Confused about what I read here and what dr tells us

I am new here and having trouble with the site.
Husband -64- had PSA 5.7 in December. After reading here had pcp draw free PSA 15.3. I was sure the free would be above 25. Wishful thinking. This week we saw a urologist. He said not to worry all men over 40 have prostate cancer. He did a Dre and sent off urine which would tell him hubs Gleason score?? He said he would call with results and see us in 6 months. He did tell me Prostate was 35 and asymmetrical. Father in law had prostatectomy in 1981- age 64.Lived to be 93. We are going to see a friend who is a urologist next week. I am confused and anxious. Can the pca3 really give a Gleason score?
Thanks fo any help as to what books to read, what questions to ask.
This site is so helpful.

The pca3 test is not definitive for PC and certainly does not determine Gleason. Only a biopsy can do that. There is a scoring with the pca3 that indicates probabilities of PC, but it is not infallible. A low number is supposed to be good. I had four pca3 tests over a 3 year period and all were <5. My last test was just two weeks before I had biopsy and found cancer.

Welcome kit49.

I suggest a new urologist. PSA 5.7 / free PSA 15.3 / asymmetrical DRE then "see me in six months" is disqualifying. Work at it as you would hiring a roofer or a plumber. The bell curve of medical competence is wide. A factor which differentiates the experiences and outcomes of posters here is the quality of their medical teams.

You've friend who is a urologist... ask him/her. Ask other medical professionals. Any friends / acquaintances who've needed urological services? Then interview - network to a uro with excellent competence and communication whose advice you trust.

Best to you -
Wilderness

The most conventional use of the PCA3 test is to help a urologist decide whether or not to do a second biopsy when a patient's PSA and fPSA continue to worsen after an initial negative biopsy. More generally, it gives some additional information that can be used as a guide when a patient falls on the borderline according to the usual tests. There have been studies that suggest that PCA3 is somewhat predictive of the aggressiveness of any disease that might later be found. Often those studies look at combinations of tests that include PCA3 in an overall ranking. These studies often have small sample sizes and look for incompatible end points. And then there are the studies that show that PCA3 has no relation to aggressiveness at all.

You husbands urologist is obviously stuck on the fence. If I were your husband I'd probably encourage the doc to climb down on the biopsy side. But that's just me. I can see the argument for waiting, too.

I'm not a particular fan of the pca3 test. One just before my last biopsy scored a 31.

In 2013, there was debate about a score that would support doing a biopsy or not. Some said 35, some said 25. My uro went with 25, so it supported doing a biopsy. If he'd preferred 35, we might not have done a biopsy when we did.

I'm obviously very glad the biopsy was done, since that found my stage 3 G9 case. These things work on broad averages I suppose. But as a barely positive indicator for what turned out to be a very serious case, I'm not very confident in its predictive ability.

What were his previous PSA results? Velocity (rate of rise) is important, high velocity is a strong indicator of possible PCa. Was his DRE normal?

Kit,

First, Welcome, even though we would just as soon not have you need to be here.

Comments above are useful, and I agree that you need to see a better doc / urologist.

As to the site, let me comment that you should use your signature as a data list, rather than a narrative. When you hit 400 characters (including spaces and editing characters), and try to update it, you'll lose the whole thing. Some folks keep a copy in a text editor so you can see the number of characters as seen by the computer, edit that, and then paste it in to avoid losing the whole thing.

Abbreviate (we have a list of our normal abbreviations in the stickies) and only include key data are the two suggestions I would have.

Kit: Take a deep breath and begin reading a number of the posts. Even if they at first seem like jibberish to you, you will begin to get the hang of it here at HW. Before you know it you will be around the curve.

Roger

I think the key point for you is to get to a qualified, experience Urologist. PC diagnosis is not something for a pcp--no matter how much you like him or her.

The ONLY way to diagnose PC is with a biopsy. MRI's, PHI, free PSA, etc etc give clues about what might be...but only the biopsy, read by a really, really good pathologist, can be diagnostic.

I'd be willing to bet that a urologist will look at all the existing work and recommend a biopsy. Get it done and let us know what the report says.

Kit,

Please talk to the folks at the Arkansas Prostate Cancer Foundation. They are up in the Heights on North Grant St., and can help you with local resources. Tell Bev I sent you. She'll be confused, but I'll sort that out later.

/arprostatecancer.org/

Kit, you don't need an oncologist--at least not yet.

I'll repeat what we say a lot in here: each specialist you encounter will know about their specialty, and will frequently badmouth the other alternatives. You'll just need to keep talking to people until you find one who listens to you, and who lays out a plan that you can live with.

Yesterday we went to uro- we have known him for 40 years. He no longer does biopsies.
He said we need a biopsy. This morning we received a call from first uro’s nurse telling us hubs has
pca3results which show 35% chance of Gleason>7 and 65% chance of cancer being found with
biopsy. We have an appt tomorrow with uro hubs knew as a resident. Hubs is an Rn- managed the OR
for 40 years. I know I am ranting here. Sorry. We do not want to go to hospital A- they are overwhelmed.
Thanks so much for your help here. There is so much we don’t know. My husband is scared.

Met with 3rd URO today. I told him we will pay for an MRI prior to biopsy- if insurance denies it. He said that will help with the biopsy- fusion. This guy is so kind and knowledgeable. Arkansas prostate cancer society recommends him. They will actually sedate hubs during biopsy. The pca3 form that was give to us says that this test is predictive of a Gleason score? This seems to be false advertising. Anyway, in a few weeks we will know something. This forum has helped us so much. So grateful to you.