First PSA Tested 24

garyfoote · Posted: Fri Jan 25, 2008 9:20 am Post subject: First PSA Tested 24

I had a DRE and two days later my first PSA test which read at 24. I am 56 and have had frequent night urination and occasional weak stream for over a year - maybe two years.

I see a urologist on Monday for followup. I've been reading a lot but there is so much conflicting info out there that I figured this place might be my best bet for real-world experience.

What can I expect at the Urologist's office? Biopsy? DRE? Second PSA?
_________________
Gary

Initial PSA 24.8. Jan 08
Second PSA 18.8. Feb 08
Biopsy Mar 08. 12 cores. 7 positive.
Gleason 8 [4+4]
Radical Retro Pubic Prostatectomy 04/29/08
Diagnosed mucinous adenocarcinoma
PSA 0.0 8 weeks after surgery
Bilateral Inguinal Hernia Repairs 7/10/08

kzimm · Regular Joined: 16 May 2007 Posts: 14

garyfoote: There's lots of info to sort out.
First, your PSA results give a single number, indicating this was an initial test. Another blood draw will determine the free/total PSA ratio; an important indicator for presence or absence of prostate cancer. The fact your physician ordered a PSA test and referred you to a urologist as a followup to the DRE suggests that he's proceeding wisely.

Your urologist will likely repeat the DRE, might order the free/total PSA test (if your physician hasn't already...but you'd have a lab appointment if that were the case), or maybe the free/total has already been done, but the urologist could be the one to consider that and report back to you.

Whether or not a biopsy is prescribed is a decision that you and your urologist will reach together.

Your symptoms - weak stream and frequent nighttime urination - can occur without prostate cancer. I was experiencing those by my late 40s, and at 50 I had my first PSA test (unfavorable), but it took 3 years of testing and biopsies before finally nailing down the culprit (prostate cancer). But even after all that time and effort, it didn't become unmanageable and after a radical prostatectomy last June, all indications are that I'm cancer-free now.

Please ask lots of questions, both here and of your urologist. Good communications make the whole ordeal a lot easier.

Your urologist might have it; if not, a library could get it for you, but I'd recommend the book "Prostate & Cancer: A Family guide to Diagnosis, Treatment & Survival" by Dr. Sheldon Marks. It's probably the most complete and easily-understood books you could hope for, and will probably answer every question you could think of.

Good luck & God bless.
_________________
Kzimm

garyfoote · Posted: Fri Jan 25, 2008 10:15 am Post subject: Re: First PSA Tested 24

Hi Kzimm,

Thanks for your response. I've fired my Dr. as he was a new physician [to me] and was not interested in listening to me at all. He would cut me off mid-sentence and pontificate. I found both him and his staff to be rude and condescending. I've gone back to my past primary physician over the phone [I've relocated] and will follow up with her as needed. Therefore no second lab testing has been ordered yet.

I'm hoping that the Urologist will order a second PSA before biopsy. The whole procedure of biopsy and followup treatments should PC be confirmed scares me as I am extremely needle shy. I guess I'll have to get over that, eh?

I'm also seeking out a better primary physician locally. I have some recommendations I'm following up on now. I'm just glad to have found this forum. I'll be around reading and learning as things progress.

Thanks for your Good Thoughts and for asking God for his Blessings upon me. Prayer is always a powerful thing.
_________________
Gary

Initial PSA 24.8. Jan 08
Second PSA 18.8. Feb 08
Biopsy Mar 08. 12 cores. 7 positive.
Gleason 8 [4+4]
Radical Retro Pubic Prostatectomy 04/29/08
Diagnosed mucinous adenocarcinoma
PSA 0.0 8 weeks after surgery
Bilateral Inguinal Hernia Repairs 7/10/08

Replicant · Moderator Joined: 01 Nov 2006 Posts: 206

Hi Gary. Like kzimm wrote, your symptoms and PSA could easily be caused by a benign condition. I think there's a good chance the urologist will want to do a biopsy, but he or she might want to try anti-inflammatory and/or antibiotics first.

On the other hand, about 2/3 of men with PSAs over 10 have cancer. (See, for example, http://70.84.59.4/~pcacoal/detect_screen_psa.htm ).

Probably more important is your PSA trend over time. Do you have your previous scores and dates? When a man has PSA over 4, an increase of .75 ng/ml or more per year can mean trouble--according to Walsh's book and the website I cited above.

Was your DRE normal?

The free PSA test is a good idea.

I have my own book suggestion--"Dr. Patrick Walsh's Guide to Surviving Prostate Cancer" 2nd edition (2007). Walsh is one of the top, if not THE top urologic surgeon in the U.S. He pioneered the surgical method that spares nerves.

Paul Lange's "Prostate Cancer for Dummies" is good, too.

I would get these books for reference even if you don't have cancer. Every man has to think about PSA scores, and a lot of men have to deal with non-cancer problems like BPH and prostatitis. These books are a big help.

Best wishes!
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

garyfoote · Posted: Fri Jan 25, 2008 10:39 am Post subject: Re: don't panic

[quote="Replicant"]Probably more important is your PSA trend over time. Do you have your previous scores and dates? When a man has PSA over 4, an increase of .75 ng/ml or more per year can mean trouble--according to Walsh's book and the website I cited above.

Was your DRE normal?</quote>

DRE was normal. This was my first PSA so no baseline is in place for comparison. It is the reading of 24 that set this in motion. All the studies I've read to date don't cite statistics with PSA above 20!

I'll be picking up copies of the books both you and Kzimm recommended. I'm sure hoping I'm one of the 1-in-3 that is cancer free. The idea of anti-inflammatories and antibiotics seems like a good first suggestion to my Urologist. Though I will have a biopsy done if she recommends it.

Thanks for taking the time to respond. It means a lot to me that people care...
_________________
Gary

Initial PSA 24.8. Jan 08
Second PSA 18.8. Feb 08
Biopsy Mar 08. 12 cores. 7 positive.
Gleason 8 [4+4]
Radical Retro Pubic Prostatectomy 04/29/08
Diagnosed mucinous adenocarcinoma
PSA 0.0 8 weeks after surgery
Bilateral Inguinal Hernia Repairs 7/10/08

badtrip · Regular Joined: 02 Dec 2007 Posts: 33

Hi Gary,

I had a similar experience to yours (I am also 56) just 3 months ago, with first PSA of 23- not a pleasant surprise...

My DRE was abnormal, blood tests showed no local infection, so went ahead with biopsy (even though I am also very needle shy)- unpleasant, but short and not really painful. Biopsy was Gleason 9 in all 6 cores, which after brief confusion helped me to decide and start treatment at once (hormone and ext radiation).

My advice (as a very short term veteran):
- if your doctor so advises- don't hesitate to do the biopsy: hopefully it will be clean and give you time and peace of mind to consider further options
- if (G-d forbid) it shows active cancer- you will be glad you did not waste precious time

May all our alarms... be false alarms...
Health!

Menachem

garyfoote · Posted: Sat Jan 26, 2008 12:26 pm Post subject: Re: First PSA Tested 24

Hi Menachem,

I've been reading like mad in advance of Monday's test. If the doc says biopsy I'm going to go ahead with it for sure.

Did your doc say anything about combined HDR Brachytherapy and EBRT? It seems to be the Big Gun for therapy as far as I've been able to discern.

Prayers for your health...
_________________
Gary

Initial PSA 24.8. Jan 08
Second PSA 18.8. Feb 08
Biopsy Mar 08. 12 cores. 7 positive.
Gleason 8 [4+4]
Radical Retro Pubic Prostatectomy 04/29/08
Diagnosed mucinous adenocarcinoma
PSA 0.0 8 weeks after surgery
Bilateral Inguinal Hernia Repairs 7/10/08

johnw100 · Posted: Sat Jan 26, 2008 6:48 pm Post subject: Re: First PSA Tested 24

The subject of lifestyle changes is not often mentioned here, although it is important in relation to PC.
Most information on diet and supplements is anecdotal, but there are obviously strong relationships with PC and other health problems.

All books I have read by PC experts cover the subject of diet to varying degrees, including the book by Dr Charles Myers, "Beating Prostate Cancer: Hormonal Therapy & Diet" and his book on diet.

Dr Myers used seeds, radiation and hormone therapy as treatment for his own high risk PC some years ago, so his book is very relevant, in fact essential reading for anyone who needs to consider treatment for PC diagnosed in the high risk category which was mentioned here.

The yananow site has lots of information and mentors experiences with stories from man who have used the various treatment options.

garyfoote · Posted: Sat Jan 26, 2008 7:42 pm Post subject: Re: First PSA Tested 24

I have recently made lifestyle changes, though my diet goes from good to bad and back again often. I'll defnitely order a copy of "Beating Prostate Cancer: Hormonal Therapy & Diet" from Amazon right after this post.

I also just checked out the yananow site and will, after my Monday visit with my Urologist, seek it out in depth. Right now all I have is a number and no diagnosis. Monday I will have had a biopsy [I'm going to insist] and within a few days, a diagnosis. Until then I'm just holding my breath...

Thanks for the information. The more the merrier, eh?
_________________
Gary

Initial PSA 24.8. Jan 08
Second PSA 18.8. Feb 08
Biopsy Mar 08. 12 cores. 7 positive.
Gleason 8 [4+4]
Radical Retro Pubic Prostatectomy 04/29/08
Diagnosed mucinous adenocarcinoma
PSA 0.0 8 weeks after surgery
Bilateral Inguinal Hernia Repairs 7/10/08

garyfoote

I had a Total and Free PSA test taken last week. Results are Total: 17.1, Free: 0.8. I'm not sure if this is a down trend or not. My primary care physician has turned out to be unresponsive so I've returned to my previous PC Doc. I am also awaiting a second opinion/test from another urologist. The first was mad at me for asking for a second urologist's opinion! Seems very unprofessional to me. No biopsy yet. I'm hoping the apparent down trend is a positive thing.

Wait and see until the 20th when I visit the second urologist.
_________________
Gary

Initial PSA 24.8. Jan 08
Second PSA 18.8. Feb 08
Biopsy Mar 08. 12 cores. 7 positive.
Gleason 8 [4+4]
Radical Retro Pubic Prostatectomy 04/29/08
Diagnosed mucinous adenocarcinoma
PSA 0.0 8 weeks after surgery
Bilateral Inguinal Hernia Repairs 7/10/08

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