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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2007Very high PSA, negative biopcies - what next ?
My dad, 69yo, had PSA growing from 12 in 1997 to 25 (highest ever) now, with fluctuations. His prostate is not that big, it was measured 87 cm3 in 2006. He had 4 biopcies - in 1997, 1999, 2003, and 2006, the first 3 with 8 needles, last one with 16 needles, all negative. He is now again at a total loss - what to do next ? Go for one more biopcy ? But this procedure by itself may have some chance of causing a cancer... > My dad, 69yo, had PSA growing from 12 in 1997 to 25 (highest ever) > now, with fluctuations. His prostate is not that big, it was measured [quoted text clipped - 3 lines] > But this procedure by itself may have some chance of causing a > cancer... I could be wrong (I was wrong once before - in 1983, I think) but I think your Dad's prostate is about 4 times the size of a normal prostate (20 something cm3). There are other tests (color doppler, PET scan) about which others know more than I. Hang on a bit and I'm sure lots of others will sign in and give you more info. -Gordy There's not a lot of evidence to support the procedure causing a cancer but you dad's in a fix no matter what. A colleague of mine at about age 70 had a PSA that hovered in the mid-20's. Nothing found after two biopsies so his doctor told him not to worry about it, he would probably die of something else anyway which he did - a stroke at age 80. Your dad is a bit younger so further tests may be in order. Has his doc suggested various scans, free-PSA test, etc., etc.? Also, I don't know the typical range of prostate sizes but 87 cm3 seems a bit on the high side. I don't know if that size prostate could produce such a high PSA just from BPH so I'll let others chime in on that. Good luck to your dad. Dave Perry > My dad, 69yo, had PSA growing from 12 in 1997 to 25 (highest ever) > now, with fluctuations. His prostate is not that big, it was measured [quoted text clipped - 3 lines] > But this procedure by itself may have some chance of causing a > cancer... > My dad, 69yo, had PSA growing from 12 in 1997 to 25 (highest ever) > now, with fluctuations. His prostate is not that big, it was measured > 87 cm3 in 2006. An 87cc prostate should express 5.916 ng/mL of PSA. The formula is: 87x.068=5.916. That leaves about 19 ng that must be explained. Have other causes been ruled out, such as infection, benign prostatic hyperplasia (BPH), prostatitis? > He had 4 biopcies - in 1997, 1999, 2003, and 2006, the first 3 with 8 > needles, last one with 16 needles, all negative. Correct spelling = biopSy or biopSies. It's OK, we all had to learn somehow. > He is now again at a total loss - what to do next ? Go for one more > biopcy ? There is a new genetic urine test called PCA3Plus offered by Bostwick Laboratories. It requires massage of the prostate before collection of the urine sample. According to Bostwick, it tests for PCA3, a gene that is expressed only by PCa cells. More information at: http://www.bostwicklaboratories.com/ > But this procedure by itself may have some chance of causing a > cancer... There is much debate about that. A lot of heat; very little light. So far as I have been able to discover, the story is based upon a handful of cases arising from biopsies of (IIRC) lungs, not prostates. I understand that any PCa cells that might be "liberated" during a biopsy cannot survive outside the gland, and that there are no confirmed cases of PCa cells being spread via biopsy. None. There also are other tests that might shed light on the situation. See the authoritative and objective websitee of the Prostate Cancer Research Institute (PCRI): http://prostate-cancer.org/index.html .....and search on "staging." Please do let us know how it goes. Regards, Steve J > My dad, 69yo, had PSA growing from 12 in 1997 to 25 (highest ever) > now, with fluctuations. His prostate is not that big, it was measured [quoted text clipped - 3 lines] > But this procedure by itself may have some chance of causing a > cancer... I'm not a doctor and I'm not knowledgeable about biopsies, but I seem to recall that some of the posters to this newsgroup have described biopsy results that reported other things besides cancer. I seem to remember that one fellow got back a report that specifically mentioned benign prostate hyperplasia and one that specifically mentioned inflammation consistent with prostatitis. I have to wonder too if it isn't possible to culture the prostate tissue and look for bacterial infection. So one thing I would do is have your Dad ask the urologist if the biopsy report provided any other information about what might have caused the high PSA. If it did not, ask if the pathologist looked for any signs of other causes and ruled them out. If not, then perhaps the slides could be examined by another pathologist who might be able to give a more comprehensive report. As I say, I'm not a doctor. I'm not sure what I'm suggesting is practical. Perhaps someone else can chime in with more facts. Alan > My dad, 69yo, had PSA growing from 12 in 1997 to 25 (highest ever) > now, with fluctuations. His prostate is not that big, it was measured [quoted text clipped - 3 lines] > But this procedure by itself may have some chance of causing a > cancer... I'm sure you will get a lot of non-doctor opinions and suppositions, and I'll add mine.... It seems to me that 87 is a huge prostate. First thought, this can add to the PSA just as a matter of course. Second thought is it still should not be 25 PSA. Third thought is it might be benign prostate issues, like BHP. And, another thought hit me that maybe 12 needles isn't enough for an 87 cm prostate. Many smaller PSA sustain 20+ needle biopsies without a problem. I'm almost moved to ask if your father is going to a prostate expert. Finally, biopsies do not cause cancer -- or at least I never heard of such a thing in six years of discussing and researching the prostate.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum > I'm almost moved to ask if your father is going to a prostate expert. Who would be such an expert ? We live in Bay Area / San Francisco. There are lots. Dr. Carroll at UCSF and Dr. Brooks at Stanford are among the gurus of the profession. I have a lot of faith in Dr. Li from Oakland Kaiser if you are part of the Kaiser Permanente medical plan. Dave Perry > > I'm almost moved to ask if your father is going to a prostate expert. > > Who would be such an expert ? We live in Bay Area / San Francisco. Thanks, yes, he is in Kaiser now. It is weird, this prostate is clearly presenting a danger, but still not a single doctor he talked to over these 9 years was willing to remove it without a positive biopsy. > There are lots. Dr. Carroll at UCSF and Dr. Brooks at Stanford are > among the gurus of the profession. I have a lot of faith in Dr. Li > from Oakland Kaiser if you are part of the Kaiser Permanente medical > plan. > Dave Perry I've never heard of any doctor removing a prostate based only on a high PSA and I suspect all the doctors you've seen are as puzzled as is everyone else. And besides, your dad wouldn't be pleased to have the side effects of surgery after discovering there was no cancer there after all, just a whole lot of prostate tissue. There simply is no tool, gadget, scan, or procedure that will say for sure there is or is not cancer short of a positive biopsy and no reputable doctor is going to pull out his knife without one nor will any insurance pay for it. Your family is going through a lot of anxiety over this and you feel the removal of the prostate would solve everything. While that could be true, there are lots of things to consider before plunging into this kind of surgery. Dave Perry > Thanks, yes, he is in Kaiser now. It is weird, this prostate is > clearly presenting a danger, but still not a single doctor he talked [quoted text clipped - 8 lines] > > - Show quoted text - > Thanks, yes, he is in Kaiser now. It is weird, this prostate is > clearly presenting a danger, but still not a single doctor he talked > to over these 9 years was willing to remove it without a positive > biopsy. If he's seen several doctors, then I presume some have been urologists. In that case, my earlier comment is moot. It must be a very weird prostate. However, I don't think anyone would take from a man his prostate without any indication of cancer or some other condition warranting the terrible side effects. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum > Thanks, yes, he is in Kaiser now. It is weird, this prostate is > clearly presenting a danger, but still not a single doctor he talked > to over these 9 years was willing to remove it without a positive > biopsy. How's it a danger to him? Is it stopping him from having a bowel movement? With such slow growth, there's other dangers. His heart's 69 years old, same for his liver, same for his brain and his eyes. His life expectancy is 13.45 years http://www.ssa.gov/OACT/STATS/table4c6.html While you're worrying about his prostate he could be in a car crash due to another driver's not having checked their vision or a plane crash or a heart attack... http://www.urologytimes.com/urologytimes/article/articleDetail.jsp?id=197985 The possibility arises that the lower biopsy yield for large glands represents not undersampling, but the existence of fewer large-volume cancers and that the PSA reflects adenoma, rather than adenocarcinoma. Certainly, it has been demonstrated previously that although prostate cancer produces about 10 times the serum PSA as does BPH, the latter is responsible for a steady linear increase in serum PSA at a rate of 0.25 to 0.3 ng/mL per gram of adenoma (J Urol 1995; 153:111-4).[end quoted[ So his (PSA) doubled in 6 years. If I saw a doubling in 3 or 6 months, and then another increase the next checkup (3 months later), time to get moving and look at age (then) vs quality of life. J Sorry for the top-post. Please ignore my post. Not enough information as to the biopsies. Follow suggestion from others. My sincere apology. J > > Thanks, yes, he is in Kaiser now. It is weird, this prostate is > > clearly presenting a danger, but still not a single doctor he talked [quoted text clipped - 28 lines] > moving and look at age (then) vs quality of life. > J > Sorry for the top-post. > Please ignore my post. > Not enough information as to the biopsies. > Follow suggestion from others. > My sincere apology. > J >> How's it a danger to him? >> Is it stopping him from having a bowel movement? Don't apologize for those questions. They're quite valid. PSA is just a number, useful at this stage primarily as a rising hint to get a biopsy. I suspect that any surgeon who removed a prostate based on a PSA alone, especially with a series of negative biopsies, would soon be teaching high school health classes for a living. I.P. My dad's biopsy cores has both chronic and accute inflammation, it says something like "consistent with chronic and acute prostatitis". I am wondering if taking an antibiotic could ditinguish between inflammation and cancer. BTW, how much PSA 1cm3 of inflamed prostate could produce ? > My dad's biopsy cores has both chronic and accute inflammation, it > says something like "consistent with chronic and acute prostatitis". I > am wondering if taking an antibiotic could ditinguish between > inflammation and cancer. BTW, how much PSA 1cm3 of inflamed prostate > could produce ? When you meet with a specialist, ask about scans. It might not be recommended but that's for the doc to tell you. If the tumor in the prostate is very small but has metastasized, that is, there is a colony elsewhere in his body producing PSA, then a full scan might reveal it's location. These include the Postascint, PET scan, and Bone Scan. These are three different scans that might find Prostate Cancer that is outside of the prostate and beyond the reach of a biopsy. In addition, early on in my diagnosis, I had an MRI. The doc said that "it was toward the front and bulky". Folks have mentioned the color doppler ultrasound. Either the MRI or color doppler ultrasound might help target the biopsy. -kh >> I'm almost moved to ask if your father is going to a prostate expert. > > Who would be such an expert ? We live in Bay Area / San Francisco. A urologist. Preferably, one who has not decided that curing incontinence in post-partum mothers is his way to fame and riches. |
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