On June 26, wwcp@infinet.com wrote, in pertinent part:

(snip)

The PSA has almost doubled in only five years. PSA velocity is, if the
numbers given above are accurate, at least 0.6ng/ml/year.

Here is what Dr. Stephen B. Strum says about it: "A PSADT (PSA doubling
time) *shorter than twelve years* and a PSA velocity greater than 0.75
ng/ml/year relates to a greater probability of a malignant condition."
From _A Primer on Prostate Cancer_, Stephen B. Strum, MD and Donna
Pogliano, page 40. Paul's friend should buy this book; it may save his
life.

*IF* the specimens were properly graded and were sent to an expert for
evaluation, it would appear to me that Paul's friend has a problem. it is
well past time to perform further staging tests. He should also ask his
medic what the hell he's been waiting for. The medic doesn't seem
impressive, to put it politely.

BTW, what were the Gleason scores, zero?

The problem, if not PCa, could be BPH, an infection or inflammation. What
else, other than biopsies, has been done?

And there is no reason whatsoever why Paul's friend must suffer "agony"
during a biopsy. Anesthetics are available. Here in Aridzona, the patient
has a legal *right* to pain relief. I suspect that that's so elsewhere. But
the medic should provide relief, required by law or not. If he won't,
fire him and hire one who will. Frankly, if what Paul reports is accurate,
it probably wouldn't be a bad idea to fire him anyway.

Generally, the lower the Gleason, the slower the tumor. I had two (though
only one was known at the time of my failed primary tx), one was
a Gleason 4+5=9, the other 4+4=4. Very bad, very aggressive, not
slow by any stretch of the imagination.

*And* my PSA was relatively low at 5.7 ng/ml.

The biopsy is a helpful staging tool, but there are other tests that
quite possibly his medic hasn't thought of or is ignorant of. The
staging tests I refer to should help to clear up the mystery.

Which, IMO, would have been cleared up long ago by a competent
and knowledgeable medic.

Not necessarily.

Oh yes, it could very well do so.

Paul's friend should refer to the website of the Prostate Cancer
Research Institute at http://prostate-cancer.org/index.html
There, he will find authoritative and objective information, and
learn about the staging tests that evidently are not being done.

Regards,

Steve J

"'MD' does not mean 'Medical Deity.'"
-- Stephen B. Strum, MD

<snip>
I'd be looking for another Clinic where they had a better handle on
doing Biopsies.

I'm fortunate (sic), to have one only 10 needle Biopsy, straight up,
with a valid  report on 9 of the cores sampled, albeit a bit ugly:
4 @ (4+4) G8 averaging 60% malignancy
2 @ (3+4) G7 averaging < 40% malignancy
2 Benign
1 insignificant (not reported in summary)
plus 1 with no report at all (possible misfire)?

With the TRUS imaging used, the picture of the prostate is not so
clear, so  you need a Skilled operator on it to be harvesting cores.

-- Reader to complete...
-- Please reply to this ng as my email adress is fake:

-- Regards

-- CC

Thanks, guys.  I would imagine that being in a relatively new marriage to a
"slightly" younger wife - my 60 year old freind was probably not so afraid
of the the actual biopsy proceedure as he was the resulting bloody SE that
takes quite awhile to get over...

However, I am going to call him tomorrow and give him your very valid points
- and, suggest he consider upgrading urologists... The velocity of that PSA
does have to mean something...  I just can't beleive that if he had PC that
SOMETHING wouldn't have shown up on one of those 20 needles 3 years, ago...
Unless, like you suggest, that the biopsy was done by an incompetent doc...
I'll make sure he gets to a good doc.   thanks again..

Paul

It seems to me that another biopsy is a good idea.  I hated the
idea of getting a biopsy and put it off and off - to my chagrin when
it came back positive.

Some others have said that your friend should go to a different
clinic.  But the fact that they found no cancer doesn't necessarily
mean that the pathologist was no good.  It might mean that, indeed,
there was no cancer.  The fact that the urologist went for a 20
needle biopsy last time indicates to me that he really was exercising
due diligence and trying to find any cancer that was there.

However, just to be sure, if the latest biopsy comes up negative,
or even if it doesn't, your friend might want to ask for a 2nd
opinion on the pathology slides.  Prostate cancer is apparently
difficult to evaluate and not many pathologists are thought to
be really good at it.  But there are some specialists who are
highly respected for their ability to evaluate the specimens.  It
is common to send slides off for a second opinion.

   Alan

You guys have been very helpful... I didn't even know about the perineal
entrance... I knew that was an option for RP, but didn't know it was just
for a biopsy...  Thanks.

I related everything you folks mentioned to him today... and, it then became
apparent that he had quoted his PSA numbers and dates off the top of his
head... which wasn't the best of diaries...  because he pretty much
remembered different values and dates, today... (No, it was a "dry" birthday
party... lol)

So, instead of giving him advise on what to do or who to see.... I dwelled
on how important it is that he should "take charge of his health."   I sent
him right back to his doc to get exact dates and values... And, what the
doc's thought's were on where he stood...  (Not..."you got it", or "you
don't got it." )  AND, BUY THE BOOK...  and, because his doc is the "best"
urologist in this really small town - I told him to get a second opion...

(How'd I do??)

Paul