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Medical Forum / Diseases and Disorders / Prostate Cancer / December 2006Update--PSA rise situation
Well, I previously posted the item below and got a lot of good answers at least confirming that I should be concerned. However, I did follow up and spoke with my regular physician who I regard highly, as well as another physician who I respect (his specialty if internal medicine and gerontology). THey both pretty much supported what my urologist (who is from Univ. of Mich Hospital) said. Given my BPH, this rise is not unusual. So, we will test again in the Spring and go from there. I'm still uneasy about all of this, but now THREE doctors have given me the same advice. I'll keep you all informed anyway! My urologist doesn't seem too concerned. I am 60 1/2 years old. Here's the history below of my PSA scores. Note the increased rise in the recent past. While he is not concerned, my thoughts are to get another PSA in May or so. If it is still increasing at this latest rate, then maybe get at least a Free PSA. At what point is more action in the way of tests needed (and what tests?) 11/2006 3.1 7/2006 2.67 2-05 2.2 3-04 2.15 2-03 2.0 11-01 2.1 10-00 2 10-99 1.7 10-98 1.6 10-97 1.5 10-96 1.3 6-95 1.2 MB How would it hurt to get the free PSA now? My internist used BPH as the reason for my PSA rise (However, my numbers were higher than yours---4's and 5's). I think the free PSA would give you one more bit of data that may put your mind more at rest or give you a more specific direction. > Well, I previously posted the item below and got a lot of good answers at > least confirming that I should be concerned. [quoted text clipped - 32 lines] > > MB I think he is suggesting a free-PSA and some other kind of PSA -- but in about 6 months. (That may better to help ascertain a trend -- but one has to temper this against the dangers of waiting too long -- at this point, I guess I'll go along with the three doctor suggestions) Mel > How would it hurt to get the free PSA now? My internist used BPH as the > reason for my PSA rise (However, my numbers were higher than yours---4's [quoted text clipped - 38 lines] >> >> MB I don't see why they would wait to do a fPSA blood test. I mean it's simple, and a fPSA can help determine the odds of it being cancer or not. I would think the fPSA result would be the determining factor to wait for the biopsy or not. Just my 2 cents though. I was treated for bph for many years, and took 5mg of proscar daily. On 11/7/05 my psa was 1.40, then on 2/6/06 the psa went to 1.77, (velocfity change of 0.37 ) both the urologist and my internist were not concerned, and felt we should wait and retest at a later date. Because of a family history of pca (brother), i demanded that a biopsy be done. Result was 3 positive cores out of 12, with a gleason of 7 ( 4 + 3). I am 69 years old, and had ADT for 8 months (Luperon), and Seeding (palladium), followed by 25 sessions of IMRT. I feel that you have nothing to loose by getting a biopsy, and everything to gain (your life). Note- Due to the fact that i was on proscar, the psa readings above need to be doubled to get a realistic value. A color doppler ultrasound by someone experienced in using this technique to examine prostates, might be a reasonable, non-invasive next step. Of course, if something is seen, a targeted biopsy good be performed..ron > A color doppler ultrasound by someone experienced in using this > technique to examine prostates, might be a reasonable, non-invasive > next step. Of course, if something is seen, a targeted biopsy good be > performed..ron Ron, Do you know what the merits of color doppler ultrasound are as compared to biopsy? Is it being used anywhere as a replacement for biopsy? Is it more or less accurate? I'm asking largely because of the the thread by "Dr. Diaz" with the subject "Prostate biopsies cab be avoided quite often". If you look at Dr. D's website, he makes a ton of outrageous claims and seems to imply, without coming right out and saying, that if you get a color ultrasound (he doesn't use the word doppler) and it comes out clear, you don't need a biopsy. Do you have any thoughts on that? Thanks. Alan Hi Alan...I've inserted my thoughts within your text...Best wishes and good health, ron > > A color doppler ultrasound by someone experienced in using this > > technique to examine prostates, might be a reasonable, non-invasive [quoted text clipped - 5 lines] > Do you know what the merits of color doppler ultrasound are as > compared to biopsy? non-invasive "sees" the entire prostate, not just areas that can be sampled by trans-rectal biopsy much better visualization than standard B&W ultrasound permits targeted biopsy, if desired >Is it being used anywhere as a replacement > for biopsy? Not that I am aware of >Is it more or less accurate? Supposedly it is very accurate when used by an "artist" > I'm asking largely because of the the thread by "Dr. Diaz" with > the subject "Prostate biopsies cab be avoided quite often". If > you look at Dr. D's website, he makes a ton of outrageous claims > and seems to imply, without coming right out and saying, that > if you get a color ultrasound (he doesn't use the word doppler) > and it comes out clear, you don't need a biopsy. I don't know, but I've never heard anyone else say that. I suggested cdus in this case as a non-invasive, possible, next step - not a final diagnostic step. It could be done with or without biopsy. If it were me and the cdus was suspicious, or if my PSA continued to rise, or if my fPSA was low, I'd get a biopsy > Do you have any thoughts on that? > > Thanks. > > Alan Thanks Ron. It sounds like Dr. Diaz is an "artist" alright, but perhaps more of the "con" variety than the "expert" type. If you haven't done so, I suggest you have a look at his website. Alan ... > still uneasy about all of this, but now THREE doctors have given me the same > advice. ... What we have here is a classic case. Patient sees a doctor. Doctor says, do X. Patient says, but I want to do Y. Patient gets a second opinion. 2nd doctor says do X. Patient gets a third opinion. 3rd doctor says do X. Patient still wants to do Y. What should he do? People on this newsgroup are almost all people who have or had prostate cancer, and we're hypersensitive to it. But in this case, you've consulted 3 experts, one a guy you didn't know, but a professor of the specialty involved, and the other two guys that you do know and highly respect. The professor for sure, and all three doctors very possibly, know more than any of us on this newsgroup do. On the one hand, it's your life, not the professor's life. It's easy for him to say everything's okay. His life isn't at stake. But on the other hand, as you say, you've now got three professional opinions all going one way and a bunch of very non-professional opinions that lean the other way. I think at this point I'd follow the doctors' advice. Cancer treatment is no piece of cake. If you do have cancer, and if it can be treated 6 months from now with just as high a probability of success as now, then it might very well be better to wait anyway and enjoy your six months. Think of it as watchful waiting - a reasonable option in some cases even for people that have an actual diagnosis of cancer. What's that you say, you're not enjoying life because of the anxiety? I have a suspicion that if you get a biopsy and it comes back negative, you won't have any less anxiety. You'll worry about whether the doc missed the right spots in the prostate. Maybe it's time to stop obsessing and think about other things. Maybe. I don't know. Who am I to say? Alan Well, I've made an appointment for 4/28 (a little over 4 months from now) and I'll get the tests at that time. So, it's a bit shorter than 6 months. I've consulted 3 doctors and, yes, I am going to go with their opinions (but follow-up in 4 months instead of 6) Mel > ... >> still uneasy about all of this, but now THREE doctors have given me the [quoted text clipped - 53 lines] > > Alan |
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