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Cancer: Prostate Message Board

Cancer: Prostate Board Index

[COLOR="DarkGreen"]Hi Rider18,

Welcome to the board! I'm sure you would rather have had no need to come to it :(, a sentiment we all share, but we're a good group! I've read through your post #4 and already viewed the fine advice offered by holler1 and daff. I'll add a few points in green.[/COLOR]

[QUOTE=Rider18;4133302]I am still a bit shocked.

[COLOR="DarkGreen"]Welcome to the club, but only as an associate member. Can't promise any official membership for those not formally diagnosed. Sorry about that. ;) But going through that initially stunning encounter with the doctor is one of the initiation rites. :dizzy: :confused: [/COLOR]

After I had my annual physical a few days ago (I'm in my early 50s), my internist informed me that my PSA was 3.3. That was the first time I ever heard that my PSA was elevated, and I have no clinical symptoms, and the rest of my blood work is normal. My internist is a very experienced and conservative physician. After commenting that my DRE was normal, he said that I should see a urologist, just in case. I saw a urologist the next day. The urologist performed a DRE and said that one side of my prostate felt a bit firmer than normal.

[COLOR="darkgreen"]As you may know, in the "old days" - meaning, actually, just a few years ago, knowledge is advancing rapidly in this field - most doctors were not that concerned until a man's PSA hit 4, and many did not take age into account. It's good that your doctor has an up-to-date way of looking at PSA. It is possible, even with your negative exam and blood tests for infection, that infection or inflammation is contributing to the increase in PSA, possibly also some mild benign enlargement, possibly all mixed with some cancer. It would also be good to know the urologists estimate of the size of your prostate. Among other things, that gives you the second number you need to calculate the "PSA density," at least tentatively. The ultrsound used for the biopsy should enable the doctor to determine a more precise volume and density.[/COLOR]

He told me to get a new PSA test, both free and total, which I did this past Friday. The urologist also said that regardless of what my new PSA test demonstrates, I should have a prostate biopsy.

[COLOR="darkgreen"]His advice strikes me as wise practice. The results will add significant information even if they do not affect the biopsy decision. :cool:[/COLOR]

I am scheduled for a biopsy next week, but I don't feel that I am armed with sufficient information to decide whether I should do it now.

[COLOR="darkgreen"]As holler1 and daff have indicated, we laymen usually feel that the doctors will want to do a biopsy in cases like yours because of the DRE, and that is a sound reason, even if the PSA is quite favorable, and yours is a bit elevated. The one question here is whether the doctor doing the DRE did a good job resulting in a valid DRE. Because he was a urologist, the chances are strong that he knew what to do and what to observe. In other words, his estimate based on the DRE was probably valid. My layman's impression is that it's somewhat reassuring that the primary care doctor did not feel your prostate was abnormal based on his DRE. That suggests that, if there is something going on, it is not massive. Some of us, unfortunately, unlike you, have strong indications of cancer from the DRE at the outset. :([/COLOR]

Unfortuantely, I do not have sufficient historical PSA data to know how fast my PSA got to 3.3. I do have my first ever PSA test result, which was in 1998 and read 0.81. I have had a few other PSA tests over the past 10 years, but my previous doctor's office tells me they can't locate the records. . .

[COLOR="darkgreen"]For now, prior to the biopsy, you might want to accept that answer, but, if the biopsy does show cancer, it would be worth being assertive in trying again to get the dates and scores for your earlier (and the date for the latest) PSA tests. Those could provide meaningful clues, especially whether your PSA had risen by more than 2.0 in the past year, which is actually quite worth knowing. You could point that out to the staff, or better, to the most senior person on the staff, and to the doctor himself if you do not get the results. You could request firmly that the doctor contact the lab that ran the test to check their records. I suspect the doctor ordering the test, or the lab that ran it, has some legal obligation to keep the records for a fairly long period of time.[/COLOR]

Should I go through the biopsy and worry later, if necessary, or should I consider taking any other steps before I undergo a biopsy? For example, I just read about the PSA3Plus test - should I have that test first? Should I see another urologist to get a second opinion? Any other advice?

[COLOR="darkgreen"]Holler1 and daff have already covered this ground, but here's one more point. There's a special kind of biopsy, known as a color Doppler ultrasound (CDU) biopsy, that provides more key information than a standard biopsy, even one sampling 12 cores. It's main feature is that the color Doppler feature allows the doctor doing the biopsy to visualize new blood vessel formation that tumors need and use to grow. That color feature allows the doctor to get a good idea of the shape, location and size of the tumor, in addition to the usual information. It is awkward for most of us to get a CDU biopsy because there are only a few sites in the country with the expertise and special, high-end equipment to do the job. (Not just any CDU will do.) However, one of the national experts, Dr. Duke Bahn, MD, practices in Ventura, California, sort of in the LA area, and might be convenient for you. If it were me facing your situation, I would want him to do a CDU biopsy. He could also confirm the DRE before the biopsy. If you are interested, PCRI (the Prostate Cancer Research Institute), a non-profit organization headquartered on Century Blvd near LAX, has publications about CDU biopsy. If you don't get such a biopsy, talk to the doctor to make sure he intends to take at least 10 core samples.[/COLOR]

I want to move fast, but prudently.

[COLOR="darkgreen"]Good for you - that's the right attitude. "Take your time in a hurry." - Wyatt Earp on gun fighting[/COLOR]

Unfortunately, I do not feel that I have adequate infromation to analyze whether my urologist is jumping the gun with recommending a biopsy this quickly. I would really appreciate any advice on what I should learn and do next.

[COLOR="darkgreen"]My take is that he is well within standard sound practice, base on what you have posted. As far as getting oriented, even just to learn about what's involved in figuring out whether or not a patient has cancer, I stronly recommend this book: "A Primer on Prostate Cancer - The Empowered Patient's Guide."


Many thanks![/QUOTE]

[COLOR="darkgreen"]Please feel free to ask followup questions to the board. You are very likely to have new questions as you learn.

But for now, good luck and take care.

Jim :wave:[/COLOR]

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