PSA growing, aggressive urologist sought

igorek · New User Joined: 19 Nov 2007 Posts: 5

My dad, who is 70yo, had PSA growing for many years: it was 5 in 1994, 12 in 1997, and it is 25 in 2007. He had 4 biopcies, all negative, last one this year, with 16 cores.

We are looking for an aggresive urologist who would agree to radically remove his prostate without waiting for a positive biopcy (it will be probably too late by then). Any suggesions will be highly appreciated.

brainman

igorek, I can totally sympathize with your dilemma. It is not easy to just wait. However, anything that causes the Prostate to enlarge can make the PSA go up. Either way your dad goes, it is taking a risk. If he waits, he is gambling that it is not a cancer making the PSA go up. If he assumes that the PSA rise is caused by cancer and goes on with the prostatectomy, he is taking the risk of possibly having an unnecessary surgery with all the risks involved with surgery. It is a very difficult choice. Has he been treated for an enlarged prostate or just had the biopsies?

I assume all of the urologist you have contacted have said they will not do the surgery or you would not be asking us for help in finding one that will. Unfortunately, I do not have any to refer you to. However, I would suggest that any major medical center would probably be your best option.

Best wishes.
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johnw100

On a positive note, as 4 biopsies have all been negative, any Pristate Cancer, ( if there is any ) is probably small.

A "free PSA" test indicates the probability of PC.

The Diagnostic center for disease Sarasota claim good results with their diagnostic equipment.

tabby2 · New User Joined: 26 Oct 2007 Posts: 7

Sounds like he is a candidate for Color Flow Doppler which is more accurate in finding cancer if it exists and place the biopsy needle at that point. It can detect cancer just outside the capsule as well. Only 4 machines in the US: 2 at Dattoli Center, Sarasota, FL., one in Detroit, Dr. Fred Lee, and one in L.A.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 206

Besides trying a free/total PSA test and color doppler ultrasound, he could also go for a saturation biopsy done under general anesthesia.

I had a regular 12 core biopsy done with "lights out" and it was a piece of cake. I imagine one would be more sore after a saturation biopsy, but least there would be no awareness during the actual procedure.

Saturation biopsies take scores of samples. They can turn up cancers other biopsies missed, and provide a much higher level of reassurance when nothing is found.

There is a bigger issue here. If you look hard enough in men 70 or older, you will find a large percentage have at least a little prostate cancer. Yet relatively few will ever be bothered by it. As the old saying goes, most men die with prostate cancer, not from it. If I were 70, and my only sign of trouble was an elevated PSA, I would not be too enthusiastic about a prostatectomy. The side effects, especially incontinence, at that age, can really impact quality of life. (I was diagnosed at 43 and had a prostatectomy, then radiation later on.) When I was going through biopsies, my wife asked "Why can't they just remove the darned thing and be done with it?" I explained to her that a prostatectomy is major surgery, with major life-changing implications that follow.

My dad was successfully treated for prostate cancer in his early 60's. His PSA has never risen subsequently. Now at 75, he says he might not do much about it if his PSA did start to creep up. I understand his point completely.

Good luck.

brainman

I totally agree with all that Replicant has said. A saturation biopsy would be a great idea to discuse with his medical team.

igorek, did you find an aggressive urologist yet? Keep us informed.

Best wishes.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

igorek · New User Joined: 19 Nov 2007 Posts: 5

> did you find an aggressive urologist yet?

No, we have not yet. If my dad were, let's say, 77, I would suggest just stop PSA tests and forget about it. But at 70, we both feel that prostectomy is the way to go - biopcies are not reliable.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 206

I understand where you're coming from. But it would be a shame to undergo major surgery--with all the attendant risks for a 70 yr. old man, end up with almost certain problems with incontinence, and then have the pathology report come back "Negative for cancer." I would really be surprised if a urologist, at least in the United States, would perform a prostatectomy under such circumstances.

As far as reliability of biopsies, you can have the tissue samples sent to a lab that specializes in PCa, such as Dianon or Bostwick. That should give you a greater degree of confidence.

I don't have the research at hand, but I do believe that statistics show that for each clean biopsy a man has, the chances for cancer to be found on a later biopsy drop substantially.

igorek · New User Joined: 19 Nov 2007 Posts: 5

There are some rumors that biopcies themselves are not 100% safe, eg that they can spread cancerous cells from an enclosed tumor. I would not be surprised either if, at some point, somebody discovers that biopcies themselves can cause cancer, considering how invasive they are.

igorek · New User Joined: 19 Nov 2007 Posts: 5

Unfortunately my dad cannot send the biopcy samples to a specialized lab because his insurance is Medicare with Kaiser Permanente (an HMO). He will need to leave them before he can use a different lab.

kzimm · Regular Joined: 16 May 2007 Posts: 14

I hope I can add some advice to the discussion.

First, my Father had a radical prostatectomy well into his 70s. He was, and still is, in outstanding physical condition, and his urologist mentioned he was quite an exception. Exactly which physical factors are considered I can't be 100% sure about, but cardiac health, physical activity and weight are known major considerations.

On a diagnostic note, I had a radical prostatectomy in early June this year (I'm 53) after hunting the cause of my high PSA level for 3 years. After an 8-core biopsy found atypia in two samples in 2004, a saturation biopsy was done with no positive cores.

A year later, with PSA still high and with an unfavorable free/total ratio, another 30-core saturation biopsy was done, again with no positive cores and no atypia.

After a course of cipro (antibiotic) reduced my PSA from about 9 to 4, but still with an unfavorable free/total ratio, my urologist suggested a new test from Bostwick labs called the PCA3plus (trademark) test, in which prostate cells are retrieved from a urine sample and examined for a genetic marker that is VERY specific for prostate cancer. When my results came back with a very high reading (whatever scale they used, 35 & up is considered a strong indicator; mine was 175) a 10-core biopsy was done and a Gleason 3+3=6 cancer was detected in two cores.

While the PCA3plus test is not yet FDA approved, it's heading that direction and many insurance companies are now fine with the idea of using it in addition to the standard PSA test for better accuracy. You might see if your father's provider will cover that.

Best of luck.
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igorek · New User Joined: 19 Nov 2007 Posts: 5

kzimm, thanks a lot for your detailed reply. But from what you've described, the final test is still the biopcy, no matter how positive other (indirect) tests are. With my father's PSA at 25, I think he can get additional biopcies without any tests, probably they can have a biopcy on him every 6 months, and apparently they'll find something eventually. It is just that

1. It may be too late when a biopcy shows cancer

2. Our gut feeling is that biopcies may not be 100% neutral in terms of cancer origination, or its dissemination

Hence our search for a more aggressive urologist.

As a side note: I had an 8 core prostate biopcy about a year ago when my PSA shot up from 1 to 2.2 (42yo), from a very reputable doctor, and still it went real bad, the urine was red for 2 weeks, and pain lasted for a few months. Luckily, my dad's biopcies did not feel as bad, but still, it is a very major procedure.

kzimm · Regular Joined: 16 May 2007 Posts: 14

Yes, unfortunately biopsy with a positive ID of cancer cells is necessary before a procedure like the radical prostatectomy.

I must say, though, that after going through 4 biopsy sessions, I've not experienced discomfort or excessive blood in the urine. Either this demonstrates the difference from one individual to the next, or the urologist doing the biopsy conducted it differently.

The first three of mine were outpatient with anaesthesia, but the final - and conclusive one - was done in the urologist's office.

Comparing the prostatectomy and its complications to the biopsy, I wouldn't want to approach the former without a positive "hit" from the latter.
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Kzimm

Hawk · Regular Joined: 22 Nov 2006 Posts: 27

Igorek,

Fist, relax. Rejoice in the negative biopsies that at the very least indicate that if there is any cancer that it must be very localized . Here is the key issue. It would have to be very contained even after a decade of growth if your suspicion were correct. That is highly unlikely. You and your Dad are in danger of letting PSA readings rob much happiness. It is important to realize that even with confirmed PC the rate of climb of PSA (PSA Velocity) is a very important indicator of aggression. A PSA that goes from 2 to 4 in 3 months may only be a 2 point rise but IT DOUBLED! That means a 3 month doubling rate which is a big concern. Your dad at 70 yrs old only doubled in the last 10 years. If he has no cancer in 16 cores then he could not have a significant amount of prostate cancer (if any) and it is false to think it will some day be too late when and if it is found. Keep in mind that if your dad lives a normal age and his cancer is not revealed with in the next year or two that there is little chance it would ever be a cause of death even with non-surgical treatment.

I understand the issues, I had 3 biopsies over 4 years before they found Gleason 8 cancer at age 52. My PSA climbed from 8 to 16 in 6 months but then dropped back to 8 with diet change. Finally a biopsy a yr later hit gleason 8 with 2 of 14 cores.

I might add that at this point I have been cancer free for 4 years.

My first biopsies nicked a blood vessel. That combined with large amounts of vitamin E caused me to pass blood clots like I was holding a beheaded chicken by the neck. After that i discontinued vitamin E prior to biopsies and ate large amounts of kale (rich in vitamin K). It may have no connection but my other biopsies were very uneventful.

Best wishes to you and your Dad.

goruck · Posted: Fri Feb 29, 2008 4:47 pm Post subject: latest psa

hi,

what is his latest psa?
what is the size of his prostate?
what is his free psa?

thanks
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