James,

I'm sorry to hear about all your health problems.

Everyone hates to be the bearer of bad news, don't they?
They don't know that you have cancer so they don't want
to alarm you by saying that you might have it.  In your
case, you know very well what PSA means so you would
probably be less alarmed if they just told you that you
might have cancer.

That sounds like a real possibility.  PSA's above 4.0 were
thought to be warning signs and, at your age, some doctors
are using 3.5 or 3.0.

Low percent free PSA is also a warning sign.  Here's a quote from
the American Cancer Society: "Many doctors recommend biopsies
for men whose percent-free PSA is 10% or less, and advise that
men consider a biopsy if it is between 10% and 25%."
(http://tinyurl.com/442gw).

So your odds might even be worse than 35%.

The urologist will perform a digital rectal exam (DRE) and almost
certainly recommend a biopsy.  The biopsy is a pain in the butt,
but not a serious one.  Anyone with Parkinson's has probably been
through much worse.

The doctor might offer a course of antibiotics in order to "rule out"
a bacterial infection of the prostate.  I personally would rather skip
the antibiotics and go straight to the biopsy.  Antibiotics don't
really rule out cancer, and most prostatitis problems that cause
elevated PSA are not due to bacterial infections, or at least not
any that respond to antibiotics.

If you have cancer, it is possible that it will grow slowly enough
that your other problems will get you before the cancer can.  Life
spans beyond 10 years are common after early diagnosis.  Your
diagnosis is still fairly early, although it might have been
discovered
a year ago if there were a PSA test then.

My general thoughts about your situation are that your cancer (if
you have it - and you very well might), is less of a threat to you
than your Parkinson's, and possibly less of a threat than your
heart condition.

Nevertheless, unless I were pretty sure of dying in the next 10
years of other causes, I think I'd ask for treatment.  What
treatment to get is highly controversial.  Some people think
surgery provides better long term cancer control while radiation
is easier on the body and easier to recover from.  Other people
disagree with both of those statements.

If you do have cancer and you do decide to get treatment, it's
important to get it from someone who has a lot of experience
and whom you feel you can trust.  As with any other medical
procedure, there are some people who do it really well and
others who are chronic bunglers, with many in between.

Don't hesitate to ask more questions here.

Best of luck to you.

   Alan

 I had a similar time with my GP.  It's the uro and the guys here that will
help you. One step at a time. Try not to dwell on this until you get some
hard results. Worst case scenario is probably not 1/2 as bad as you imagine.

My first impression is that you doctor is a cold, heartless SOB.  However,
it also indicates, as I am sure you already know, that you might have
prostate cancer.  It does NOT mean you do have prostate cancer, but your
urologist is almost certainly going to want to feel your prostate (digital
rectal exam) and set up a biopsy.

About the only encouragement I can offer is that your PSA is still
considered low enough that you might encouraged that the cancer is still
small enough that it might still be contained within the prostate.  If so,
you can yank the prostate and be rid of it.  You won't really know how
serious it is until the biopsy gives you the Stage (how far it's gotten) and
Gleason (how aggressive it is) scores.

I'm sorry to report that during this period, you're going to have to suffer
not knowing.  And you won't know on the 21st nor on the date of your biopsy.
You won't really know anything until the day the urologist tells you what
the results of the biopsy were -- and I hope he doesn't send it to you by
email.

I screwed up similarly.  Got my PSA in 1998 and skipped 1999.  In 2000 it
was 16.

God has dealt you a poor hand.  I am sorry about that.

Excellent!!  The most important weapon in fighting this bastard (if you have
it) is knowledge.  I rcommend also books by Dr. Patrick Walsh and Dr. Peter
Scardino

How long have you had urinary issues?  This may be a symptom of cancer OR a
benign prostate problem.