First PSA test
 

With a history of Prostate cancer in the family its time for the test, had a moderate level and will be tested again in 6 months.

So what would cause a moderate level? Doc didn't give me the actual number because he know I would be hitting the internet to find out how long I have to live:D

He does not seemed worried, easy for him to say, Im a basket case, sort of!!

Get the number from him. Request a biopsy-no fun and it hurts. Then you will have information to make decisions.

Insist on the number. Doc should not be playing games with you on this.

How old are you? Get your first test before you hit 40-45 or so to establish a baseline.

Did mine when I was about that age and it was around 3 or so. Now that I am 10 years older and the readings are about the same thats good news. What you want to watch for are any drastic changes in the reading.

Agree with the above the the doc need to give you the amount, not just "its ok" comment. If he wont, then find a doctor who will work with you.

your butt=your #,
caution..don't go # crazy.
Mom's cancer #'s where high at the start, and are still high 5 years later.

Rika

Repeat. 1000 X.

But when you have to . . . take drugs.

Ian

If you have a history of worrying about cancer or cancer re-occurrence as I do, I'd play along with the doctor. That is, if you have a really good, trusting relationship with him/her as you should.

If you don't, get a second opinion from a specialist. Or get a second opinion anyway. Have the new doc get the records/results from the current doc, and let them do the worrying for you. Stay away from the web. Follow the process.

Life is too short to worry about this stuff. The docs are lawsuit-averse enough they won't let this get out of control. Two docs on the job will give you the peace of mind you want without micro-managing.

Just my opinion as cancer survivor and ex-hypochondriac who is in a much better place now ;)

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.

I'm not a doctor, don't play one on TV, and didn't sleep at a Holiday Inn last night. And so, the following information is worth exactly the price you will pay for it. Or less:

My PSA was 4.1. The normal range is anything under 4.0. I have a GF that works in a Urology office. I asked her what's the highest PSA she ever saw. I think she said somewhere around 70 or 90 or something. It's fairly sensitive. Above 4.0, and they're interested.

They did the biopsy thing. Negative. BTW, if you ever go in for the biopsy, make sure they use an anaesthetic. I have two friends who passsed out when the first core sample was 'snapped.' And so, they were asleep for the other eleven. They didn't get anaesthetic and neither did I. All three of us will get anaesthetic if it ever happens again. Not fun.

Recently, on a follow-up, my PSA was a 4.3. I confessed that I had not refrained from ejaculation at least 24 hours prior (just got back from vacation, GF missed me.....what's a Superhero to do?). He wants to wait four months and do another PSA.

You see, generally speaking, prostate cancer is quite slow-growing. If you get it past the age of about 80, they will do nothing. They'd predict that something else will kill you first.

Again, while prostate cancer is dangerous (it's cancer), and while it can spread, it's generally not a really aggressive form. If and when you find cancer, you will have plenty of time to consider your options.

double-post

I am a little confused. If 70% are false positives, then wouldn't you want a test that gave 100% accurate results?

Cost/pain/risk of re-test and monitor is << cost/pain/risk of biopsy/pathology work.

Ask me how I know. Trust your doctor, or find one you do trust. Patients asking for tests is one of the reasons we pay so damn much for health care in this country.

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.

Rick, you and Moses sound like a couple of know-it-alls. :D

Then why not skip the PSA completely and just get a biopsy?

The biopsies are not without risk. How often do prostate biopsies correctly detect existing cancer? About half the time.

So why not just skip the PSA and skip the biopsy and get a prostatectomy...

The screening procedures for prostate cancer are not perfect, but they are designed to maximize disease detection and minimize unnecessary surgery. The protocols are statistically determined.

Need some further clarification. Do you mean to imply that biopsies have 50% false positives or 50% false negatives? Or is there a 50% chance the biopsy will miss the cancerous material? But if it hits it, there is 100% detection?

About half of patients with an elevated PSA have cancer. Among elevated PSA patients who undergo biopsy, about 25% of biopsies show cancer, but another 25% fail to detect the cancer. (Not exact numbers).

Now, on the positive side . . .

I have had an elevated risk - enlarged prostate, brother diagnosed at 48 with PC. I have had several exams & PSA tests & 1 x biopsy. I am still here & still PC free. Follow the advice of a doctor you trust.

Ian

Read, read, read, read and read more. Here is an article from John Hopkins on biopsy.
http://www.johnshopkinshealthalerts.com/alerts/prostate_disorders/JohnsHopkinsHealthAlertsProstateDisorders_1949-1.html?ET=johnshopkins_blog:e5260:163328a:&st=emai l&st=email&s=EPH_080508_005

On Treatment. All Doctors have a specialty. They all give you the best outcome scenario. Keep in mind the prostate produces most of the fluid you ejaculate. The nerves to make your penis hard are attached to the prostate. ANY option will diminish sexual pleasure. Sure you can pump up your tool or take pills.

Read, read, read...

John_AZ

It always comes down to the hard-on...doesn't it?

A good point though, sexual dysfunction is fairly common following prostatectomy.

Unfortunately there just isn't a great test for detecting prostate cancer. I wish we had a tricorder like on Star Trek, but it just hasn't been invented yet.

Of course the good news is that the vast majority of folks die WITH prostate cancer rather than FROM prostate cancer. At autopsy a good majority of prostates in those over the age of 70 have cancer.

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

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

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

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%?

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
:(

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

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

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.

Thanks, I'll see what happens.

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

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

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.

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?

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!

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

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.

Beat me to it, Moses.

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