Without more details, we can only guess.  Also, we are not ourselves
pathologists or urologists, so we can only try to relate this to our own
experiences and reading.   It would be best to ask the urologist about it.

Having said that, let me make a stab at it.   Sometimes, one of the
prostate samples may seem to be borderline as to the presence of cancer.
 A second biopsy with more samples convinced the urologist that there
wasn't anything currently there.   But he is continuing to follow the
PSA to see if it keeps rising.   If it does, he will probably order
another biopsy further down the line.   There is also another test
called a free PSA test.   There are two kinds of PSA, and the percentage
of so-called free PSA can help determine whether the rise in PSA is more
likely to be due to cancer as opposed to other benign causes.   Men with
high free PSA percentages typically don't have cancer and can avoid
repeated biopsies.  You or your husband might ask his uroloist about
such a test.

It does seem that your husband's urologist is continuing to monitor the
situation.   The likelihood is still that your husband doesn't have
prostate cancer, but he should definitely go for further PSA tests as
recommended by his urologist.   Worrying about something that probably
won't happen is not going to make it less likely, so at this point you
should assume the best rather than the worst.   But just make sure that
your husband does go back for more PSA tests.

Angela,

By asking about this, you may be saving your husband's life.  So my
compliments to you.

Now I am not a doctor, so I can't give any medical advice.  But in cases
where it is questionable whether or not the biopsy has found cancer, it is
usual to request a second opinion on the biopsy slides.  How you get that
from the NHS I don't know.  Persistence, I guess.  And you specifically want
to ask for the Gleason score.  That is a predictor of whether or not the
cancer will spread.  http://urology.jhu.edu/Partin_tables/

I'm an American, but my wife is British and we have flats in both countries.
So I know that the NHS has a different attitude toward prostate cancer than
doctors in the States.  Because the NHS is so short of money, it does not
even do PSA screening.  I think that in your husband's case, because it
cannot be demonstrated for certain that this cancer will kill him, the
doctor is doing what is called "watchful waiting."  I predict that Martin
will only be offered treatment if his rising PSA or a subsequent biopsy
justify it.

I found that approach unacceptable when I was diagnosed at age 52.  I had my
case cured by surgery here in the States, knowing that if I took a chance
and waited, and by then I was retired and in the UK, the NHS would
watch-and-wait just as it is doing with your husband.

So how exactly do you get action out of the NHS?  Is there an ombudsman at
your local NHS trust?  Would it be too embarassing to go to the local paper
or your MP?  What about that new system of sending overflow patients to
France?  French surgeons have been reporting excellent results with radical
prostatectomy for years.

jimhoney

There are others in this NG far more knowledgeable than I am who will
no doubt provide a more informed response, but it sounds to me as if
Martin does indeed have very little to worry about.  Given his family
history, it's possible that he has some cancer just beginning to form
that the biopsy may have missed.  If that's the case, he has plenty of
time to monitor the situation and investigate treatment options.  Like
him, I was ready to throw in the towel when I was told I had prostate
cancer, but I have learned since then that my fears were groundless.
If caught early, this disease is almost 100% curable.

Angela:

Did the urologist who said there was a small area of cancer give you
any other information, such as his gleason score or tumor level like
t1c ect?  When the cancer is small it can sometimes be missed in a
biopsy.  This is a slow growing cancer, however the earlier you do
something about it the better.  Most men are in denial, and are
looking for the "come back in 3 months" so they can ignore it a little
while longer.  My husband wasn't even going to go for the biopsy, but
I nagged him into it.  If his brother died of prostate cancer, I would
not put off doing something about it.  If caught early enough this
does not have to be a death sentence.  Are there any other urologist
in your area? Seems like a second opinion might help.

You will get some great advice on this ng from the guys, and the few
wives that post here.

Husband DX age 55 Jan 2004
PSA 3.9
Gleason 6 (3+3)  
T1C
Robotic LRP 3-15-04

   Get yourself another opinion RIGHT NOW. Travel if you have to. Bring
copies of the pathology report.

Hi, Angela.  Welcome to our little newgroup.

We are not doctors, but in my opinion, you are not getting told accurate
information or not hearing it accurately.

Hundreds of thousands of men are dx'd with prostate cancer annually, so it
is common enough that you should be concerned for Martin.  A PSA above 4.0
is further cause for concern.  It is usually a sign of some prostate
problem, not necessarily cancer.  A rise from 4.9 to 5.9 in six weks is
further cause for concern, but still maybe not cancer.  The DRE showing an
enlarged prostate is still more concern, but still not necessarily cancer.
And, being smooth, it might be less concern for cancer.  But, at this point
something should be done for Martin.  He should have been put on Cipro or
another heavy duty antibotic to see if that had an effect on the prostate.
The can help reduce the concern for cancer.

Now on to the biopsy.  If he had a 6-core biopsy, I'd fire the urologist
that did it.  If he can't tell whether there was cancer, I'd fire him again.
I would then take the "suspicious" core to someone who is an expert at
grading cancers.  That 12 core sampling doesn't change the suspicious core
they found on the first one.

However, on the bright side, if Martin has cancer, it must be very, very
small and in it's very first stages.  I agree, at this point, going for
another PSA in May is a viable option.  At that time, he should ask
specifically for a FreePSA test.  That will give your doc(s) a better
indication than just a straight PSA.

Prostate cancer can be heredity-based (mine certainly is), but usually only
when it occurs very early in life, like in the 40s.

You are correct.  It is not over and done with.  Something is causing
Martin's PSA and enlarged prostate.  He's got to find out what it is.  Right
now, without a May result in hand, I'd say there is a better liklihood that
his problems are benign, but he has to find out.

Hello, Angela.

I can only speak from personal experience (boy! can't we all?) and tell you
that this nsg is a great source of information on this topic. Hang in here
and you'll quickly learn quite a bit about prostate cancer and what people
that post here are doing (have done) about it.

I'm 57 and in my own case, except for an elevated PSA, I was completely
asymptomatic the entire time I was being worked up for prostate cancer. That
is, right up until the final diagnosis and subsequent RRP (radical
retropubic prostatectomy) I had this past Feb.

Prior to my final diagnosis, all my DREs were normal. I had no associated
symptoms, such as enlarged prostate, nodules, urinary frequency, burning,
pain, discomfort, etc., just an persistently elevated PSA that, ironically,
actually kept getting lower each time it was taken, though it still remained
above the 4.0 ceiling.

My first biopsy (a 12-core transrectal ultrasound) was "normal" except, like
in your husband's case, the urologist found "an area of concern," that
turned out to be PINs (prostatic intraepithelial neoplasia), a marker or
pre-cursor of subsequent prostate cancer. Realizing that the transrectal
ultrasound biopsy only had access to the rear (posterior) side of the gland
and missed the entire front and lateral sides, we decided to pursue a
transpubic MRI-assisted needle biopsy in the hospital under general
anesthesia, taking a sample of 24 cores from both front and rear as well as
right and left sides of the gland -- considerably more thorough than my
earlier 12-core transrectal biopsy.

This follow-up biopsy resulted in 6 of the 24 cores of tissue sampled
showing up as "positive" for cancer, with a Gleason staging score of 6. The
Gleason score is a way of assigning an "aggressivity" grade to the cancer
tissue, with a 6 being in the middle of the range and not generally
associated with metastases or cancer spread. It would be informative to know
what your husband's Gleason score is.

Well, needless to say, there was nothing else to find out or decide. I had
cancer of the prostate and, to sum up, I subsequently decided to have the
prostate removed. I read a lot of posts here, including those that referred
me to outside reasding materials. These were all intrumental in helping me
decide on treatment options I would pursue.

During this process I learned that the risk of developing prostate cance
among men goes up tremendously if a primary male blood relative, such as a
father or brother, has been diagnosed with it. So, I quickly alerted my
brother (3 years younger) and cautioned my son to start thinkking PSA when
he turns 40.  I noted in your post that your husband's brother, in fact,
died of prostate cancer.

So, in my humble non-medical opinion, I would encourage your husband to
pursue this further and not close the book on it, since he does appear to
have an "area of small cancer" that, given all the facts you've provided,
appears to still be at a very early and, thus, curable stage.

Mine's all gone and never spread beyond the prostate, according to the
pathology report I received from the surgeon. I'm thankful that my urologist
and I decided to persist and pursue this to the very end. I'm confident my
decision to do so has added quite a few years to my life.

Best wishes,

Ed

The fact that the 12 core biopsy was negative is irrelevent.  The cancer found
in the 6 core biopsy is difinitive.  Your husband has prostate cancer.  At this
stage there is a very good chance of curing it.  I am not a physician and am
not giving medical advice, but find yourself another physician.  If the Gleason
Score was 2 or 3, you could wait, probably, but your physicians' colleague said
the word "cancer".  17 May of 2004 is only 6 weeks away- you can wait that long
safely.  If he has prostate cancer, his PSA should be about 7.0 by that time,
at the rate of increase he had between the first two readings.