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Cancer: Prostate Message Board

Cancer: Prostate Board Index

I'm 51, I have had 2 neg 12 core biopsies within a year and a low free psa 13 and last check a psa of 5 at what point can I be diagnosed with bph I have a 45cc prostate gland. Is it possible the enlarged prostate is the cause of the high psa
[QUOTE=maxman526;3456634]I'm 51, I have had 2 neg 12 core biopsies within a year and a low free psa 13 and last check a psa of 5 at what point can I be diagnosed with bph I have a 45cc prostate gland. Is it possible the enlarged prostate is the cause of the high psa[/QUOTE]

Hello maxman,

Having two negative 12 core biopsies is a good thing because it suggests that cancer, if there is any, is not widespread. :)

BPH does lead to more PSA production from healthy prostate cells, and there is a rule-of-thumb formula based on research to relate prostate size and predicted PSA where all the cells are healthy: gland volume in cc X .066. The formula is on page F4 of a very useful book for prostate cancer patients, "A Primer on Prostate Cancer -- The Empowered Patient's Guide," by Dr. Stephen B. Strum, MD, a medical oncologist, and Donna Pogliano, a prostate cancer activist and wife of a survivor.

Using that formula, a 45 cc prostate would account for a PSA of about 3 (2.97 to be exact, but we are using a rule of thumb, so that precision is overkill). That would leave 2 PSA units to be accounted for to get to 5. But your title notes that your PSA has fluctuated between 4 and 10. Prostate cancer is not indicated by fluctuation like that; I'm guessing, as a School of Hard Knocks educated layman with no enrolled medical education, that infection or inflammation is playing some role. They can boost PSA from a little to a lot from what I've learned. You also need to avoid certain activities that might stimulate the prostate for a day or so before the test; some advise avoidance for two or three days. It is thought these activities may boost the score somewhat.

However, that free PSA percentage suggests there may be some prostate cancer also present. There is a fairly new test available that complements the PSA test - it is strong where the PSA test is weak and vice versa. Combining the two gives a much clearer picture whether a man has prostate cancer. It is known as the PCA3Plus test, and it is based on a urine sample taken after a prolonged DRE. One of its main uses is in men who have indicators of prostate cancer but biopsies have been negative. Any doctor able to do the special DRE can take the sample, and the sample can then be shipped from anywhere to one of the labs that does the test. I have heard several doctors say that the PCA3Plus test adds valuable information in addition to the clues provided by PSA, the PSA trend (or fluctuation in your case), and the free PSA test result. Earlier versions may also be available; one is known as the uPM3 test (Urinary Prostate Marker 3), and another as the PCA3 test.

Two drugs for BPH that are mild for most men also appear to counter prostate cancer, especially the less aggressive types of prostate cancer (lower Gleason scores, probably up to 6) according to the thinking of some of the researchers taking the lead with these drugs. They are similar; both are known technically as "5-alpha reductase inhibitors". The one with a long track record and a large, gold-standard type clinical trial behind it is finasteride, now available generically (formerly Proscar).

You can see abstracts of research about finasteride by going to the Government website [url][/url] and searching for " thompson i [au] AND finasteride AND prostate cancer ". Dr. Ian Thompson is a prominent urologist at MD Anderson Hospital in Houston and is the lead investigator in the finasteride research. The other drug is Avodart, which you no doubt have seen heavily advertised. On paper it is more effective than finasteride, but it is fairly new and is more expensive. Some urologists have not kept up with developments, and are still worried about the safety of these drugs, fearing that they actually may promote aggressive prostate cancer. There is now strong evidence that they do not promote aggressive prostate cancer but rather are superior at detecting it. I have taken finasteride for eight years and have looked into this carefully, convincing myself that finasteride is both safe and effective. But I'm not a doctor.

A lifestyle program including diet/nutrition/supplements, exercise and stress reduction also appears to help counter prostate cancer. There is a lot of promising research evidence behind the elements of the program, but unfortunately none of the evidence is conclusive at this time. If you are interested, there are several books that discuss these tactics and the evidence.

I hope you are one of the lucky ones with a low free PSA percentage who just happens to be free of prostate cancer. If you do have the disease, there are a lot of effective ways to deal with it if you catch it early, and it surely looks like you will do that if you do turn out to have it. :)

Good luck and take care,

[QUOTE=shs50;3457790]Not being a Urologist, I cannot tell you at what point BPH can be assumed. However I would consult a specialist if you haven't yet or seek a second opinion. The 2 negative biopsies are reassuring but not necessarily conclusive. The PSA of 5 is ambiguous and could easily be the result of BPH. The Free PSA reading of 13 might be a concern which is why I would seek a Urologist's opinion of these results or a second opinion if the first is unsure or complacent.
My son-in-law's father required 3 biopsies before P.C was discovered. Depending on high a comfort level you or your urologist would want, a saturation biopsy is another way of going the extra mile.[/QUOTE]

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