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Cancer: Prostate Message Board

Cancer: Prostate Board Index

No-one has diagnosed me as having prostate cancer yet, however I am very concerned about my rising PSA and have come here looking for advice or comments.

Briefly, I am a 54 year old Caucasian and my father died of Prostate cancer 15 years ago after radiation therapy and about a decade of hormonal therapy. I think he was first diagnosed when he was in his late sixties. My older brother has a nice low PSA of about 1.0 and apparently no problems. I had my first PSA check at age 41 and by age 48 (2003) I could see it steadily climbing. Here is a rundown of my numbers and major events:

1-11-1996 [B]1.2[/B]
11-20-1998 [B]3.0[/B]
11-13-2003 [B]1.73[/B]
2-17-2005 [B]4.6[/B]
3-2-2005 [B]3.9[/B] after 2 weeks cipro
9-1-2005 [B]3.4[/B] (12% free psa)
3-3-2006 [B]3.8[/B] (13% free psa)
8-29-2006 [B]7.35[/B] (12.4% free psa)
9-18-2006 [B]4.75 [/B]after 2 weeks cipro
9-22-2006 [B]4.5[/B]
7-3-2007 [B]5.4[/B] (15.9% free)
July 12-2007 PCA3 = 47.4
8-2-2007 [B]6.04[/B] (22.2% free psa)
12-6-2007 [B]5.45[/B] psa / [B]5.24 [/B]psa IMX
8-27-2008 [B]7.04 [/B]psa IMX
1-12-2009 [B]5.67 [/B]psa / [B]6.8[/B] psa IMX (16.6% free psa)
1-21-2009 [B]5.47 [/B]after 1 week cipro
3-12-2009 [B]4.78[/B]
6-29-2009 [B]4.23[/B]
11-23-2009 [B]5.04[/B]
1-07-2010 [B]4.06 [/B](42.5% drop in PSA after 18 months)
6-1-2010 [B]5.96[/B]
9-2-2010 [B]8.80 [/B](20.1% free psa)
9-24-2010 [B]9.01 [/B](14.5% free psa) after short course antibiotics

My prostate volume has been estimated 6 times by various doctors and the PSA densities that follow are my own calculations:

Mar 2005 – [B]51cc[/B] PSA density = .[B]077[/B] (3.9/51cc)
Sep 2006 – [B]52cc[/B] PSA density = .[B]086[/B] (4.5/52cc)
Aug 2007 – [B]66cc[/B] PSA density = .[B]091[/B] (6.0/66cc)
Jan 2009 – [B]48cc[/B] (after 4 months finasteride) PSA density = [B].118 [/B](5.67/48cc)
Mar 2010 – [B]48cc[/B] (18 months of finasteride) PSA density = .[B]084[/B] (4.06/48cc)
Oct 2010 – [B]51cc[/B] (8 months after stopping finasteride) PSA density = [B].196[/B] (9.01/51cc)

During the first six months on finasteride I had only a 32% drop in the PSA, but after 18 months the total drop increased to 42%. Having stopped the finasteride my number has in six months more than doubled and is now almost 2 points higher than my previous highest reading. Actually, on a chart, my climbing number seems to be rejoining an upward trend line of roughly 1 point per year that was being projected two years ago. Anyone here had similar results going on and off of finasteride? Can benign prostate cells continue to grow or multiply while taking finasteride?

I might add that between September 2006 and March 2010 I have been examined 4 times by an expert in Michigan with Color Doppler Ultrasound – no suspicious areas have been noted. Also, all of my DRE's have been normal so far and I've never experienced prostatitus pain or any difficulties urinating.

I recently heard of a procedure called a trans-perineal mapping biopsy. For men like me having undergone repeat trans-rectal biopsies with negative results, the procedure reportedly finds cancer 39% of the time – mainly in the apex and anterior zones that are apparently either difficult or impossible to sample transrectally.

I wish I had known about this long ago before my PSA ever got anywhere near this high but none of my doctors ever hinted [I]anything [/I]to me that transrectal biopsies don't sample the whole gland, or that there is another way to do biopsies.

I am scheduled for another PSA later this week followed by the transperineal mapping procedure in about two weeks (November 9) and plan to pay the necessary ten to fifteen thousand dollars for it out of pocket since my insurance company doesn't want to.

Advice or comments about any or all of the above?

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