Hubby is diagnosed with BPH. His PSA has been high for 5 years or so, ranging from 4-7ish. He has BPH, and had a biopsy a couple of years ago when his psa was at its highest of 7.3.
Doctor said he would eventually need surgery for BPH, but he should wait as long as possible, due to possible side effects.
But his latest PSA came back 9.7. Is this more worrisome for possible cancer again, or just a result of his prostate growing even more?
Experiences with BPH and a PSA this high?
PSA is notoriously poor for predicting cancer and if he had a negative biopsy at 7.3 who’s to say it will be any different at 9.7? It would make sense to have an MRI scan to see if there are any suspicious areas so there can be a more targeted approach in a biopsy leading to diagnosis. It is entirely possible for the “blind archery” approach of taking random samples to miss any areas of concern and return a negative test.
Yes, BPH and PSA between 9 and 11 over the last few years, and prostate around 98 cc. I’ve had 3 biopsies, all negative. I would strongly suggest doing a 3T MRI before doing another biopsy. The MRI may come back with no suspicious areas, and then biopsy most likely not necessary. If MRI comes back with suspicious areas, then another biopsy would be advisable, but it will be a targeted biopsy rather than a “pin the tail on the donkey” random biopsy.
On my third go around, when I learned about MRI diagnostics, I had a 3T MRI. Came back with PIRADS 4/5, which is suspicious, so had targeted biopsy which was negative.
If no cancer for your husband, then consider PAE also when considering surgeries to deal with BPH that are more invasive and have more troubling side-effects
Is your husband on any meds? What are his symptoms?
Rich
I have been fighting BPH for years. PSA always hovers around 6.6. I’ve had two biopsies (both negative) then opted for The Green Light (PVP) procedure in December, 2018. My PSA jumped to 9.9 after the procedure but now enjoy normal emptying of my bladder. No more problems but PSA is still around 8.0. Elevated PSA doesn’t always indicate cancer. My father had the same issue and just passed at the age of 90 from kidney failure. Hope I am just as lucky as him.
When my prostate was growing to 75 grms my PSA gradually went up from an initial 5.0 when it was 35grm to 9.8. I had two negative biopsies in that time. After a GL laser procedure it went back down to 5.1.
As it regrew over time to 135 grms my PSA went up to about 7.8. Amazingly after a second laser procedure in 2013 (Thulium/Holmium it came down to 0.74.
One option is to go to someone like Dr. Karamanian in Houston.You can have a 3T scan done where you live, and then confer with Dr. K. It’s an expensive route as he doesn’t accept Medicare and (I think) other insurance. So it’s about $25 K out of pocket. His FLA procedure addresses any cancer nodes and the BPH, while avoiding access via the urethra. I have a friend who had a similar situation to your husband, and he was totally satisfied with the outcome, as it avoided all the bad side effects of TURP procedures.
PSA scores are so bad at predicting cancer that they don’t statistically save lives. If it would make him feel better, a 3tmri is the best cancer screen.
Waiting on a BPH treatment is a bad idea. Forcing will lead to bladder damage which isn’t always reversible. Someone mentioned PAE - that’s a good option with no enlarged median lobe, not so good with one. Rezum would most likely work regardless - but the first 4 weeks can be messy at time - but permanent side effects are extremely rare. Greenlight works too, but it’s more invasive, requires anesthesia and brings permanent side effects in (RE 50% of the time - incontinence rarely).
He should get a scope and urodynamics test from a doc who does most of the procedures to make an informed decision. And don’t have anyone touch him that hasn’t done that procedure at least 100 times
I should have said that hubby did have an MRI. Don’t know if it was a 3t MRI or not. Based on the suspicious areas on that, they did an mri guided biospy.
Mama,
What was the result of his guided biopsy ? It really should be a 3T MRI. It gives more detailed images than 1.5T MRI. Dr Karamanian in Houston recommends a MP 3T MRI, where MP means Multi Parametric, which means contrast, and prostate protocol among other things. I called his office yesterday, and the admin who answered the phone told me all of the above, she also recommended facilities in my area, from a list they have. She also said that so far (as of 1/29/20) Medicare and insurance companies have not covered their procedure, FLA, Focal Laser Ablation. He may not want to consider FLA, unless cancer was found, because of the cost, $21K to $25K. You also need a good person to read your 3T MRI images, but I believe that if the facility is on their list they have a qualified person to read the images. Dr Karamanian also has a link on his web site for uploading MRI images.
Other things you should find out about your husband’s prostate are:
size
enlarged median lobe or not
Best Wishes,
Thomas
Thanks for the info! I don’t know if it was a 3t or not. I do know that none of the samples came back as cancer. So they have just been watching his psa. His last one was 6.3 six months ago. They just had him repeat it now…so with the jump, I don’t know what the next move will be.
He is already on medications for bph. Also has plenty of symptoms, but only he can decide when that is bad enough to do something about the bph, I guess.
Unless they recommend treating the bph…b/c of the psa? Or is that not a thing, and the psa is only used to determine if they should check for cancer again?
PSA is only for for cancer diagnosis, and not very good at that either. When was his MRI done?
For BPH, The larger the prostate the higher the psa # may be. My 220g size n i register psa of 6.0 early summer n 6.2 October. Negative DREs for many past years…
Are you not going to do anything about your massive prostate ?
2015, I believe. psa at that time was 7.3. His psa’s since then were: 6.3, 6.3, 7.35, 6.3 and this week was 9.7.
Doctor said he would eventually need surgery for BPH, but he should wait as long as possible, due to possible side effects.
That’s an interesting comment coming from a doctor. If his BPH is affecting this quality of life (e.g., getting up multiple times per night to pee, having to go frequently during the day, etc.) he should consider getting some kind of treatment. When my PSA jumped from 3 to 11, my uro did a biopsy and it was negative. About 5 months later I had a TURP (best thing I ever did for my BPH) and the pathology found cancer. I’m in the active surveillance mode now.
For men with very large prostates the PSA number is not very helpful when diagnosing cancer. The range of 4 to 10 cited when talking possible prostate cancer is for normal size prostates around 30 to 40 cc. What is more diganostic is the PSA density which is computed by dividing the PSA number by the prostate size. Numbers less than 0.1 are considered good when worrying about cancer. In my case my PSA number is around 15 and my prostate size is about 300cc ( ten times normal!). So my PSA density = 15/300 = 0.05 which is very good.
Another indicator for prostate cancer is the Free serum PSA which should be greater than 18% though there is some uncertainty whether this applies to BPH patients.
The best test is still the oldest - the simple DRE - since most cancers appear near the surface of the prostate.
Over the years I was subjected to 3 very unnecessary blind TRUS biopsies because my urologists did not understand BPH and were alarmed by my high PSA numbers. Many millions of unnecessary biopsies have been performed for this reason and have left prostates butchered up and infected.
An excellent diagnostic tool is the 3T-MRI with dynamic contrast ( ask for Dotarem only as other contrasts have been implicated in dementia). This will show clinically significant focal lesions that can be targeted for biopsy if they appear suspicious.
The rule of thumb is that there is the same probability of having prostate cancer as our age. So I am 70 which means that if enough biopsies are done there is a 70% chance that at least microscopic cancer cells will be found. But so what! Microscopic cancer cells, that are contained within the prostate may never become important over our lifetimes. This is the problem with blind biopsies - if some cancer cells are seen what do you do about it? Perhaps order an MRI to follow up and see if there are significant lesions that can be selectively removed w/o affecting the whole prostate.
consult next Friday at Univ of Okla Medical Center…i’m done w bacteria infections!
Doctor was being honest about possible side effects of Turp like procedures. Retro ejaculation, incontinence, erectile disfunction, etc.
So doctor called and said he wants to repeat the psa in 4 months. Will figure out a plan, based on that number, I guess.
PSA number can be misleading. Some say that trend is more indicative of something going on in the prostate. PSA in general reflects size of the prostate, but not always. I have prostate about 70-75gr and PSA range between 15- 18 and sometimes spikes to 24. Dr wants to do biopsy , but I opted for 3T scans. I had one 4 years ago, one last year and I just had one in January with no indication of cancer. Bottom line high PSA does not necessarily mean cancer.