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Cancer: Prostate Message Board


Cancer: Prostate Board Index


Hi whitebeach and welcome to the board! :wave:

I'm responding to your initial post, #1 on your new thread.

A few years ago what your urologist is advising would have been standard advice and may still be the usual approach. However, things have changed since then, and you have some bases you can touch without getting a biopsy, at least right now.

It appears that you already know that BPH and prostatitis can elevate PSA, and the increase to 9.4 could easily be within the range of those two effects. In fact, elevation to a PSA of 50 is not uncommon for prostatitis, and levels much higher than that sometimes occur. However, cancer could also be in the mix but be cloaked by the effects of BPH and prostatitis. It is possible that BPH is causing the increased PSA. There are some things you can do to help figure out what is going on.

Do you have any other PSA scores either before or between the 6.4 two years ago and the 9.4 from yesterday? Sometimes the pattern of change can tell us a lot. Prostatitis often causes PSA to have a changing up and down pattern that repeats in what I believe is an irregular way. If you get past this episode, with or without a biopsy and without a diagnosis of prostate cancer, you might benefit from having the PSA checked every six months. If I were in your situation, I would want a check three months from now too. Prostate cancer causes the PSA to rise in a steady exponential pattern as 100,000 cancer cells split into 200,000, then the 200,000 split into 400,000, 400,000 into 800,000, and so on; PSA due to pure prostate cancer, undisturbed by other influences, causes the PSA to double in a period of time that does not change. For instance, the PSA might double every 3 years. Prostate cancer does not cause the PSA to go waver up and down.

There is a test known as PCA3 that can be done to help smoke out the likelihood of prostate cancer. It can be done locally with results shipped to an analysis center. It requires the urologist to basically massage the prostate for a short time - my recollection of what I've read is that it can take a minute - and then, a little later, urine is collected and the sample sent off. Distance to the analysis center does not matter, so you could use a center in the USA or beyond Australia if you do not have a local center. There is some vigorous research in prostate cancer going on in Australia, so you may have a center that can analyze the results within country. PCA3 is strong - specificity to prostate cancer and few false alarms, where the PSA test is weak, and PCA3 is not so good where PSA is strong - sensitivity to the presence of cancer. In other words, while PSA is very likely to signal that something in the prostate is going on (e.g., BPH, prostatitis, or prostate cancer), PCA3 is a bit less likely to indicate prostate cancer, but if it does suggest PC, it is likely to be there. PCA3, or PCA3Plus as it is known in one advanced version, has fairly few false alarms. Unlike the "free PSA" test, it is not fooled by prostatitis into giving a score that looks like it might be prostate cancer.

Do you have a current size estimate for your prostate, ideally done by Trans Rectal Ultrasound (TRUS), but also estimatable based on a DRE by an experienced urologist? Two research based rules of thumb are (1) multiply the size of the prostate in cc by 0.066 to get an estimate of PSA produced by healthy prostate cells, or (2) multiply the size in cc by .1 for the same estimate. If your prostate were very large, say 100 cc, that would explain a non-cancerous PSA of from about 6.6 to about 10. Of course, PSA can be driven by infection as well as BPH, and cancer can also be in the mix, but, if so, we would expect the PSA to be higher than predicted using the above calculations.

Another approach is to use a drug to "challenge" whatever is producing the PSA. Either finasteride (formerly Proscar) or Avodart is prescribed for up to six months to see whether the PSA drops by about 50%. These drugs reduce BPH and typically cause a drop in PSA of about 50% if BPH is causing elevated PSA. If the PSA does not drop by that much, then there is greater concern that prostate cancer is involved. Of course, these drugs also will usually reduce or eliminate urinary problems if BPH is involved.

There is an outstanding new book that goes into your kind of issue: "Invasion of the Prostate Snatchers -- No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual Potency," 2010, by Ralph H. Blum and Mark Scholz, MD. Dr. Scholz is not shy about recommending a biopsy, but he is in the new school of doctors who are trying to reduce the number of [U]unnecessary[/U] biopsies. The non-profit organization known as PCRI (the Prostate Cancer Research Institute) also has excellent free publications that deal with situations similar to yours.

I hope you find something that works, and I hope you do not find you are a member of our club. ;)

Take care,

Jim :wave:
[QUOTE=IADT3since2000;4747031]Hi whitebeach and welcome to the board! :wave:

I'm responding to your initial post, #1 on your new thread.

A few years ago what your urologist is advising would have been standard advice and may still be the usual approach. However, things have changed since then, and you have some bases you can touch without getting a biopsy, at least right now.

It appears that you already know that BPH and prostatitis can elevate PSA, and the increase to 9.4 could easily be within the range of those two effects. In fact, elevation to a PSA of 50 is not uncommon for prostatitis, and levels much higher than that sometimes occur. However, cancer could also be in the mix but be cloaked by the effects of BPH and prostatitis. It is possible that BPH is causing the increased PSA. There are some things you can do to help figure out what is going on.

Do you have any other PSA scores either before or between the 6.4 two years ago and the 9.4 from yesterday? Sometimes the pattern of change can tell us a lot. Prostatitis often causes PSA to have a changing up and down pattern that repeats in what I believe is an irregular way. If you get past this episode, with or without a biopsy and without a diagnosis of prostate cancer, you might benefit from having the PSA checked every six months. If I were in your situation, I would want a check three months from now too. Prostate cancer causes the PSA to rise in a steady exponential pattern as 100,000 cancer cells split into 200,000, then the 200,000 split into 400,000, 400,000 into 800,000, and so on; PSA due to pure prostate cancer, undisturbed by other influences, causes the PSA to double in a period of time that does not change. For instance, the PSA might double every 3 years. Prostate cancer does not cause the PSA to go waver up and down.

There is a test known as PCA3 that can be done to help smoke out the likelihood of prostate cancer. It can be done locally with results shipped to an analysis center. It requires the urologist to basically massage the prostate for a short time - my recollection of what I've read is that it can take a minute - and then, a little later, urine is collected and the sample sent off. Distance to the analysis center does not matter, so you could use a center in the USA or beyond Australia if you do not have a local center. There is some vigorous research in prostate cancer going on in Australia, so you may have a center that can analyze the results within country. PCA3 is strong - specificity to prostate cancer and few false alarms, where the PSA test is weak, and PCA3 is not so good where PSA is strong - sensitivity to the presence of cancer. In other words, while PSA is very likely to signal that something in the prostate is going on (e.g., BPH, prostatitis, or prostate cancer), PCA3 is a bit less likely to indicate prostate cancer, but if it does suggest PC, it is likely to be there. PCA3, or PCA3Plus as it is known in one advanced version, has fairly few false alarms. Unlike the "free PSA" test, it is not fooled by prostatitis into giving a score that looks like it might be prostate cancer.

Do you have a current size estimate for your prostate, ideally done by Trans Rectal Ultrasound (TRUS), but also estimatable based on a DRE by an experienced urologist? Two research based rules of thumb are (1) multiply the size of the prostate in cc by 0.066 to get an estimate of PSA produced by healthy prostate cells, or (2) multiply the size in cc by .1 for the same estimate. If your prostate were very large, say 100 cc, that would explain a non-cancerous PSA of from about 6.6 to about 10. Of course, PSA can be driven by infection as well as BPH, and cancer can also be in the mix, but, if so, we would expect the PSA to be higher than predicted using the above calculations.

Another approach is to use a drug to "challenge" whatever is producing the PSA. Either finasteride (formerly Proscar) or Avodart is prescribed for up to six months to see whether the PSA drops by about 50%. These drugs reduce BPH and typically cause a drop in PSA of about 50% if BPH is causing elevated PSA. If the PSA does not drop by that much, then there is greater concern that prostate cancer is involved. Of course, these drugs also will usually reduce or eliminate urinary problems if BPH is involved.

There is an outstanding new book that goes into your kind of issue: "Invasion of the Prostate Snatchers -- No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual Potency," 2010, by Ralph H. Blum and Mark Scholz, MD. Dr. Scholz is not shy about recommending a biopsy, but he is in the new school of doctors who are trying to reduce the number of [U]unnecessary[/U] biopsies. The non-profit organization known as PCRI (the Prostate Cancer Research Institute) also has excellent free publications that deal with situations similar to yours.

I hope you find something that works, and I hope you do not find you are a member of our club. ;)

Take care,

Jim :wave:[/QUOTE]





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