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Cancer: Prostate Message Board

Cancer: Prostate Board Index

[COLOR="DarkGreen"]Hi Looney,

Welcome to the board! :)

That's a scary ride that you and your husband have been on these last two years. :eek: :dizzy: You are certainly getting more than your money's worth of anxiety. I'll insert some thoughts in green. Jim[/COLOR]

[QUOTE=Looney1;4071506]My husband's psa has been steadily rising for the past 4 years or so. He has had 3 -12 sample biopsies and one 6 sample biopsy after a finding of HGPIN. His last 4 psa tests the past two years are as follows: 4.2, 6.2. 4.6 and his most recent, an 8.2!

[COLOR="darkgreen"]Actually, there are some important clues in that pattern, and if you think about it, your husband has [U]not[/U] experienced a steady rise, and that could be important: after increasing [U]by 2.0[/U] from 4.2 to 6.2, it dropped by almost the same amount before the recent increase. One of the reasons that's important is because cancer, all by itself - uninfluenced by benign enlargement, infection or inflammation - results in a steady increase; cancer alone does not cause a PSA to go up and down, nor does benign enlargement. For cancer alone, 1,000 cells become 2,000; 2,000 split into 4,000; 4,000 divide into 8,000, and so on, with each doubling taking about the same amount of time, though that "PSA doubling time" is particular to each man's case. If you are into mathematics, that is an "exponential" pattern of increase. Benign enlargement causes, by itself, a gruadual increase in PSA, but not an exponential doubling. However, infection and/or inflammation often causes an up and down pattern in PSA as the disease waxes and wanes. The bottom line: just based on the PSA, your husband's pattern sure looks like infection or inflammation rather than the other two. :) (But keep in mind that, like most of us, I've spent a lot of time in the School of Hard Knocks for prostate cancer, but have had no enrolled medical education.)

His free psa has now dropped from 17 to 13.

[COLOR="darkgreen"]Of course, that is a concern, both the drop and the level. However, unfortunately for free PSA as a test, it is not as selective for cancer as we would like; in fact, infection often causes free PSA to drop. Therefore, in light of your husband's see-saw PSA pattern that is typical of infection, you could probably notch down your worry level a bit - not all the way, but down a little. :)[/COLOR]

I am terrified at the sudden large jump in PSA.

[COLOR="darkgreen"]The PSA test dates are important here. While a sudden large jump - short period of time - could indicate a very aggressive cancer, that is quite unusual in this era of regular PSA screening. On the other hand, an on-and-off chronic infection could easily account for a big jump. :) My hunch is that a jump from a PSA from 4.6 to 8.2 in a short (how short?) period is more likely to be due to an infection, especially in view of the history of a previous substantial jump, followed by a decline.[/COLOR]

He saw his urologist today and he said my husband does not have an infection because the exam would have hurt, so he wouldn't give him any antibiotics. He does not have any symptoms of an infection either.

[COLOR="darkgreen"]This is where I wish I knew more about diagnosing prostatitis (infection or inflammation of the prostate gland). My impression is that some infections do act like what your husband is experiencing: no symptoms, and not painful on examination, but I'm not that sure. I do know that urology experts concur that some cases of prostatitis are very hard and sometimes impossible to diagnose, and that challenging the condition or tissue culture with various medications is a common tactic. Maybe one of our other board participants knows more about diagnosing prostatitis, especially in the absence of pain during an exam.[/COLOR]

The urologist also mentioned that other than slight enlargement, his prostate felt normal. He is scheduled to get, yet again, another biopsy next Friday.

[COLOR="darkgreen"]There is a fairly new test that can help rule prostate cancer pretty much in or out in conjunction with PSA tests, and unlike the PSA and free PSA tests, it is not thrown off by prostatitis. The latest version is known as the PCA3Plus test; it is based on a urine sample, collected shortly after an "attentive" DRE that causes some prostate cells to be shed into the urine. It is strong (specificity) where the PSA test is weaker, and to some extent vice versa (weaker on sensitivity - it takes a stronger "signal" to indicate prostate cancer). Bostwick Laboratories, run by one of the world leaders in prostate cancer pathology, is one of the labs that can do this test, with samples shipped in from anywhere.

If it were me, after four negative biopsies, I would want to give this test a try before having a fifth biopsy, but that is a highly individual call to make. Many doctors do not yet know about this test (used to be known as the uPM3 test), or have not used it, but the number is growing. It has been discussed on this board.

Also, rather than going down the same biopsy road again, if the PCA3Plus test resulted in a substantial likelihood of prostate cancer, your husband could consider either a color Doppler ultrasound (CDU) guided biopsy or a saturation biopsy, even the "3D mapping" type of saturation biopsy favored by Dr. Gary Onik of Celebration, Florida. There are, unfortunately, only a handful of sites with the expertise to do a good CDU biopsy, but I think it would be worth it to get the added precision and information that biopsy affords. It's big advantage is that it can determine and display where new blood vessels are growing in the prostate, and the resulting sites ar where there is likely to be prostate cancer.[/COLOR]

I am so scared that he now has aggressive cancer.
I have been reading that a jump of more than 2 points in psa in one year usually leads to a bad outcome.

[COLOR="darkgreen"]That's true, and it's good that you are aware of it, but, if the increase is due a little to BPH and a lot to infection, it seems quite possible that none of it is attributable to prostate cancer.[/COLOR]

I am scared and confused and don't know what to think. Thanks for reading.[/QUOTE]

[COLOR="darkgreen"]You're welcome. Please followup if you have additional questions. I hope you can keep your spirits up during this scarry time.

Take care,

Jim :wave:[/COLOR]

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