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Enlarged Prostate/High PSA

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Posted 2/5/2018 4:27 PM (GMT 0)
Hello...my husband has finally been scheduled for a biopsy next week....his doctor today told him he'd never seen someone his age (40) with numbers so high (psa 6.7) and a prostate as large as his....

I guess my question is...is an enlarged prostate a symptom of cancer? He's had an enlarged prostate since he was 32...never had a PSA until this year...his PSA has gone from 5.34 to 7.98 to 6.71 in the past 5 months, after multiple rounds of different antibiotics.

I guess I am trying to figure out what we should brace ourselves for....he has seen 2 doctors and neither of them have said what they lean towards....cancer or infection or what. Everyone seems puzzled by his prostate.

I appreciate your comments...
Posted 2/5/2018 4:39 PM (GMT 0)
In and of itself, no. We have seen many men with huge prostates not be cancerous and men with small prostates be cancerous. What size do they assume the prostate is? Has the DRE been abnormal or just inconclusive? The biopsy will enable them to measure the prostate.

Remember that about half of all biopsies are negative, that is they don't find cancer. The biopsy only samples a very small amount of the prostate. For those men with negative biopsies and persistent high PSA they have to continue to search for the cause of the PSA.
Posted 2/5/2018 4:58 PM (GMT 0)
His doctor must not have had many prostate problem cases. I say this because I have read accounts of men with PSA of 60 who had benign issues, and others with PSA up to 8,000 with prostate cancer. His single-digit readings are nothing in comparison. Also, two points; (1) a fluctuating PSA is more indicative of prostatitis than cancer, as cancer does a steady rise. (2) Most cases of prostatitis do not respond to antibiotics, they just come and go on their own.

BTW, was he told the size of his prostate in grams or cc's? That can be a significant factor in his diagnosis.
Posted 2/5/2018 5:01 PM (GMT 0)
Thanks for your reply.
His DRE's have been fine, other than that he has an enlarged prostate. But, symmetrical and smooth, etc.

His doctor prefers for him to have an MRI before the biopsy, in order to prevent repeat biopsies, but we are in Raleigh ,NC, so it takes some time to have an MRI at Duke...the doctor doesn't want to wait for the MRI at this point, given that it could be months before scheduling the MRI.
Posted 2/5/2018 5:16 PM (GMT 0)
Given that he has a history of enlargement, I would want to do more to determine the cause before I subjected to a biopsy. Has he been specifically treated for BPH? That is different than being treated with antibiotics for suspected prostatitis.

Is his urologist a prostate specialist? That he has never seen that high PSA indicates to me, as AS mentions, that he may not have suffecient experience. If the docs want a MRI first, it is probably worth the wait. In the absence of an abnormal DRE, I don't think the PSA should yet indicate a biopsy. While biopsies are routine, they should be used only when truly indicated. That 50% are negative indicates that too many men are having biopsies before ruling out other conditions.

He could start a course of Avodart which will shrink his prostate and reduce the PSA. Then monitor the PSA and look for increases that would be far more indicative of PCa than what he is seeing now. A smaller prostate may also present a better DRE to determine any abnormalities that may be masked by the enlarged prostate. If the PSA drops and then stabilizes it could indicate that the problem is not cancer.
Posted 2/5/2018 6:45 PM (GMT 0)
I agree with JNF - a biopsy is premature. However, I can certainly see why his doctors are puzzled by a grossly enlarged prostate in a 40 yo man - that is very unusual. I hope he his taking Proscar or Avodart. That will reduce the size of his prostate over time, and get him peeing better. But they take time to work - about 4-6 months to have a measurable effect. It has a couple of side benefits:

(1) it reduces the PSA output due to enlarged prostate (BPH) but doesn't have much effect on any pSA that may be coming from prostate cancer. Rule of thumb is that PSA is reduced by about half. if it doesn't go down, or if it goes down and then comes back up - that would be a good sign that a biopsy is in order.

(2) it prevents low grade prostate cancer, and some think it may be able to shrink low grade, insignificant PC that is already there. i have a friend who had a 120 cc prostate with a very small amount of pc on a biopsy. He took Avodart, which reduced his prostate to about 40 cc, and on 2 subsequent biopsies, they have not been able to find any signs of cancer. He wishes he'd never had the first biopsy.

(3) If after ruling out the more obvious causes of increased PSA he decides to have a biopsy, the biopsy is more likely to detect anything that may be there if his prostate is reduced in size. It's easier to find a needle in a smaller haystack.

Another step he can take is to ask for a Prostate Health Index (PHI) test next time instead of just a PSA (it includes PSA and a lot more). It is inexpensive and covered by insurance. Importantly, it is less affected by BPH and more specific to prostate cancer, so it can help him avoid an unnecessary biopsy.
Posted 2/5/2018 7:00 PM (GMT 0)
Wow, thank you for all of the info....here's the latest as of his morning...

He now has an MRI schedule for next week at Duke Cancer Center....he already had a biopsy appt for next Friday with his urologist....his doc says to have the MRI on Tuesday, and to call him on Thursday to discuss the results...but to plan on having the biopsy.

I feel several things from this....a little anxious that he got in so quickly for the MRI (should take months) and that the biopsy was only mentioned IF the MRI showed anything suspicious....but it seems like his doctor is set on both the MRI and the biopsy happening next week.

Anyways, I'm a giant ball of nerves....hoping he just has a gigantic prostate and we can call it a day....but also not wanting to be naive. Just not sure what to brace myself for....we are young, and have 2 young kids, so this is all overwhelming.
Posted 2/5/2018 7:33 PM (GMT 0)
One thing common among us in this forum is that we have all had biopsies. That is how we know that we have prostate cancer. The biopsy will reveal the volume of the prostate which will have an effect on the treatment options. The doctors, as you say, will not give a diagnosis because they do not have the evidence yet to determine if your husband has cancer or BPH. When you have the results, I am confident that you will get plenty of good information here as I have. I found out that the more I have studied this disease, the more at ease I have become. I will get palladium seeds on the 14th. and feel that will cure me.
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