First PSA test

[imcarthur]

Other prostate tidbits:

Tomatoes reduce risk. (So they say)
Red wine is good too. (So they say)
Regular - think daily - workout of the equipment is very good. (So they say)

So eat Italian food with red wine & jump the woman or self abuse & life can be mighty fine.

Ian

[Zeke]

Moses and others, isn't an ultrasound a viable second diagnostic step? I've had a couple of those and the discomfort is minimal.

[John_AZ]

Followup so as not to be misunderstood.

Take any test suggested. Your outcome is determined by how soon it is detected. Wait too long for initial testing could result in the cancer moving from the inner prostate to the outer wall and then you have real problems.

John_AZ

[Buckterrier]

My level is 6.4. In for the finger in the bum test 3 weeks ago. Doc said he felt something hard. Having a biopsy the 31st. Yikes 50%?

[imcarthur]

My brother - who has PC & has had for 8-9 years or so has PSA in the hundreds . . .

Ian

[Buckterrier]

Originally Posted by imcarthur

My brother - who has PC & has had for 8-9 years or so has PSA in the hundreds . . .

Ian

Man, I don't feel so bad now. As long as they don't have to remove. I don't want to be a eunuch

[Moses]

Originally Posted by milt

Moses and others, isn't an ultrasound a viable second diagnostic step? I've had a couple of those and the discomfort is minimal.

It is VERY difficult to detect prostate CA with ultrasound or even MRI/CT.

[imcarthur]

My brother has had surgery, radiation & chemo. All potentially scary possiblities. Plus he has had some experimental treatments. He has also self-prescribed numerous herbal remedies. It has been his career for years, but he is still alive. Failing as of late, but still alive. 8-9 years diagnosed with an aggressive strain.

But as above, most men have it, but don't die from it. Do what you need to do & don't hide from it.

Ian

[Nathans_Dad]

Ultrasound is usually done in the same procedure as the biopsy. Most urologists in the face of a significantly elevated PSA or concerning lump on DRE will do a ultrasound guided biopsy. Sometimes they will do blind biopsies if there is no area on the ultrasound that is concerning.

As far as the hard lump poster, the positive predictive value of finding a lump on DRE is somewhere between 16 and 60% depending on what study you read. Most studies fall somewhere in the 30% range. So of those people with positive tests, only 30% actually have cancer as the source of that positive test. Bottom line, don't get all worked up over a lump in the prostate.

John_AZ: While I agree that it is usually wise to follow the recommendations of your doctor, prostate cancer is a very slowly growing disease in the vast majority of patients. There is a subset of younger patients who get a more aggressive form, but the time from disease diagnosis to first symptoms can be years to decades in most cases. Prostate cancer is not your usual cancer as we think about it, again most people die WITH prostate cancer rather than FROM prostate cancer.

[Buckterrier]

Originally Posted by Nathans_Dad

As far as the hard lump poster, the positive predictive value of finding a lump on DRE is somewhere between 16 and 60% depending on what study you read. Most studies fall somewhere in the 30% range. So of those people with positive tests, only 30% actually have cancer as the source of that positive test. Bottom line, don't get all worked up over a lump in the prostate.

Thanks, I'll see what happens.

[Moses]

Originally Posted by Nathans_Dad

While I agree that it is usually wise to follow the recommendations of your doctor, prostate cancer is a very slowly growing disease in the vast majority of patients. There is a subset of younger patients who get a more aggressive form, but the time from disease diagnosis to first symptoms can be years to decades in most cases. Prostate cancer is not your usual cancer as we think about it, again most people die WITH prostate cancer rather than FROM prostate cancer.

That's really prostate cancer in a nutshell. We really need better diagnostic tests.

[John_AZ]

Originally Posted by Nathans_Dad

Ultrasound is usually done in the same procedure as the biopsy. Most urologists in the face of a significantly elevated PSA or concerning lump on DRE will do a ultrasound guided biopsy. Sometimes they will do blind biopsies if there is no area on the ultrasound that is concerning.


John_AZ: While I agree that it is usually wise to follow the recommendations of your doctor, prostate cancer is a very slowly growing disease in the vast majority of patients. There is a subset of younger patients who get a more aggressive form, but the time from disease diagnosis to first symptoms can be years to decades in most cases. Prostate cancer is not your usual cancer as we think about it, again most people die WITH prostate cancer rather than FROM prostate cancer.

Thank you Nathans_Dad for your information,

Now, for you scaredycats. Virtual Colonoscopy=somewhat worthless. If they see something they will invite you back for the real deal!!

John_AZ

[cgarr]

Originally Posted by Nathans_Dad

The bottom line is that PSA is a bad test. It is falsely elevated the vast majority of times and falsely normal in a significant number of prostate cancers. It can be elevated by prostatitis, benign prostatic hypertrophy (BPH), prostate cancer, a rectal exam...and sometimes (I think) by holding your breath and crossing your eyes...just kidding.

Anyhow, I use PSA in my clinic because it is the only thing we have besides digital rectal exam for detection of prostate cancer. If the test is elevated then I will refer to a urologist for a possible ultrasound and biopsy.

Moses is right, prostate cancer is slow growing and sometimes not detected even on needle biopsy. If the PSA is normal and your DRE (digital rectal exam) is also normal then there is no indication for biopsy.

This is pretty much what my Doctor has been telling me for years now. I gave him my family history 10 years ago when I was 40 and he has been running regular yearly exams (remove watch, put on glove test) without any problems and explained what was said above, "we can do all these tests but what then?" He is looking at the long term, no knee jerk reactions from him like me. If it were up to me I would jerk the damn thing out but then I only work on cars not people, I do have a special Doc he sent me to for my kidney stones (all that area innards stuff) and that would be the one he would send me to if this becomes a problem or in need of further attention in the future. I do have a call in to the office just to see what my number was.

[imcarthur]

Originally Posted by John_AZ

Now, for you scaredycats . . .

Yeah, while we're talking about invasive . . . I'll raise you a bladder to kidney stent . . . with a string so they can take it out . . . that required morphine both in & out . . . and Demerol . . . yum yum . . Demerol . . .

But I digress . . .

Ian

[cgarr]

Originally Posted by imcarthur

Yeah, while we're talking about invasive . . . I'll raise you a bladder to kidney stent . . . with a string so they can take it out . . . that required morphine both in & out . . . and Demerol . . . yum yum . . Demerol . . .

But I digress . . .

Ian

Is that the string that hangs out your little thing? They were going to use one for me with my stones after breaking them up but didn't. My friend the nurse said you can just pull it out yourself, is that not true?

[Zeke]

Originally Posted by cgarr

Is that the string that hangs out your little thing? They were going to use one for me with my stones after breaking them up but didn't. My friend the nurse said you can just pull it out yourself, is that not true?

Yikes!! I take out my own stitches, but I've heard that a catheter is another story. And that thing is smooth, right? A string? Hooboyy!

[Jim Sims]

A lot of "HMO" type (cost optimized) medical advice and wishful thinking posted in this thread.

There is much involved with PSA data and the tests and uses are evolving.

I suggest you do plenty of your own research; you will get some poor and contradictory advice, even from the physicians - if your best tool is a hammer, most problems will be seen as nails. Guess what a cancer specialist in radiology will recommend!

From my experience, the biopsy procedure was a trivial procedure - less pain than some of my blood donation experiences. Do not fear it.

If indicated, get the treatment you need, not what the medical statistics indicate for the overall population. It is your body and your life.

Many continue to die OF prostate cancer (not with) and from my research it is a miserable way to die.

If you need surgery (the so called "gold standard" treatment), find a good, experienced surgeon - your future quality of life depends upon it. If the cancer remains within the capsule (early detection is the key) a good surgeon can often get all the bad stuff (full cure) and leave all the "good stuff" intact.

For more information on the topic the below link is one place to start; I also recommend Dr Walsh's (of John Hopkins) book on the topic.

http://www.drcatalona.com/default.asp

[snowman]

Doctor will not give you the result of your PSA test! Get another DR, NOW! There is no excuse for this type of nonsense. There is no place for this type of Dr.

The most important thing is the rate of change in PSA. Any change over about 0.6 in one year and you need to be concerned. DO not stay with any Dr who will not tell you the result or discuss it with you, he is a QUACK! Degree or not, he is a Quack if he does not discuss the result with you and explain it in detail. Also if you exhibit any symptoms or have any family history of prostate cancer be very concerned, do any extra exams that may or may not show whats going on. Be safe and do not let them cower you into accepting symptoms as being "normal". Get a second opinion.

The condition IS genetic. Genes do not mean your doomed, just that you need to be extra vigilant.

I say the condition may be genetic because my family history. It runs in the family. One of my family is a leading cancer research surgeon, he says it is genetic. He has also been elected as one of the Good Housekeeping, cancer Surgeons of the year, a couple years back. So he knows what he is talking about. It runs back over 6 generations in my family.

Bottom line----get a good Dr. One that will talk to you, explain whats going on, one that knows whats going on, usually noted by one that is good at explaining whats happening.

[livi]

Originally Posted by Moses

Sorry, bad advice. The vast majority of prostate cancers are not deadly. Doing a biopsy after a negative screening test is asking for trouble.

There are good statistic based protocols regarding when to do biopsies. Best to follow them.

I agree, you should have been told the number. With your age and your PSA result, it's easy to determine the proper follow up. Keep in mind that 70% of elevated PSA results are false positives. One third of 50 year old men have already got prostate cancer and two thirds will have it by age 75, yet the vast majority will not die of prostate cancer whether they are treated or not. It's exceedingly difficult to predict which prostate cancers will grow rapidly and kill us and which cancers are slow growing indolent cancers that will never pose a health risk. Tread carefully.

Beat me to it, Moses.

[imcarthur]

Originally Posted by cgarr

Is that the string that hangs out your little thing? They were going to use one for me with my stones after breaking them up but didn't. My friend the nurse said you can just pull it out yourself, is that not true?

That's the one. I had lithotripsy to smash kidney stones. The rubble clogged a kidney exit & I was in agony the day after. Then 5 days on Demerol before the urologist could put the stent in & give me relief.

I didn't know self-removal was an option. I think I'm glad that I didn't . . .

Ian