First PSA test

[cgarr]

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

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

[stevepaa]

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

[Dottore]

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

[Joeaksa]

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.

[Rikao4]

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

[imcarthur]

Originally Posted by stevepaa

Request a biopsy-no fun and it hurts.

Repeat. 1000 X.

But when you have to . . . take drugs.

Ian

[TechnoViking]

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

[Moses]

Originally Posted by stevepaa

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

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.

[Superman]

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.

[Superman]

double-post

[stevepaa]

Originally Posted by Moses

Doing a biopsy after a negative screening test is asking for trouble. Keep in mind that 70% of elevated PSA results are false positives. .

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

[TechnoViking]

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.

[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.

[Superman]

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

[Moses]

Originally Posted by stevepaa

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

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.

[stevepaa]

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?

[Moses]

Originally Posted by stevepaa

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).

[imcarthur]

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

[John_AZ]

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=email&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

[Nathans_Dad]

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.