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Medical Forum / Diseases and Disorders / Prostate Cancer / June 2004plans change
I was wondering if anyone has had this problem. I had an initial psa done in January of this year. It was 28. I then had a free psa about a week later and it was the same. I then had a biopsy where one of 12 cores was positive with a gleason score of 6 (3+3) and the cancer was t1c. I then had a bone scan and an MRI which showed no spreading of the cancer. I had a PSA of 28 on April 28th. I then saw the surgeon and he was concerned that the psa was high and he put me on antibiotics for a month and then I had another PSA which came back the same 28.4. I just came back from the Doctor's and am now in a quandry. The doctor is very worried because my PSA taken last week was still in the high 20's, 29 to be exact. This after a month of antibiotics. He now wants me to have a colorectal MRI and a cat scan. He also put me on 600mg of ibuprofen, 3x's a day. I'll tell you it was not what I expected. I thought we were going to schedule the surgery and now more tests and a doc who is talking lethal and spreading and he is confused with the test results. The doc needs the test so he will know what to do with the surgery. Can someone help me figure this out? Jim Rocks PS Friday, I found out that the Veterans Admin considers Pca a service related disability due to me being in Vietnam. Agent orange causes Pca. Jeez and I volunteered but that is another story for another group. hi jim - well, the good news is this. since it is caused by vietnam related and you can prove that you were "in" vietnam, then you've got a good chunk of money coming your way. the bad news is that they don't know why the psa is as high as it is and they don't want to go into the body until they got a good handle on what they will find. the psa should have came down with the antibiotics, but didn't. that is what they are concerned with. but on the other hand, you have a high free psa which is not characteristic of pca. then turn around and you've got a positive core, confirming your pca. i would ask what % of the core was involved. if it is a low number, then my guess is that you've got a chronic prostate infection that is hard to treat. the other tests should come back neg. if that is correct. but i'm not a doctor. hope this helps. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." > hi jim - well, the good news is this. since it is caused by vietnam > related and you can prove that you were "in" vietnam, then you've got a [quoted text clipped - 8 lines] > free psa which is not characteristic of pca. then turn around and > you've got a positive core, confirming your pca. Prostatitis can cause high PSA. I don't know exactly how high. In any case, most cases of prostatitis are not caused by a bacterial infection and so don't respond to antibiotics. The fact that the cancer is Gleason 6=3+3 is encouraging, but I can see why the surgeon might be concerned. If the cancer had already spread beyond the prostate region, surgery would not be indicated. Perhaps he just wants to be confident that it hasn't spread before going in. > i would ask what % of the core was involved. if it is a low number, > then my guess is that you've got a chronic prostate infection that is [quoted text clipped - 8 lines] > "Many more men die with prostate cancer than of it. Growing old is > invariably fatal. Prostate cancer is only sometimes so." > I was wondering if anyone has had this problem. I had an initial psa > done in January of this year. It was 28. [quoted text clipped - 19 lines] > related disability due to me being in Vietnam. Agent orange causes Pca. > Jeez and I volunteered but that is another story for another group. Sounds very weird to me Jim? They already found positive proof of cancer, so why antibiotics and more PSA tests? I would yell and scream until I had answers.  SignatureJK Sinrod Sinrod Stained Glass Studios www.sinrodstudios.com Coney Island Memories www.sinrodstudios.com/coneymemories The test core was 5%. The doc wants the tests so he knows exactly what he is up against when he goes in. He is from Sloan kettering and has done 100 LPR's in the last 8 months. He wants to do nerve sparing but really wants to make sure I have already seen a MD about this and he concurs with the tests. I am seeing another doc for a second opinion. Alan Wein from the University of Pennsylvania. > > I was wondering if anyone has had this problem. I had an initial psa > > done in January of this year. It was 28. [quoted text clipped - 31 lines] > so why antibiotics and more PSA tests? I would yell and scream until I had > answers. > I was wondering if anyone has had this problem. I had an initial psa > done in January of this year. It was 28. [quoted text clipped - 19 lines] > related disability due to me being in Vietnam. Agent orange causes Pca. > Jeez and I volunteered but that is another story for another group. Jim, I would go for a second opinion as soon as possible. You didn't say whether your Dr is VA connected or not, but he sounds very shaky. An MD Oncologist without a specific tie to Surgery or Radiation would be my suggestion. He can examine you and your records and should be able to give an unbiased opinion on your treatment options. Keep us posted and good luck. Age - 69 8/12/02 - PSA 3.7 10/13/03 - PSA 4.69 11/11/03 - PSA 4.8 11/18/03 - Biopsy - 10 cores one core-25% of core-Gleason 4+4=8 all other cores benign tissue 12/10/03 - Consult - Oncologist MD 12/16/03 - Consult - Radiation Oncologist Treatment Plan - Northeast Ga Cancer Center HT - started 12/17/03 - Eulixen & Lupron (2nd 4 mo Lupron-4/26) 2/10/04 - Started - Flowmax and Megastrol Radiation - IMRT to begin 3/30/04 - 42 treatments - Completed 6/8/04 If Radiation's got you burnin', And quick relief is what you're yearnin' Olfart's Butt Salve does the trick, It puts the fire out - right quick. Available in 1 oz., 1 lb., and the economy size 55 gal. drum My gut instinct is "do something, even if it's wrong". Seems to me it should be treated aggressively rather than sit around doing more studies. Surprising he hasn't even started you on hormone therapy while trying to figure out what to do. My urologists plan of action with me when he discovered my "aggressive" cancer was to start on Zoladex for a few months followed by 25 EBRT's followed by seed implant therapy. I just concluded my seed implants on June 10. Of course, what you do only you can decide but if my opinion is worth anything, I suggest maybe a second opinion is in order. Good luck, Larry > I was wondering if anyone has had this problem. I had an initial psa > done in January of this year. It was 28. [quoted text clipped - 19 lines] > related disability due to me being in Vietnam. Agent orange causes Pca. > Jeez and I volunteered but that is another story for another group. > I was wondering if anyone has had this problem. I had an initial psa > done in January of this year. It was 28. [quoted text clipped - 13 lines] > doc needs the test so he will know what to do with the surgery. Can someone > help me figure this out? You had several PSA tests within 4-5 months. They are coming back ever so slightly elevated each time. It is difficult to tell how fast they are doubling (which is important) but I'd say your cancer is not very aggressive. If you had surgery, your post op biopsy might come back 2+3 or, maybe even 2+2 (though that is unheard of around here). The Ibuprofen confuses me. I'm thinking your doc thinks he has plenty of time and wants to get as much infection (antibiotics) and swelling (Ibuprofen) our of there as possible before the probably surgery. If that's his thinking, I wonder why he didn't hit you with a dose of Lupron, too, to reduce the cancerous tissue in your prostate. In any case, I think it's all preparatory for eventual radical treatment. > PS Friday, I found out that the Veterans Admin considers Pca a service > related disability due to me being in Vietnam. Agent orange causes Pca. > Jeez and I volunteered but that is another story for another group. I think you'd be surprised at how many think that is a story for this group. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .07 .05 Lupron 7/03, 8/03, 12/03, 4/04 That's exactly what the doc thinks. It is an inflamation and he wants it controlled. I am goig to have surgery no matter what and before the summer is out. I just want him to have all the info he needs to see if he can do nerve sparing. If he can't then que sera sera. Jim Rocks > > I was wondering if anyone has had this problem. I had an initial psa > > done in January of this year. It was 28. [quoted text clipped - 41 lines] > > I think you'd be surprised at how many think that is a story for this group. > That's exactly what the doc thinks. It is an inflamation and he wants it > controlled. I am goig to have surgery no matter what and before the summer > is out. I just want him to have all the info he needs to see if he can do > nerve sparing. If he can't then que sera sera. Nerve sparing is desirable, but it's not the end all. I had no nerves spared because the cancer was too invasive. However, 2? years later, I was able to get an erection good enough for .... er.... framing? Since then, I've been on Lupron, so it's not an issue anymore, but remember that nerve sparing isn't necessarily going to bring it back and non-nerve sparing isn't necessrily going to end it all. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .07 .05 Lupron 7/03, 8/03, 12/03, 4/04 >> I was wondering if anyone has had this problem. I had an initial psa >>done in January of this year. It was 28. [quoted text clipped - 49 lines] > his thinking, I wonder why he didn't hit you with a dose of Lupron, too, to > reduce the cancerous tissue in your prostate. My guess isn't any better than yours, but I think the surgeon is considering the possibility that the high PSA may be caused by inflammation unrelated to the cancer. If so an NSAID like ibuprofin may bring it down, and if di that would mean the cancer was not the reason for the high PSA. I think there may be some recent evidence that NSAIDs may help reduce the risk of some cancers, but I doubt if anyone thinks they can slow down prostate cancer in a relatively brief period of time. > In any case, I think it's all preparatory for eventual radical treatment. > [quoted text clipped - 3 lines] > > I think you'd be surprised at how many think that is a story for this group. * I was wondering if anyone has had this problem. I had an initial psa *done in January of this year. It was 28. * I then had a free psa about a week later and it was the same. I then had *a biopsy where one of 12 cores was positive with a gleason score of 6 (3+3) *and the cancer was t1c. I then had a bone scan and an MRI which showed no *spreading of the cancer. I had a PSA of 28 on April 28th. * I then saw the surgeon and he was concerned that the psa was high and he *put me on antibiotics for a month and then I had another PSA which came back *the same 28.4. <snip> When I had blood drawn at the VA, they also found my PSA abnormal, and did the same thing you described. Minus the bone scan and all. I had my private doctor to evaluate it again. I did not allow the VA to proceed with any other procedures after the second PSA test. *PS Friday, I found out that the Veterans Admin considers Pca a service *related disability due to me being in Vietnam. Agent orange causes Pca. Interesting, wonder if PCa is service connected disability for any GI? Al Please be quiet if replying via email, flames will be deleted promptly. I won't even read the whole message... For any GI who has spent time in Nam or was home-based and handling Agent Orange. OTOH, I know someone who spent 2 years on the DMZ and was constantly sprayed with AO. They knew when they were getting doused as their skin burned from it. So far all his PSA's have been normal and he has had no signs of any other cancers. He is checked constantly. Bev > * I was wondering if anyone has had this problem. I had an initial > psa [quoted text clipped - 30 lines] > flames will be deleted promptly. > I won't even read the whole message... Hi Jim, I suspect your physician is having difficulty with the relatively high PSA and relatively low grade, small volume tumor. A PSA of 28 strongly implies that there is already spread of tumor outside the prostate gland. So far, your tests indicate otherwise, which is good. Your free PSA also doesn't quite add up and suggests a non-cancerous cause...hence the trial of antibiotics and antiinflammatory drugs. The endorectal MRI is a sensitive means of looking for local spread of cancer outside the prostate. The CT is to look for metastases as well. While it sounds frustrating for you, I think your doctor is trying to figure out exactly what's going on before plunging ahead with a therapy which may not be curative and leave you with significant side effects...If the tumor really is a Gleason 6 with only minimal gland involvement, you and he have time to sort it out. If there is already spread outside the gland, there is little point in undergoing radical therapy for cure. Best of luck. CPW |
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