Back here - can i get some comments

I have been away from here for a while. Reason for not being here is i took Peter Abelards and others advice to stop wasting my time worrying when i haven't even been diagnosed yet. Still have not been diagnosed
I realize i am likely not in a serious situation at this point, but am curious to get some comments, nonetheless.

You can see the PSA history below in my signature, it has been steadily rising since 2008, from .7 to todays result of 3.1. And 6 months ago it was 2.8, down from 2.9 8 months before that, this is the only time it dropped (although insignificant amount.)

My biopsy in 2012 showed 1 core of 14 with hi grade PIN, but no cancer in any cores. My dad had PC, diagnosed in his 60s.

So after todays visit, doc seems not concerned. He is Dr Aaron Katz, Chairman of Urology at Winthrop on Long Island, very reputable and i do have total confidence in him. So i guess i shouldnt be concerned.
He said PSA of 4, is no longer a magic number, its the trend, age, etc. And although mine has been trending up, its slow, and he would be more concerned if it doubled in a year. So nothing to do right now except follow up in 6 monhts, as usual. My age is 63.

Anybody have any thoughts on this? I'm not looking to get a biopsy, i didnt particularly enjoy the first one. But at the same time, if i do get diagnosed i would like every possibility of it being very early. I think, hmmm....hi grade pin, rising psa over the last 6 years, maybe something is going on?

I know my situation is a joke compared to some of you, especially after reading Davids thread. So apologies. Still, I'm a worrier, for those of you who dont remember me from my last visit here.

Thanks for listening
_

Pratt,

I am listening to your thread. And I do understand the underlying concern. It took 3 biopsies to find my cancer. My uro was convinced all along, and if he hadn't insisted, almost begged me, to have the 3rd one done (I was fed up with the process after the 2nd), I could have found in a much more dangerous situation.

HGPIN can be a precursor to the actual cancer cells, and its not uncommon to have HGPIN cells right next to a truly cancerous tumor. Not saying that is the case with you, but again, makes me understand where you are coming from.

My first biopsy showed no cancer, lots of PIN. A year later, after my PSA tripled from 4.x to 12.x, 2nd biopsy, no cancer but instead of PIN, loads of HGPIN, especially in two particular portions of my prostate.

Less than 2 months later, after my doctor pleaded with me, he did the 3rd one, went in with only 7 cores into the shadows he had seen on the scan, and there it was, a mother lode of Gleason 7 cancer, surrounded by even more HGPIN cells.

His point, the standard 6-14 core biopsies can simply miss the cancer, plain and simple. He knew it was there, based on a fast climbing PSA and zero evidence off infection. The needles simply kept missing it.

In hind sight, I am thankful for his insistence. I told him I wanted to wait at least another year before agreeing to the 3rd one. I would have been way wrong, and no telling what cancer situation I would have been in a year later.

So that's the moral of my story. If you have to have another one in the future, my advice is to have what is known as a saturation biopsy, where they can do 20-60 cores at a time. Much less likely to miss something. Wished I had that done on my first, might have caught the cancer when it would have been simpler to deal with.

I don't think your situation is a joke, I view each guy's situation as being unique, and your's is unique as well.

For your sake, I hope you continue to dodge the cancer bullet, but not because a biopsy is missing it, but because you really don't have prostate cancer.

Whether it be a Gleason 6 or a Gleason 10, I don't think anyone has a simple time dealing with prostate cancer, all of the cases are a big deal to the person with the cancer, and each person has their own battles and fears to fight.

Good luck still.

David

Thanks for the responses guys.
In reexamining my trend, i noted that the PSA was just under a double, in 2 years. Would that be concerning? (Notwithstanding the docs comment about doubling in 1 year being a concern)

My advice is to continue to take Peter Disabelard's (and your doctor's) sage advice. PSA kinetics have been found to be a poor predictor of a positive biopsy. Perhaps take a class in Mindfulness - it would serve you better than fruitless worrying.

- Allen

Pratoman,
You do what your "gut" tells you to do... Take all the advice that you have gathered and then make the decision.
For what it's worth my PSA went up from 2.54 to 3.04 in one year. Because I had a father and two grandfathers who died of prostate cancer I had been diligent about tracking my PSA for 15 years. I made an appointment with a well known urologist who asked why I was there and then told me to come back in six months for a PSA retest. At first, I felt good about the recommendation but after further deliberation I made another appointment with a different highly regarded urologist. I met with the doctor who like the first asked me why I was here... He knew I had seen Dr. Z because they were both in the same network and my medical records were available to him. He asked what I would do if he said come back in six months. I told him I would seek out another urologist. He said then let's do the biopsy. It will either tell you its something you need to pursue or it will put your mind at ease. As you can see from my signature cancer was found. All that to say that at the end of the day it's your call... You have to do what you believe is the right thing for you.

Prat:

I think Tall Allen was being a bit harsh on you (Tall-- this isn't like you).

Some people are just worriers. I never used to be... until my PSA crossed the old 4.0 threshold. Guess I should have worried sooner.

Anyway, I think you should try not to obsess over this, but yes there is reason to be concerned.

I did notice your PCA3 was 13. That is fantastic. I, too, did a PCA3, hoping to stop worrying at that point. Unfortunately, mine was about 70 (the worry point is 35). So, that is a real good indicator that you do not have PC.

I guess you should just keep monitoring the situation.

Mel

Peter:

It just sounded a bit harsh and very uncharacteristic.

No big deal

Mel

Mel,

As PDA says, I am a true believer with a bullhorn about Mindfulness. It is the antidote to fruitless worrying because it keeps one's focus on the present moment rather than on some imagined future that may or may not eventuate. Worrying is a cause of distress, and can be unlearned. Accepting and dealing with things as they are now is a much more beneficial behavior. Thanks for providing the opportunity to whip out my bullhorn.

- Allen

Tall:

This is a serious question.....
Can you give me some resources to learn about mindfullness so i stop wasting good time worrying about what might happen?
Serious, really.

Pratoman-

Mindfulness classes are available in most major cities. Just Google "Mindfulness" and the city you are in. You can also buy CDs by Jon Kabat-Zinn and others that will take you through a series of Mindfulness exercises. But I recommend practicing with a group at first if there is one convenient to where you live. The key is to keep practicing. I found that after just a few weeks, I was able to condition myself to trigger a Mindful state of mind at will. It's amazingly simple to learn. It has been shown to increase the brain's neuroplasticity with practice. I hope you enjoy it as much as I do.

- Allen

I'm another guy who has not been diagnosed with prostate cancer, but has anxiety about it because my dad died of it and I have a higher-than-typical-for-my-age psa level. I try not to worry about it (but I fail). The mindfulness training sounds like a good idea.

For Pratoman, IF you wanted to do some more testing, short of a bx, you could consider:

(1) a prostate MRI (these come in a variety of flavors -- different magnet strengths, with or without a coil inserted in your posterior, with or without contrast, etc.). If the MRI showed something suspicious, that would be reason for a bx, and the doctor might know where to aim his needles

(2) this test, which melds psa level, PCA 3 score, and a genetic test, and gives you an estimated percentage likelihood of prostate cancer and high grade (which they define as > Gleason 6) prostate cancer: http://www.pathology.med.umich.edu/handbook/?search=MIPS

(3) some other tests that are being developed, such as this one: http://www.bostwicklaboratories.com/Company/News/MDxHealth-and-Bostwick-Laboratories.aspx

Or you could just take your doctor's advice and come back in 6 months.

Best wishes,
Another Worrier