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Cancer: Prostate Message Board

Cancer: Prostate Board Index

[COLOR="DarkGreen"]Hi Chris and welcome to the board! :wave: (I hope you are only a temporary participant. ;)

I'll respond to your initial post in green, but I'll answer your last question first: "Would I be out of line insisting on these conditions (ultrasound only and a fresh PSA)?" No, you would not be out of line, but it may not be the best course at this time. You wrote in part:[/COLOR]

[QUOTE=Chris61;4715848]I'm 57. My primary care doctor noted increased velocity in my PSA score, which was 3.9 a week ago, an increase of nearly a full point from early 2010.]

[COLOR="darkgreen"]Those scores and the pattern actually give you two indications for a biopsy. First, these days a lot of doctors are using a PSA of just 2.5 as a trigger point. While that strikes me as overly eager in the absence of other clues (the net benefit appears to be catching about 1.5% more significant cases somewhat earlier than they would otherwise be caught), your PSA of 3.9 is almost at the traditional threshold for concern of 4.0. Moreover, you are not that old, and the "normal" PSA for a man in his 50s is 3.5. ("Normal" is a subjective term here, meaning less than strong likelihood of prostate cancer. The actual norm for a man in his 50s with no infection, benign enlargement or prostate cancer is a PSA of just 0.9.

The second factor is the increase of 1.0 in a year. That's enough to trigger concern. It's more than you would normally expect from benign enlargement in a year, as I understand it as a fairly savvy layman with no enrolled medical education, but it is less than is often seen with an infection. That leaves cancer as a suspect :confused:, but infection and benign growth, either separately or in combination, could still be responsible. Even if the culprit is cancer, the increase of just 1.0 is well below the threshold rise of 2.0 in a year due to cancer that is an independent risk factor for more aggressive disease. [/COLOR]

[QUOTE]He referred me to a urologist. I'm inclined to consent to a transrectal ultrasound but not to a biopsy of the prostate without further consultation (with all parties fully clothed.) I also think another PSA test should be done just BEFORE the urologist does his thing.[/QUOTE]

[COLOR="darkgreen"]That referral is sound and wise. The urologist is the expert in doing digital rectal exams, which not only can reveal clues of possible cancer but also give a good estimate of the size of the prostate, which can be related to PSA, giving more clues. The urologist should also be able to consider and execute a workup that has a good chance of smoking out an infection. Some infections are stealthy and very hard or impossible to pin down, by the way. The urologist can also prescribe other tests, such as the follow-up PSA you mentioned, a "free-PSA" test from the same blood draw, and perhaps a PCA3 or PCA3Plus test that nicely complements normal PSA tests and overcomes limitations of "free PSA" tests.[/COLOR]

[QUOTE]What I've read about the PSA leaves me with the impression that it produces many false positives as a result of numerous factors, notably benign prostatic hyperplasia (the most common cause of an elevated PSA), ejaculation within 48 hours of the test, manipulation of the prostate during the digital rectal exam, etc.[/QUOTE]

[COLOR="darkgreen"]Right, but PSA is very useful as a hyper alert sentry that something is going on; hopefully it is not cancer. Generally, the odds would be about 25% just based on the elevation.[/COLOR]

[QUOTE] Since we're talking tenths of points here,[/QUOTE]

[COLOR="darkgreen"]As I noted above, that's not really the case. There is a sound basis for concern.[/COLOR]

[QUOTE]a fresh PSA result -- say 3.4. or 3.5 if I behave myself and refrain for a couple of days -- could lessen the medical motivation to biopsy as a precaution, to be "on the safe side" or some other subjective rubbish. Besides, while intending no disrespect, I'm not about to allow a young, non-board-certified urologist to fire needles into my prostate because he thought he saw something on a computer monitor. Indeed, if I'd scored in the mid-3s on my test a week ago, I doubt I'd even be in this situation.
Would I be out of line insisting on these conditions (ultrasound only and a fresh PSA)?[/QUOTE]

[COLOR="darkgreen"]It's true that many urologists are over eager. There is an outstanding, expert book that was published just last August that is right in line with the concerns you are raising, as you can see from the full title. Here's the info: "Invasion of the Prostate Snatchers -- No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual Potency," by Ralph Blum and Dr. Mark Scholz, MD. The emphasis is on determining what is necessary and what is unnecessary using tools we now have and sound thinking.

Take care,

Jim :wave: [/COLOR]

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