Wayne....maybe you'd want to look into a color doppler test. Take a
look at the thread started on Feb 1st titled "diagnosis" for a
discussion of this. Otherwise, I would do an early PSA follow up, and
then re-assess.

I'm not a doctor and my advice is worth every penny you are paying me
for it (or less).

Fred

On February 3, Wayne wrote:

(snip)

I wonder whether Wayne has a first-degree male relative such as a father
or brother with prostate cancer (PCa), which would be a reason -- though
not the only one -- to track PSA.

I hope that a course of an antibiotic such as Cipro was undertaken
before the followup PSA test in order to take care of any infection that
could increase PSA.

Was PIN (prostatic intraepithelial neoplasia) detected? If so, that
should be reported by the pathologist. It could be a precursor of PCa.
Get a copy of the path report.  Moreover, get a copy of everything.

The expected "normal" PSA expressed by a 30cc gland is 2.04 ng/mL. The
formula is: 30 x 0.068 = 2.04. This leaves 3.04 ng/mL that must be
explained.

The biopsy is the "gold standard" test for PCa. But as I know from study
and from personal experience, it can miss small tumors. Nothing is perfect.

There is another test, offered by Bostwick Laboratories, a
well-respected pathology laboratory specializing in PCa. It is the
PCA3Plus genetic urine test. It is new and is *not yet* accepted by the
FDA. It detects PCA3, a gene that is expressed only by PCa cells. More
information at: http://www.bostwicklaboratories.com/default.htm

I understand that it involves "massage" of the prostate gland before
collection of the urine sample.

There are other staging tests that can provide useful information. I
recommend study of this section of the authoritative website of the
Prostate Cancer Research Institute, especially the subsection "Undiagnosed":
http://prostate-cancer.org/education/education.html

If all else fails, I can think of nothing else to do but to undergo
another biopsy.

And if PCa is reported, the specimens should be studied and validated by
a specialist PCa pathology lab such as but no restricted to Bostwick.
No, I'm not an employee. I can furnish a list of such labs if requested.

No.

But uros are on the whole not educated in treatment of PCa beyond resort
to surgical options. Consultation with a cancer specialist, an
oncologist who is trained in PCa treatment, might be warranted if PCa is
discovered.

Regards,

Steve J

"If you know the enemy and know yourself, you need not fear the result
of a hundred battles. If you know yourself but not the enemy, for every
victory gained you will also suffer a defeat. If you know neither the
enemy nor yourself, you will succumb in every battle."
-- Sun Tzu, "The Art of War"

Before your biopsy, I would have said that it was likely.  However, it is
not very often that the cancer is missed in a biopsy.  That said, there are
people who found cancer in their second or third biopsies.  Keep in mind
that PSA, fPSA, biopsy and DRE are individually portions of criteria to
determine if a biopsy is warranted.  I think you are wise to keep on top of
it, but you may very well be cancer-free.

Wayne:

My husband is in a similar situation to yours except that he is 64 and
his numbers are somewhat lower than yours.

Here are his numbers:

11/2005 -- psa =1.8 (previous psa's right around this number)
6/2006 -- psa = 2.77 (taken at a different lab)
6/2006 -- psa =2.6 (taken at original lab)
8/2006 -- 18 core ultrasound guided biopsy -- negative -- no detection
of HGPIN, atypia

1/17/2007 -- psa = 3.5

Local urologist wanted to do another biopsy immediately.

We took his opinion into consideration but decided to go with a color
doppler ultrasound with possible biopsy (if anything is seen on the
color doppler ultrasound). The equipment is not widespread. In fact,
the urologist's first comment when we asked about it, was "I don't
have that equipment".

Husband has an appointment with Dr. Duke Bahn in Ventura CA. He is one
of the known experts for this test. According to his staff, he only
biopsies if he sees something that he feels needs biopsying on the
color doppler ultrasound. Here is his website:

http://pioa.org/

Good luck.

CW89134

On Feb 3, 5:21 pm, wdshe...@woh.rr.com wrote:

No one really knows.

Both a business partner and myself were diagnosed after several (3 for
him, 2 for me) biopsies.   In my case, the docs said,

"yours was in the anterior (front) of the prostate, this is an unusual
location so it wasn't picked up right away."

and

"The majority of tumors are toward the posterior (back) of the
prostate."

Well, maybe.

The cynic in me says that needle biopsies, because they enter from the
posterior find tumors that happen to start there.  The bias for that
location is because of the test protocol and not anything about the
cancer.

If so, and if there is a 50-50 distribution front to back, the the
front 50% is diagnosed late.

Here's another thing to think about.  Once the docs found the cancer
in the biopsy, they were very certain of the location and size of the
tumor from an MRI (with coil).

Rather than go for an 18 or 24 needle biopsy, perhaps the next step is
an MRI or color doppler ultrascan?

-kh

 I have a friend that had high PSA numbers and a family history.  He had
regular biopsies for many years because his Uro was sure it was just a
matter of time.  Well it took 10 years of those numbers to finally make him
a member of our club. Thing is it's very slow growing, ang he's 20 years
older than you are. Just keep going for your tests, and try not to worry
about it.

Hi Wayne,

It took me 6 biopsies in 4 years to finally get a positive result. The
positive result was only obtained with a double sextant biopsy (2x 6
cores at 2 different depths). PSA went from 9.2 to 14.4 in that
period. And I had RP 8 years ago.

I would repeat previous advice:
- Just keep going for your tests, and try not to worry about it.
- Make sure that you have a course of an antibiotic such as Cipro
prior to next biposy.

Good luck.

Just