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newbie - appt. with urologist

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Posted 3/24/2016 10:18 PM (GMT 0)
Hi Guys, I could really use your expertise right now. I am 66 years old and have an appointment with an urologist on 4/4. Had a physical recently and psa came in at 6.8ng. with free psa at 1.0ng. DRE negative. Had another psa test 30 days later after being placed on a 10 day regiment of Cipro. New psa came in at 6.5ng and free psa at 1.0ng. Now waiting for urologist appt.

My prior psa tests are as follows:
11/04 - 1.89ng psa - 1.0ng free
02/11 - 3.44ng psa - 0.90ng free
2/12 - 3.58ng psa - 0.84ng free
2/13 - 4.72ng psa - 1.01ng

I have been healthy all my life and foolishly did not pay much attention to my lab results since my Dr. didn't seem concerned. He recently retired and after my new Dr. got results from my recent physical he immediately started the Cipro. It was a wake-up call for me and my research of Pca began in earnest. From your experience, does this look like Pca?

Post Edited (oldboy) : 3/24/2016 4:37:32 PM (GMT-6)

Posted 3/24/2016 11:55 PM (GMT 0)
How big is your prostate?
Posted 3/24/2016 11:57 PM (GMT 0)
Old boy
Like you I had a sudden rise in PSA after enduring BPH for ten years. I was on meds to reduce prostate size and open up the urethra so I thought everything was under control. PSA velocity ( sudden increase) sent me for a biopsy. Then I got the bad news.
I think a biopsy is your next step. Good luck.
Bob
Posted 3/25/2016 12:52 AM (GMT 0)
Tall Allen, I didn't know enough to ask my GP. I'm sure the urologist will do a DRE and I will ask him.

Break60, trying to learn all I can about velocity, etc. Psa seems to be doubling at a rate of about every four years right now but since I don't know the size of my prostrate right now I don't have a clue what that means.

What about the biopsy? I have read about 3t mri guided biopsy? Are they worth it?
Posted 3/25/2016 1:12 AM (GMT 0)
Depending on your prostate size, that may explain your elevated PSA. Your free PSA isn't raising any red flags. There is a relatively inexpensive blood test called PHI that is somewhat more accurate than PSA alone. PSA velocity and doubling time is irrelevant for men before a diagnosis. No, you don't need any fancy imaging for a first biopsy - save that for later ones, if needed.

- Allen
Posted 3/25/2016 1:25 AM (GMT 0)
The Urologist will probably want to do a biopsy...While unpleasant, it's not that big a deal.. While you are waiting for that, pick up a copy of Dr. Walsh's book "Surviving Prostate Cancer" and at least learn what your doctors may (or may not) be talking about. Know your enemy....
Posted 3/25/2016 1:46 AM (GMT 0)
I really appreciate the feedback. Based on my info is it really reasonable to hope for something else other than Pca? Even if I have a negative biopsy, how much higher can my psa go without it being Pca?

I'm still working and plan on continuing to about 72 if at all possible. Right now I have private insurance through the company I work for. Is there a difference in quality of treatment between private insurance and Medicare? My yearly out of pocket max is about $5,500 a year (a lot more for out of plan treatment). Would I be better off with Medicare and a Medigap plan?
Posted 3/25/2016 3:19 AM (GMT 0)
Old, I've never gotten a good answer for your question about how high psa can go before being PCa, but I have known several men with results between 8 and 10 that have had multiple negative biopsies and scans.

Biopsies are not without some risk. Two of mine caused pain and elevated psa's that lasted for up to six months. I would suggest the PHI test that TA mentioned, before any biopsy.

But, that said, you have a somewhat abnormal psa and it needs to be investigated, which may include biopsy. A 3T mpMRI would determine if there are suspicious areas in your prostate, and provide a target template for a biopsy needles to follow-up for a definite determination. But, this is presently unusual for a first-time biopsy, which is usually "blind".

I've had many ultrasounds, MRIs, biopsies, genomics and blood and urine tests, and never paid one cent. I am on Medicare.
Posted 3/25/2016 3:41 AM (GMT 0)
Welcome to HW, sorry you need to be here.

To answer a couple of your questions, as has been mentioned, high PSA isn't always PC, so yes it's very possible to be something else. That's why you need to talk to the doc.

On the insurance, my brother turns 65 this summer and after a bit of investigation found that Medicare with a senior medi-gap plan provides much better insurance than the one he gets through his wife's employer (his employer's plan is very bad so he uses his wife's). At 66 it's well worth looking into. My wife has a plan like that too and all we pay is normal co-pays for visits and meds.

Hang in there,
Andrew
Posted 3/25/2016 12:08 PM (GMT 0)
Somewhere or other (probably in here) I heard it said that PSA is your "check engine light". By itself, it doesn't mean a lot other than something is going on under the hood. The fact that yours didn't change much after a course of Cipro suggests that it's not an infection.

Like it or not, a TRUS biopsy is likely in your future. They'll put an ultrasound probe up your butt, put a little lidocaine in there, and take 12 samples through the rectal wall into the prostate. Yep, it's as unpleasant as it sounds, but it's over in a few minutes. They'll give you some more cipro to take the evening before and the morning of, and an enema to use that morning. Plus a shot of more antibiotic in your butt. THAT was the worst part for me, it was sore for a week or more.

Afterwards, you'll pee out some blood clots for a week or so. Your semen will have blood in it for a few weeks. After 5-10 days you'll have your biopsy results. When you get them, if they come in positive (at your age, it's likely you will have a little bit) and we'll talk you down off the ledge and help you understand what they mean.
Posted 3/25/2016 4:14 PM (GMT 0)
oldboy,

Your PSA is low for PCa, BPH, prostatitis, or urinary retention. For PCa they sometimes break PSA into ranges of 0-10, 10-20, and 20+ -- those ranges are consistent with low risk PC, intermediate risk PC and high risk PC. For BPH, it would be unusual for PSA to go much over 15. Prostatitis and urinary retention can send PSA soaring. Your % free PSA is high (which is good).

So I hope you're beginning to see that you can draw no conclusions based on your current PSA alone.

- Allen
Posted 3/25/2016 4:26 PM (GMT 0)
Hi Oldboy. Good to see you're listening to your prostate's singing finally.

The poets have already brought you up to speed and I would agree with everything they've said so far.

It "may" be something, but your PSA looks like it's been on a consistant rise since 2004.

The other thing that has been consistantly rising since 2004 is your age. The 2 do go hand in hand to a certain degree based on most of the info I have read.

I vote for "no issues" and would urge you to not worry about it, but do attend your Uro appt and see what he has to say.

Wishing you a PCa FREE rest of your life.

 

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