Hi All. I had Green Light Procedure on December 17th. Took a good month to stop all the bleeding and all healed up fine. Went to the Urologist for my last follow up two weeks ago and he said all is well. I had a PSA test before I left. Was told today that my PSA is 9.5. Before the GL procedure it was 5.9. I had two Biopsies the latest being about a year ago. No Cancer found in either one. Usually PSA goes down after GL. Urologist wants to wait until mid April for a PSA retest. Any one out there ever heard of this happening after Green Light? System I be thinking about a third Biopsy? Thanks..
Nick,
I am not a doctor or clinician, but I would suggest getting a multiparametric (mp) MRI scan to see what is going on in your prostate. A 5.9 PSA reading before having Green Light laser is considered high. A TRUS biopsy regularly misses 40% of clinically significant cancer. The fact that you had two previous TRUS biopsies that were negative does not mean that prostate cancer is not present. Personally, I would avoid any future TRUS biopsies. My advice would be to get an mp MRI scan and if any suspicious areas show up, then ask for an in-bore MRI guided biopsy targeting just the suspicious area. Please feel free to message me if you have trouble locating a facility to get this done.
Best wishes,
Henry
Nick,
Henry52457 is correct, if you want to get checked for cancer get a 3T (3 Tesla) multi parametric MRI. It is less invasive than a biopsy and better at detecting tumors.
It may be possible your getting checked too soon after the Green light procedure. Any procedure that traumatizes the prostate will raise the PSA and it takes time for it to go back down. Other things that will raise the PSA is sexual activity, or antibiotics.
Is it possible you may have a prostate infection, or prostatitis ? That can also raise the PSA. Has your urine or seminal fluid been checked for bacteria ?
Thomas
My PSA was 9.8 prior to my GL procedure... big prostate it was 75 grms = high PSA. About a month later when checked it was down to 5.1. Over the years my prostate regrew to 135 grms and PSA up to around 7.8. After next procedure PSA came down to 0.74 and nearly six years later it is 0.70.
Two months post procedure is not that long and the prostate experienced a lot of trauma or you may have a slight infection. I would not be rushing to have another biopsy.
I'd be pressing for a multi parametric MRI rather than play another game of pin the tail on the donkey (standard biopsy) and risk not finding any significant PCa tumours.
The one big negative issue about GL surgery is no tissue is recovered for examination and if PCa were present in any of the vaporised tissue, there is no way of confirming its presence.
I opted for a HoLEP for this very reason and the tissue that was recovered found the PCa which had been missed during previous biopsies.
Don't forget that increasing PSA can be down to other things as well, such as kidney stones/bladder stones as a seat for continuing infections and if you have had BPH for a long time, stone formation is highly likely, due to prolonged urine retention which is what increased my PSA along with the PCa.
Good luck.
yes, i was told you shouldn't have a PSA test for at least 6 months post procedure.
After my last Thulium/Holmium procedure (similar to HoLep) when commenting to the urologist on the histology samples being cancer free he said that usually cancer cells are found in the outer prostate rather than the inner area removed.
Derek, I'm intrigued by your comment "after my last Thulium/Holmium procedure".
How many have you had so far?
My surgeon said my HoLEP should last my lifetime or 30 years, assuming I last that long and therefore shouldn't need another one. Did the procedure you had not last that long before you required another?
A GL in 2004 and the Thulium/Holmium in 2013 that hopefully was the last needed. I turned down the Uro's suggestion of taking Avodart to keep it in check and said to him at my age do you think it has time to regrow ? He glanced at his screen and noted that I was then 79 and said probably not :-)
What was next procedure? Thanks.
Henry I agree with the 3T MRI with contrast and without contrast. I had one last year. Biopsy was targeted at one spot that showed up which indicated it was probably cancer. They did 16 cores and all were negative.
Thanks for that.
Age plays a great part in decision making and the time eventually comes for us to say "enough is enough".
It's a balancing act for all of one way or another and taking my own problems into account following another recent urological procedure (laser kidney stone removal), how many more such procedures where an intrusive piece of equipment is passed along your urethra and strictures start to develop, the word "enough" dictates how you will live the rest of your life.
By that I mean how much discomfort am I prepared to endure without a procedure to fix something that in itself will cause more discomfort and probably end up causing something else to kick off!
Excellent advice. Say "no" to another TRUS biopsy, and get a scan, preferably a 3T scan. In my opinion, given the availability of a high quality MRI, a blind biopsy should be considered an obsolete procedure.
Re decision making. I met two aging sisters who had "Always resuscitate" tattooed on their chests.
Nick, I have been told that ANY kind of trauma to the prostate can increase PSA. I agree with all the others about the 3T MRI.
I am unfamiliar with the term GL, but believe it is also called KTP laser. If so then I hear that the PSA can rise after treatement, but should stabilise 3-6 months later.
If the PSA at 6 mths is greater than the pre GL PSA then further investigation is needed.
I agree with Henry regarding TRUS bioposies or for that matter any more biopsies. If or when the time comes for further investigation then a 3T MRI is the way to go.
My PSA dropped from 9.8 down to five at my next PSA test after GL.
Great and if at 6 mths it is close to the pre GL reading, then the PSA rise was most likely a side effect of the treatment.
It was 9.8 for a couple of years prior to the GL. Big prostate= high PSA. My retention was around 400 mls when checked.