is 10.14. (-saw palmetto) now. Doctor Hahn (brady institute John Hopkins) called me last night and kind of put the ball in my court as to the next step. We spoke about having a mri to look for liaisons and then direct a biopsy. But we just did a mri in March and he didn’t see anything suspect. We decided on a regular biopsy on Oct. 2.  Two times last night he mentions he is a little nervous, whenever I asked him his opinion for the last couple of years he has said he is confident I have a small slow growing cancer that it is still in the prostate. Last night when I asked does he still feel confident its still in the prostate and he said he just don’t know. Do you have any thoughts on what my next move should be? I have asked him a few times to just take my prostate I have a 12yr old son and he says they cant do that till they find cancer but do I just sit back while they keep testing and then get the call that I have stage 4 prostate cancer?Any thought would be greatly appreciated
Posted 9/19/2013 3:57 PM (GMT 0)
The biopsy is the right way to go. Certainly the rise is worrying. Have you had a biopsy before?

Take it a step at a time. If the standard biopsy doesn't turn give the result you're expecting, there are other methods - saturation biopsy for one.
Posted 9/19/2013 4:05 PM (GMT 0)
biopsy
Posted 9/19/2013 4:28 PM (GMT 0)
Your doctor has to be careful how he answers direct questions like "is it just in the prostate"? Not because he's trying to be evasive, but because he truley doesn't know yet and doesn't want to make statements he can't back up 100% (which is going to be rare in the medical world anyway). The biopsy will tell them a lot. I know it's hard to wait, but it's for the best in my opinion. One step at a time john. Let us know how you make out. We'll be here for you.

Mike
Posted 9/19/2013 4:40 PM (GMT 0)
The kind of MRI he is suggesting may be different from the one you had before. The different kind of MRI is done with an endorectal coil in place, hopefully on a 3 Tesla machine, and they look at various parameters, so it is known as multi-parametric. An experienced radiologist (and I'm sure Johns Hopkins would have that) can often use it to detect cancer, especially higher grade cancer, in the prostate. The image from that MRI is then ingeniously fused with a real-time ultrasound image to guide a biopsy. This can sometimes help find cancer in places that the conventional ultrasound-guided biopsy wouldn't be able to see.
Posted 9/19/2013 5:25 PM (GMT 0)
You are making it too complicated.

It is time for a biopsy, for sure

Mel

Posted 9/19/2013 10:24 PM (GMT 0)
Thanks mel I have had around 6 biopsy with a typical cells and a saturated biopsy (30 cores) i just feel like im sitting as things are getting worse to the point the cancer escapes the prostate. By all accounts dr hohn is world renown so i think im in good hands. Thanks for everyones responses
Posted 9/19/2013 10:30 PM (GMT 0)
If you've had 6 biopsies including a saturation biopsy, I think you ought to look at other causes, especially prostatitis. Ask your urologist if a "4 cup test" is appropriate.

I assume you've tried taking antibiotics and that didn't have an effect. Perhaps another antibiotic and a longer course. But the 4-cup test will help identify which if any is most appropriate.
Posted 9/19/2013 11:18 PM (GMT 0)
A PCA3 test might also help guide a decision whether to do another biopsy. It's a simple urine test, captures the first couple ounces after a slightly more vigorous DRE. Results are a percentage, showing a ratio of cancer cell RNA to normal cell RNA. Values above a cutoff value (25 to 35 are common) are suggestive of a biopsy.
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