BPH with PSA of 9.7

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Hubby is diagnosed with BPH. His PSA has been high for 5 years or so, ranging from 4-7ish. He has BPH, and had a biopsy a couple of years ago when his psa was at its highest of 7.3.

Doctor said he would eventually need surgery for BPH, but he should wait as long as possible, due to possible side effects.

But his latest PSA came back 9.7. Is this more worrisome for possible cancer again, or just a result of his prostate growing even more?

Experiences with BPH and a PSA this high?

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  • Posted

    PSA is notoriously poor for predicting cancer and if he had a negative biopsy at 7.3 who's to say it will be any different at 9.7? It would make sense to have an MRI scan to see if there are any suspicious areas so there can be a more targeted approach in a biopsy leading to diagnosis. It is entirely possible for the "blind archery" approach of taking random samples to miss any areas of concern and return a negative test.

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  • Posted

    Yes, BPH and PSA between 9 and 11 over the last few years, and prostate around 98 cc. I've had 3 biopsies, all negative. I would strongly suggest doing a 3T MRI before doing another biopsy. The MRI may come back with no suspicious areas, and then biopsy most likely not necessary. If MRI comes back with suspicious areas, then another biopsy would be advisable, but it will be a targeted biopsy rather than a "pin the tail on the donkey" random biopsy.

    On my third go around, when I learned about MRI diagnostics, I had a 3T MRI. Came back with PIRADS 4/5, which is suspicious, so had targeted biopsy which was negative.

    If no cancer for your husband, then consider PAE also when considering surgeries to deal with BPH that are more invasive and have more troubling side-effects

    Is your husband on any meds? What are his symptoms?

    Rich

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  • Posted

    I have been fighting BPH for years. PSA always hovers around 6.6. I've had two biopsies (both negative) then opted for The Green Light (PVP) procedure in December, 2018. My PSA jumped to 9.9 after the procedure but now enjoy normal emptying of my bladder. No more problems but PSA is still around 8.0. Elevated PSA doesn't always indicate cancer. My father had the same issue and just passed at the age of 90 from kidney failure. Hope I am just as lucky as him.

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  • Posted

    When my prostate was growing to 75 grms my PSA gradually went up from an initial 5.0 when it was 35grm to 9.8. I had two negative biopsies in that time. After a GL laser procedure it went back down to 5.1.

    As it regrew over time to 135 grms my PSA went up to about 7.8. Amazingly after a second laser procedure in 2013 (Thulium/Holmium it came down to 0.74.

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  • Edited

    One option is to go to someone like Dr. Karamanian in Houston. You can have a 3T scan done where you live, and then confer with Dr. K. It's an expensive route as he doesn't accept Medicare and (I think) other insurance. So it's about $25 K out of pocket. His FLA procedure addresses any cancer nodes and the BPH, while avoiding access via the urethra. I have a friend who had a similar situation to your husband, and he was totally satisfied with the outcome, as it avoided all the bad side effects of TURP procedures.

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  • Posted

    PSA scores are so bad at predicting cancer that they don't statistically save lives. If it would make him feel better, a 3tmri is the best cancer screen.

    Waiting on a BPH treatment is a bad idea. Forcing will lead to bladder damage which isn't always reversible. Someone mentioned PAE - that's a good option with no enlarged median lobe, not so good with one. Rezum would most likely work regardless - but the first 4 weeks can be messy at time - but permanent side effects are extremely rare. Greenlight works too, but it's more invasive, requires anesthesia and brings permanent side effects in (RE 50% of the time - incontinence rarely).

    He should get a scope and urodynamics test from a doc who does most of the procedures to make an informed decision. And don't have anyone touch him that hasn't done that procedure at least 100 times

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  • Posted

    I should have said that hubby did have an MRI. Don't know if it was a 3t MRI or not. Based on the suspicious areas on that, they did an mri guided biospy.

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    • Posted

      Mama,

      What was the result of his guided biopsy ? It really should be a 3T MRI. It gives more detailed images than 1.5T MRI. Dr Karamanian in Houston recommends a MP 3T MRI, where MP means Multi Parametric, which means contrast, and prostate protocol among other things. I called his office yesterday, and the admin who answered the phone told me all of the above, she also recommended facilities in my area, from a list they have. She also said that so far (as of 1/29/20) Medicare and insurance companies have not covered their procedure, FLA, Focal Laser Ablation. He may not want to consider FLA, unless cancer was found, because of the cost, $21K to $25K. You also need a good person to read your 3T MRI images, but I believe that if the facility is on their list they have a qualified person to read the images. Dr Karamanian also has a link on his web site for uploading MRI images.

      Other things you should find out about your husband's prostate are:

      size

      enlarged median lobe or not

      Best Wishes,

      Thomas

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  • Posted

    Thanks for the info! I don't know if it was a 3t or not. I do know that none of the samples came back as cancer. So they have just been watching his psa. His last one was 6.3 six months ago. They just had him repeat it now....so with the jump, I don't know what the next move will be.

    He is already on medications for bph. Also has plenty of symptoms, but only he can decide when that is bad enough to do something about the bph, I guess.

    Unless they recommend treating the bph.....b/c of the psa? Or is that not a thing, and the psa is only used to determine if they should check for cancer again?

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  • Posted

    For BPH, The larger the prostate the higher the psa # may be. My 220g size n i register psa of 6.0 early summer n 6.2 October. Negative DREs for many past years...

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