Dear Self,

What is your PSADT?  What is your PSAV?

What other symptoms do you have, besides a very high PSA reading?

Have you had any other tests, such as an endorectal MRI with
spectroscopy?

Please post all the tests you have had, with dates and results, for
better information from us.

Best regards,

laurel

Also, we need your age.  To do the nomograms.
thanks, laurel

Dang, I'm sorry I'm so scattered.  What are the results of your DREs?
(Dates, etc).  Also were they done by a urologist?  A urologist who has
a lot of prostate cancer experience?  A GP?

What is the size of your prostate?  Also, you may as well put the
highlights from the path report on your biospies on here.

What about this inflammation?  What treatment have you had?  Has it
worked?  Have you had your biopsies re-read at a specialist lab, say
Johns Hopkins?

Sorry about the repeated replies.  I'm having a hard time today,
myself.  But your questions are valid, and, depending on your history,
might be cause for concern.  It is *really* hard to have any idea, with
the limited information you have given.  I'm sure sorry you have had
three biopsies.  OMG.

Also tell us what town you live in (or nearest large city) so hopefully
you can get some referrals.

Have you see www.pcri.org?  Lots of info there.  I know how hard it is
to sort through all the information one could find.  Almost impossible.
This group does have the best experience, knowledge, and balance.  You
just have to give them information.

Again, best wishes.

laurel

From: me@mine.com (self)

For two years I have been concerned about a rising PSA, now 9.1, and
falling % free, now 13%.

This is the third time in the last 2 years that I have been biopsied,
now with 16 cores. All cores on all tests were benign, [though with much
inflammation.]

My question is:
I now know, as well as anyone can "know," that I do not presently have
PC.
But in the future what do I do, keep getting biopsied, or do nothing,
and possibly develop PC?
Thank you.

self wrote...snip...

Pat...There are regions of the prostate (such as the transition zone
[TZ]) that cannot be sampled by the normal trans-rectal biopsy.
Trans-perineal biopsy or color doppler ultrasound by an "artist" can
often detect such tumors.  Because of difficult detection, TZ tumors
often grow large and therefor produce significant amounts of PSA.  Here
are a couple of relevant abstracts...Best wishes and good health, Ron

J Urol. 1993 Mar;149(3):510-5. Related Articles, Links

Large, organ confined, impalpable transition zone prostate cancer:
association with metastatic levels of prostate specific antigen.
Stamey TA, Dietrick DD, Issa MM.
Department of Urology, Stanford University School of Medicine,
California.

We present 3 of 25 patients with massive, occult transition zone
cancers 7 to 86 cc in volume. Despite serum prostate specific antigen
(PSA) levels of 150 to 456 ng./ml. (Yang polyclonal assay), all 3 were
organ confined at radical prostatectomy and have undetectable serum PSA
levels by an ultrasensitive assay at 300 to 650 days postoperatively.
This clinical syndrome includes a highly elevated PSA level, benign
prostatic hyperplasia on digital rectal examination, a nondiagnostic
transrectal ultrasound and frequently negative transrectal or perineal
needle biopsies. Clinical recognition of this syndrome plus systematic
biopsies of the transition zone are the keys to diagnosis and potential
cure of these patients. These cases may explain the 10% rate of men who
present with metastatic prostate cancer and a normal rectal
examination, much of the discrepancy between focal cancer on biopsy and
large cancers in radical prostatectomy specimens, and why some men have
an extraordinarily high serum PSA level and organ-confined cancer at
prostatectomy.
-------------------------------------------------------------------------------------------------------------------------
Urology. 2005 Jul;66(1):114-8
Cancer core distribution in patients diagnosed by extended
transperineal prostate biopsy.
Satoh T, Matsumoto K, Fujita T, Tabata K, Okusa H, Tsuboi T, Arakawa T,
Irie A, Egawa S, Baba S.
Department of Urology, Kitasato University School of Medicine,
Sagamihara, Kanagawa, Japan. tsatoh@kitasato-u.ac.jp

OBJECTIVES: To perform systemic 22-core transperineal ultrasound-guided
template prostate biopsies in patients with previous negative
transrectal ultrasound-guided prostate biopsy findings and evaluate the
cancer core distribution.
METHODS: Between April 2001 and December 2003, 128 men underwent
systemic ultrasound-guided biopsy using the transperineal template
technique. All patients had undergone at least one previous set of
biopsies. Prostate biopsy was performed transperineally using an
18-gauge biopsy needle driven by a spring-loaded device. Four biopsies
were obtained anterior to posterior from each of four coronal planes in
the mid-region, and three biopsies were obtained anterior to posterior
from each of two coronal planes in the apical region.
RESULTS: Of the 128 patients, 29 (22.7%) had cancer according to an
extended transperineal biopsy. Patients with prostate cancer had
significantly greater prostate-specific antigen (PSA) levels (11.4
versus 7.6 ng/mL, P = 0.0125), smaller transition zone volumes (12.7
versus 21.2 cm3, P = 0.0012), smaller prostate glands (31.5 versus 44.0
cm3, P = 0.0015), and greater PSA density (0.36 versus 0.19 ng/mL/cm3,
P < 0.0001). The cancer core rates in the mid and apical parts of the
anterior region (5.3% and 8.0%) were significantly greater than in the
mid and apical parts of the posterior region (3.3% and 3.6%, P = 0.0297
and P = 0.0132, respectively).
CONCLUSIONS: The results of our study have shown that transperineal
approaches are appropriate for sampling from the anterior half of the
prostate gland. In patients in whom the diagnosis of prostate cancer is
suspected, we believe that systemic 22-core transperineal
ultrasound-guided template prostate biopsy might be the next optional
diagnostic step after an initial negative prostate biopsy.

PMID: 15992910

You probably do not have cancer.  With inflammation, 9.1 is probably a
reasonable level.  With all the biopsies, cancer would seemingly have to be
extremely, almost intelligently, elusive.

I guess you have to go with your doctors' advice on this one, and that would
drive me nuts.

Pat,

It sounds to me like your doctors are doing the right
thing by giving you three biopsies.  I'm thinking that if
your PSA goes up again in 6 months or a year, then
yet another biopsy might be warranted - though the
doctors will know better than I about that.

Assuming that your PSA is really due to inflammation
and not from cancer, what have you tried to get the
inflammation down?

Some doctors prescribe antibiotics and they work for
some cases of inflamed prostates due to bacterial
infection.  But apparently most cases of prostatitis are
not caused by bacterial infection and do not respond
to antibiotics.

Sometimes anti-inflammatories might work.  You could
try a regular course of ibuprofen or aspirin using
something close to the maximum daily amounts
that are recommended for non-prescription use.  You
might also try curcumin, i.e., curry powder, which is
available in pill form without a prescription and is said
to have strong anti-inflammatory effects.

Some people have used saw palmetto.  I tried it and
my prostatitis went down after about 6 weeks, but
I have no way of knowing whether the saw palmetto
really helped or whether it just cleared up by itself,
which often happens.

As for the issue that Ron raised about cancer developing
in areas that aren't easy to reach in a standard trans
rectal biopsy, I think it's worth bringing that question up
with your urologist.  Maybe they can do an MRI scan
to look at the prostate next time.  That was done for me
and I was told it would reveal any tumors bigger than
some size (maybe .5 millimeters, I don't remember)
In my case I had a big whopper of a tumor and it
showed up as a nasty, ugly, black thing in the MRI.
An MRI can image a much larger field than a standard
biopsy, though if it shows something suspicious, you
still need a real biopsy to find out just what it is.

I sympathize with your predicament.  Cure for
prostatitis is a hit or miss thing.  Doctors don't know
all the causes or cures.  All they can do is try things
that sometimes work.

However, you may be reassured by the fact that some
people suffer from prostatitis for years and years,
getting biopsies from time to time and getting scared
every time they see a high PSA reading, but they never
get cancer.  I have two friends who have had that problem
with high PSA's and prostate pain.  Each of them had the
problem starting about 5 years ago, and neither of them
has yet shown any cancer on a biopsy.

Good luck.

   Alan

Just wondering if you have had any treatment besides biospies.  That's
ridiculous.  Do your doctors think that the prostate is unimportant,
like an appendix, unless it gets cancer?  Obviously there is a problem
with your prostate health and annual biopsies is not a way to deal with
that.  laurel