I am a 75 years old. My PSA last year was 4.03 this year it has elevated to 5.83. This has me stressed and worried. My urologist has recommend I have a biopsy. I have been reading and go ogling about prostate cancer and biopsies. The more I read and learn,the more confused I get. I am 50- to get a biopsy and 50 not to get one. Taking my life span in consideration I could die of something else if I did have the cancer. This is what I have been finding out through my research. I am presently taking Flomax to help my frequent urination. I Have also learned that they are risks involved with the biopsy. I am going nuts thinking about my elevated PSA result. Any advice coming my way, would be appreciated.
If you can afford it, have a MRI first. If this shows something suspicious, then you can have what is techincally termed a Transperineal Fusion Biopsy (fancy for MRI guided biopsy). There is no chance of infection with this method as the needles enter in the area between the scrotum and anus. In a random method they go through the anus. It is a half day procedure with no pain, followed by a few days of blood spotting into a pad in your undies.
I thought I needed a PAE, and had the MRI as part of the pre-op procedure. The MRI showed a bladder stone to be the culprit behind waterworks problems. Once removed, I was as good as new -- except for one thing. The MRI identified a suspicious area in one lobe that presented as a possible PCa. The aforementioned biopsy showed it was indeed PCa with a Gleason (4+4) 8. After a good deal of research into Radical Prostectamy, Proton Beam Therapy, Photon Beam Therapy plus Brachytherapy, I settled on a Robot-Assisted Prostatectomy.
The procedure was carried out last Thursday afternoon. I was up walking on Friday, and home midday Saturday. I have a catheter and bag for 14 days, and then begin the slow recovery of pelvic muscles to overcome incontinence.
Pathology showed the PCa to be more aggressive than first thought (Gleason 9) and that sampling of the lymph nodes indicated an all clear. That is we acted early and it was still contained in the prostate. The moral here is don't sit about worrying, act early.
I meant to add that my PSA was 2.4 to 3.5 over a decade. I would not rely on PSA or even a digital rectal examination. These showed nothing in my case.
Hello Roger2Dodger... I know the stress you are going through. My PSA went from 4.0 to 5.2. My urologist prescribed an antibiotic to make sure the raise in PSA was not an infection. After the antibiotic, the PSA went to 5.1 which I thought was good. He said no and suggested the biopsy which he scheduled for the next week. This was last October. I was told to arrive 30 minutes earlier than the scheduled biopsy procedure. This was because they would give me some kind of numbing agent prior. Honestly, what ever numbing agent they gave me was not effective at all. The biopsy was not pleasant - but tollerable. I have heard from other people that the biopsy was not painful, so I still wonder if what the assistant used was not the right thing... I would ask your urologist what they would use to numb the area for the biopsy. I was given antibiotics to take before the biopsy and to continue a few days after to help prevent any infection. I think this is a very good idea too. Follow the directions from your urologist - including an enema the morning of the biopsy... this also helps prevent infection. The procedure takes roughly 20 minutes or so and you go home. That day you are a bit sore - but take some ibuprofen and it helps greatly. I developed prostatitis from the biopsy - which my urologist said was probably already there, the biopsy just brought it forward. I was also given Avodate due to a slightly enlarged prostate. At first I wasn't sure if the discomfort I was feeling (sort of like I had a golf ball up my back side) was from the Avodate, or the biopsy. The doc told me it was the prostatitis and gave me another regimen of antibiotic which cleared everthing up. The biopsy came back 3 days later - it indicated 2 out of the 12 core samples had some cancer cells. 1 sample was 10%, the other was only 2%. My urologist said that put me the the 'low risk' group. After the antibiotic for the prostatiis, my PSA went down to 2.0 which he said was very good. The biopsy is important because it will give you your Gleason score. That number will help determine a good treatment option. 6 or less is good. Mine turned out to be 6. And with the lower PSA of 2.0. he said I could even do the 'active survailence' option which lets you monitor the situation every 3 months or so. Then he said if the PSA rises againi, another biopsy - ouch! I just felt like I should deal with it now and get it over with. I am in reasonably good health otherwise, and I thought it I wait longer it would be harder to deal. I researched many treatment options and I think for me the Brachytherapy (low dose radiation seed implants) was a good choice. I had that done 3 weeks ago... and I am doing pretty good. It is a one time treatment done as an outpatient procedure. It takes about an hour. The ibuprofen helps with discomfort after - and it was not any more painful than the biopsy - but at least you are asleep during this one.The first few days it is a bit painful urinating - sort of buring sensation. Not terrible, just uncomfortable. The doc also put me on Tamulosin (generic Flomax) even though I did not have a problem with urination he said this was a precaution. And probably a good idea to keep everytihing working. I have my follow up with the urilogist and the radiation oncologist next Monday. In the first 2 weeks, All treatment options have side effects, but most all will go away from what I've read and been told. I think the Brachytherapy has the fewest side effects, and after a few months, all the radiation is gone. My urologist told me that the side effects will peak at about 3 to 4 months - then be less and less. As I go into the 3rd week after treatment, I feel pretty good. If I start feeling a little discomfort, the ibuprofen seems to knock it out. If I can tell you anything further, please ask. I know this is a tough time. The biopsy should be done to see what options are available for you. Also, what ever you consider, just make sure your doctors have performed that procedure successfully many times. Also, ask you doctor what treatment he would do if it were him or a relative with the same diagnosis as you. Good luck to you.
Charles
Hi Roger ,my PSA was 4.1 two years ago and last December went up to 8. I went to few urologists and all said I shoulg go for biopsy. I didn't. I ran few tests for biomarkers for cancer ( any test related to PSA is not in my favor, and any test which does not include the psa in the algorithm shows less probability of finding cancer in a biopsy ). My point is that psa is not specific, and many reasons other than cancer can cause the psa numbers to go up.
The more important thing is to check if anybody from your immediate family died from prostate cancer ( if immediate relatives had BPH, it is not cause for alarm ).
I am 68 years old and I feel and research shows that i will live same length of time without treatment, as with treatment that will ruin my quality of life.
Don't make decisions under stress or anxiety. Prostate cancer is most likely indolent and grows very slowly, so you have time. Family might put pressure on you ( but you are the one to read and research and you should be the most informative one ), so don't rush into a decision.
You are worrying needlessly. The change in PSA could easily be mere differences in test samples and is in no way significant even were it accurate. Plus the rise in PSA is very slow (look up doubling time). You can get on the diagnostic treadmill if you like, but I would suggest you read the US Preventative Services Task Force Recommendations on Prostate Cancer regarding both diagnosis and treatment. If you can't simply let go of this, then look up the recent article in Science Daily on predicting aggressiveness of prostate cancer before surgery with a blood test. You would be suprised to learn that testosterone levels (too low) predict Gleason score (too high). The authors of the article suggest the possibility that if your testosterone is too low you might supplement testosterone.
Realistically, you have nothing to be concerned about. Carl
You have to do what you think is right, but if it were me I would not have a biopsy. I would keep getting PSA tests to see if it rapidly goes up. Biopsy can be harmful and even deadly do to infection. Slow growing cancer can take many years to be a problem. Many men will have pc at your age but do nothing because it isn't causing symptoms. Most likely you will not die from it. But again you have to do what you think is right for you. I am 47 and having trouble but I would pass even at my age. I figure I will die of something else.
I am 60. In 7 months my PSA rose from 2.6 to 6.8. I visited 2 urologists and both told me to get a biopsy. After reading Dr Jay Cohen's book on prostate breakthroughs, I decided to try to solve it on my own without a biopsy. There are serious risks that need to be considered when getting a prostate biopsy. There is a relatively new blood test called the 4KScore which gives an accurate probability of having serious prostate cancer. I decided to have the test done and the result was I had a 7% probability of prostate cancer. To followup, I went to a clinic and had a special ultrasound done which showed no signs of prostate cancer, but possibly an infection. I took the antibiotic Septra and my PSA went down to 2,1.
The PSA test has around an 80% false positive. That means that as many as 80% of people with high PSA do not have prostate cancer.
I would consider asking your doctor to prescribe the antibiotic for an infection first, to see if that lowers the PSA, and if not, get a non-invasive diagnostic test such as color doppler ultrasound, MRI or 4KScore test.
Hi Roger2
You have no need to worry at this stage, your PSA count is actually quite low, my oncologist told me he would not be concerned till my PSA was above ten, at one time mine was 7.6
They put me on hormone treatment and straight away it dropped to 0.6.
There are many other things that will bring the Grim Reaper knocking on our door,
I have a blood test every year it's called a watch and wait policy.
Good luck and talk to an oncologist and put your mind at ease
John
Thank you for your information on the MRI Guided biopsy. Apparently medicare does not pay for this procedure. I shall explore the procedure and will discuss this with my Urologists. I can pay for this out of pocket.
Hello Charles, our PSA scores are about ther same. Only yours were a little lower. My urologist has not mentioned any antibiotic for infection. This Urologist seems to give me an uneasy feeling regarding his care. I went to him whem my PSA was 4.03 he was not concerned at all, he flat out told me I had no cancer. he prescribed FLOMAX taken twice a day and sent me on his way. My family Doctor ordered this second PSA March, 1 and it elevated to 5.88. I went back to my urologist and he more or less gave me the option of If I had cancer, I would probably die from something else before the prostate cancer wouild kill me. I told him I wanted to know for sure if i had cancer. I did not want to wake up every moting wondering if I had cancer or not. So, he told me the only way to find out was do a biopsy. I took it on my self, and paid out of pocket and had another PSA test done to make sure the 5.88 was accurate. He came back at 5.83 confirmed it was. So, today I am going to call and have the biospy performed. Your story has helped me, just the unknown is getting to me. I will just man up and do waht I have to do , to get through this. If the stress and anxiery dont get me first. Thanks, again Charles!
Helllo Marcos, I truly apprecite your story. My thinking on the biopsy was same as yours. 50- to have on -50 not to have one. Quality of life is very important to me also. I am a healthy 75 year old and I sure don't want to have the Incontinence AND Impotence that can happen after treatment. The only factor that concerns me is, My research tells me that if your PSA score goes up more that .75 within one year, cancer could be present. Mine is well over that, And that causes me concerns. To my knowledge no one died form prostate cancer. Knowing the significant rise in justy one year will probably pull me to the Biopsy. Your case does give one hope to avoid all the invasive treatments that goes with the biopsy. I truly appreciate your reply.I am stilll mulling over this, but just about at the ropes end.
Hi Roger2Dodger,
From our experience, pls do not go for biopsy (i.e. the random / blind biopsy), if its unavoidable, pls do it with the guidance from MRI.
This rise in PSA might be due to infection also. Pls do not worry.
You can have an ultrasound to check if it shows some infection in the prostate.
Hey Carl, You sure made me feel relieved and put some anxiety aside after reading your reply. Like I told Marcos, the concern I have is the sigingicant difference in my score last March and the present score this March. any riase over .75 is of a concern for cancer. I copied a pasted your recommendations on the articles you mentioned. And I will surely read them. Thanks for your advice, and more I read, the anxiety is not as great. I am sure glad i found this discussion forum, very helpful and informative!
Hi Craig. I appreciate your positive thinking on a biopsy and the cancer itself. The more I read my anxiety level goes down. I am a worry wart any ways and have an anxiety disorder, which I take antivan for that. I am just going to man up and and make my decision soon. YES, The risks of biopsy are a concern of mine. Dang if you do, dang if tou don't. Thats me right now. Thanks again!
Hey Bruce,The numbers you specified (80% of people with high PSA do not have prostate cancer. is certainly somethig to ponder. I just got taking antibotics for 2 weeks in the latter part of January for diverticulitis. It just amazes me that urologists do not suggest tests as you just described. In all probability they make good money doing Biopisies. I thank you for your reply. Your intestinal fortitude to do things on tour own I can appreciate!
Attempt82.
Active Surveillance I have considered. As I stated in a reply previously Urologists do not give any options, except a biopsy. What is the difference between a onocolgist and a urologist? Than you for the advice. This decision is on me, And i am going to take additional time to make my decision. The risks of a biopsy just adds to the anxitey and stress. Thank you for your story. This forum have given more education about prostate than all the times I have spent on research . Thanks again!!!
Hello Meenal22,
In another thread, I indicated I was on antobotics for 2 weeks in latter part of january. for diverticulitis . So, infection might not be the cause. It's very strange my urologist didn't mention a MRI. He told me the only way to derermine cancer or not was a biopsy. I will certainly run this across my urologist ASAP. BTY- I am getting more and more skeptical of my urologist after reading the threads in this forum. Again TKS!
I would agree. A high resolution 3T MRI can show if there is a problem and can be used for guiding the biopsy needle if you decide to have it done. I have read some bad stories about biopsy causing damage that can't be reversed. Your PSA rise isn't all that unusual for someone your age. I would be more scared if it went over 10. remember that BPH will also cause a rise in PSA and that is very common. The PSA test wasn't designed to detect cancer in men it was designed to see if it was coming back in those with cancer that was previously treated. There are so many false positives with PSA. It really can't predict cancer unless it is super high. Over 10, but even then it can be wrong.
I agree.