Can anyone please give me an opinion as to what I should do about my
PSA level. I have had an enlarged prostate for years now say about
10. It has been looked at several times, but I do not have any
serious symptoms, except ED, which may not even be related.
As my PSA has been steadily going up I have been to the local hospital
a year ago when it was 6.0. The specialist examined me said there was
no sign of cancer, but he ordered a series of biopsies to be taken.
This was not really a problem, although I had leaky blood for several
weeks afterwards. The biopsy came back negative.
A year later on my PSA is now 12.0 and although my symptoms are no
worse and fairly minimal the same specialist is asking me to have a
larger series of "shots" which, - he says will require me to have a
general anaesthetic. This is a causing a bit of a problem with getting
there and also the hospital has had outbreaks of C Difficile and
something else and visitors are being discouraged from visiting. I
don't like the idea of any procedure on principle. What must turn out
to be a worse experience compared to the previous one is not something
to which I am looking forward.
I have read that because of the slow moving nature of Prostate cancer
and the fact that I am 65 it may not really be necessary to have
this, there are significant risks of infection, etc. I have no
history of cancer in my family. What else could cause a high PSA and
how high is 12.0? What are the factors that should influence me in
making the decision to have this biopsy or not.
Any comments would be welcome. Thanks, George Bell.
ron - 20 Apr 2007 20:14 GMT
Hi George...Two things other than PCa that can drive PSA up are
prostatitis and BPH. The former is marked by spikes up and down as
the infection waxes and wanes, not the "steadily going up" that you
mention. For an enlarged prostate to produce a PSA of 12, you'd need
a prostate size larger than 120 gm. This would be uncommonly large.
I think both you and the doc are wise to follow up, a PSA over 10 is a
signal that something is happening and further investigation is
required. If you do nothing at this point and have a life expectancy
greater than 10-15 years and have PCa, then the PCa may cut time of
your life span.
Saturation biopsies are becoming more widely practiced in cases where
earlier biopsies (BTW, how many sticks did you have last time?) failed
to show evidence of PCa. I understand your concerns about going to an
"unhealthy" hospital. Depending where you live, or if you are willing
to travel, a targeted biposy during a color doppler ultrasound (cdus)
might be an alternative worth considering (artists are in NY, CA and
MN). An advantage of the cdus route (not to mention fewer sticks)
would be that it can image the entire prostate, but the regular trans-
rectal biopsy cannot take samples from all parts of the prostate (a
trans-perineal biopsy can access areas that the trans-rectal cannot).
While you're planning your course of action, you might want to get a
free PSA test run (just another blood draw). Values lower than 15%
are consistent with cancer (15-25 is a gray area, >25% suggests that
cancer is not present).
lizotr@juno.com - 21 Apr 2007 00:37 GMT
> Can anyone please give me an opinion as to what I should do about my
> PSA level. I have had an enlarged prostate for years now say about
[quoted text clipped - 25 lines]
>
> Any comments would be welcome. Thanks, George Bell.
hi george, my husband was 48 his psa had gone up from 4.0 to 6.0
with a negative biopsy. then a 8..0 with a negative biopsy. the a 12.0
with a right sided positive biopsy. all 6 biopsy's on thr right were
positive. can you go to a different hospital for the biopsy if you are
uncomfortable with the current hospital? 65 years old is very young in
this day and age. you may want to consider a different facility. my
husband had a rp after that.
good luck to you
I.P. Freely - 21 Apr 2007 00:58 GMT
> I do not have any serious symptoms
We must catch our PC long before we have symptoms if we want to be cured
or postpone it until something more pleasant kills us.
> I
> don't like the idea of any procedure on principle. What must turn out
> to be a worse experience compared to the previous one is not something
> to which I am looking forward.
Beats unchecked prostate cancer ALL to hell, though, doesn't it? ;-)
> I have read that because of the slow moving nature of Prostate cancer
> and the fact that I am 65 it may not really be necessary to have
> this.
No, not unless you would like to still be beating your son in tennis 20
years from now. Prostate surgery has been shown to be very useful even
in selected octogenarians, as we discussed here a few weeks ago when the
Mayo Clinic announced it.
> What are the factors that should influence me in
> making the decision to have this biopsy or not.
How long you'd like to live and how you wish to die are factors. There's
no reason we should become fatalistic before the age of 80-90 unless we
have specific medical reasons to do so. Get thee and thy prostate to a
cleaner hospital and get stuck; it may save your very life from this
oft-avoidable scourge.
I.P.
glassman - 21 Apr 2007 01:46 GMT
> Can anyone please give me an opinion as to what I should do about my
> PSA level. I have had an enlarged prostate for years now say about
> 10. It has been looked at several times, but I do not have any
> serious symptoms, except ED, which may not even be related.
The fact that you turn to a bunch of strangers on the internet, rather
than your doc, tells me that you may need a new doc. You have an even chance
that you have PCA. Get it biopsied as many times as it may take to find it
George.

Signature
JK Sinrod
www.SinrodStudios.com
www.MyConeyIslandMemories.com
MAS - 21 Apr 2007 17:59 GMT
George,
A negaative biopsy means that the "stick" did not reveal and trace of
cancer. In otherwords, cancer cells could be present and the stick just
missed the location. Interesting would be, how many samples did the uro
take. Some get 6; some 12.... Man, I had 15......
Successive rises in PSA is suspecious. My boss had three biopsies over 15
months. The first the uro took 6, the second, took six; the third, took 12
and finally found the cancer....
Good luck, I hope that you are cancer-free.
GD
> Can anyone please give me an opinion as to what I should do about my
> PSA level. I have had an enlarged prostate for years now say about
[quoted text clipped - 25 lines]
>
> Any comments would be welcome. Thanks, George Bell.
Steve Kramer - 21 Apr 2007 21:48 GMT
> Can anyone please give me an opinion as to what I should do about my
> PSA level. I have had an enlarged prostate for years now say about
> 10. It has been looked at several times, but I do not have any
> serious symptoms, except ED, which may not even be related.
Most of us who are still alive had asymptomatic cancer.
> As my PSA has been steadily going up I have been to the local hospital
> a year ago when it was 6.0. The specialist examined me said there was
[quoted text clipped - 6 lines]
> larger series of "shots" which, - he says will require me to have a
> general anaesthetic.
A biopsy using more needles is probably in order. As fare as requireing a
general anaesthetic, that is probably dependent on your pain tolerance. If
you did fine the first time and think you can stand 20 or 30 snaps of the
proverbial rubberband, then your problem is over.
> I have read that because of the slow moving nature of Prostate cancer
> and the fact that I am 65 it may not really be necessary to have
> this, there are significant risks of infection, etc. I have no
> history of cancer in my family. What else could cause a high PSA and
> how high is 12.0? What are the factors that should influence me in
> making the decision to have this biopsy or not.
If it is prostate cancer and your PSA was doubling every three or four
years, I'd agree you might consider Watchful Waiting. However, yours
doubled in one year. That's bad enough to be concerned. If it doubles
again, 24 next year and 48 the year after. I'm thinking that if it is
cancer, it is aggressive and you need to find it and kill it before it kills
you. You need to decide if you want to live to 70 or 80.
BTW, anything over 4 or 5 is high for your age. But, it could be something
other than cancer. I would not bet my life on it.

Signature
PSA 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 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
Casodex added daily 07/06
PSA <0.04, <0.05
Non Illegitimi Carborundum
George - 22 Apr 2007 17:53 GMT
> > Can anyone please give me an opinion as to what I should do about my
> > PSA level. I have had an enlarged prostate for years now say about
[quoted text clipped - 48 lines]
> PSA <0.04, <0.05
> Non Illegitimi Carborundum
Thanks for all the opinions; I am in UK now, so I can't really visit
clinics anywhere else! Not on the NHS, anyway.
I had a polyp removed in 2001 because of "carcinoma in situ", could it
have spread from that? There has been no sign of anything in my colon
since then (2001).
I also have heart block, an angioplasty and stent, atrial
fibrillation, a bit of arthritis and this morning did a personal best
(over the last 4 years) for a 6 Km run - 37min: 43sec. I have had
negligible symptoms for any of the above except the polyp which bled a
bit and prompted a frightening investigation, with a hospital abroad
telling me that I had to have major surgery and a bit of my rectum
removed, because the polyp was on a fold and effectively
inaccessible. A brilliant alternative was performed at the St. John
Radcliffe hospital in Oxford involving inflation of the rectum and
removal up the back passage. I am thinking of asking Prof. Mortenson
if they do any good deals on prostates. The angio plus stent seemed
to be more for the foreign surgeon's benefit as I was employed by an
oil company and I think he needed to get his quota in. I had no
symptoms either before or after, but this was in 98 and water under
the bridge now.
To try and cure the atrial fibrillation, here, they performed a cardio-
version which stopped the rapid motion, but it went into an un-
synchronised slower beat which brought on some really awful symptoms
for about 6 weeks, - swollen legs, always tired and out of breath,
waking up gasping, - I could hardly do anything, running was out of
the question. Luckily this reverted to my normal fibrillation and
after turning down a pacemaker, I went back to my normal active life.
I have 4 and 5 milligrams of Warfarin every day and a small amount of
blood pressure lowering pills - although how much the higher systolic
(130 average) and lower diastolic (60 average) is due to my very low
heartbeat, (from which I have absolutely no symptoms), say 30 bpm at
rest to about 100 flat out, is open to question. I have to do 30 push-
ups to get my blood pressure monitor to work!
I think I had 12 shots last time. When I went for my first bowel
inspection in UK they wanted to give me a sedative, but I declined,
when they told me I would not be able to drive home. I did not have
any problem at all with this. I shall discuss the need for a general
anaesthetic on Wednesday when I go for the pre- procedure. They want
to keep me in for two days plus someone will have to drop me off and
pick me up. Am I right in assuming that the only reason for the
general anaesthetic and 2 day stay is my perceived lack of tolerance
to the greater number of shots, - if so I shall suggest we see if I
can tolerate them.
I take a lot of omega 3, nuts, fruit and veg. and am very fit for my
65 years. One wine and one beer per day and no cigs for 30 years. I
have a young family and, as has been pointed out, am rather partial to
impartial advice.
Thanks and regards, George.
Steve Kramer - 23 Apr 2007 02:48 GMT
> Thanks for all the opinions; I am in UK now, so I can't really visit
> clinics anywhere else! Not on the NHS, anyway.
National healthcare.... sorry.
> I had a polyp removed in 2001 because of "carcinoma in situ", could it
> have spread from that? There has been no sign of anything in my colon
> since then (2001).
No. You cannot catch prostate cancer from colin cancer (assuming that's
what it was). Prostate cancer develops in the prostate, but can (and often
does) go from there into other organs and bone.
> I also have heart block, an angioplasty and stent, atrial
> fibrillation, a bit of arthritis and this morning did a personal best
[quoted text clipped - 4 lines]
> removed, because the polyp was on a fold and effectively
> inaccessible.
Hmmmmmmmmm. Maybe you would not be a candidate for surgery if you do have
prostate cancer.
> I think I had 12 shots last time. When I went for my first bowel
> inspection in UK they wanted to give me a sedative, but I declined,
[quoted text clipped - 6 lines]
> to the greater number of shots, - if so I shall suggest we see if I
> can tolerate them.
Assuming you are talking about a biopsy where they stick the probe up your
arse and shoot needles into your prostate, I would say yes. But, you have
had considerable work done around your rectum and maybe they are considering
another method... Maybe even a TURP. Ouch! I've heard that is possible,
but never communicated with one who ever went through it.
> One wine and one beer per day and no cigs for 30 years. I
> have a young family and, as has been pointed out, am rather partial to
> impartial advice.
I would rather not characterize it as advice, but maybe a few
considerations.