Can prolonged use of Combodart for BPH make it difficult to detect cancer in PSA tests?

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Hi, About 5 years ago (aged 49), I was referred for further tests as a result of a routine blood test revealing a PSA level of 9.5 The standard 10 biopsies were clear, so I was referred for a further 25. Of this further 25, one came back as 'A Typical'. The specialist explained that this basically meant that the laboratory could not be sure and that it might indicate a pre-cancerous condition, or perhaps that the biopsy was taken from an area near a cancerous growth. At that point I was introduced to a Macmillan nurse and advised to consider a TURP procedure. I decided to pay privately for the template biopsy procedure, where a further 65 biopsies were taken. To the surprise of the specialist, this came back clear and he advised me that with 99% certainty my diagnosis was BHP. As a result I've been on Combodart ever since. My only follow up is an annual PSA test which has consistently been 3.8 The question I forgot to ask was whether the BPH drug could affect the PSA reading, making it impossible to tell whether there was or is cancer present?

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  • Posted

    Hi,

    I think this does affect the PSA reading making it read lower but your GP will know this and adjust his interpretation of the reading.  However, even without that, PSA readings can be unreliable.  Congratulations on taking Combodart, I was unable to take it and stopped in favour of watchful waiting.  My PSA level now reads between 1 & 2  (I'm 67)

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    • Posted

      Thanks Robert, my GP wasn't able to give me an answer that I was confident in. I guess what I want is some reassurance that if it turns cancerous, or that if there is a worsening of an existing, undiagnosed cancer, that the annual 3.8 would rise, even a little bit.
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  • Posted

    I know it is in retrospect but to be honest with you I think that you have been over investigated already. Combodart does not interfer with PSA and I would not go near another urologist unless my PSA went over 10 and continued to rise from there. Prostate biopsy is not without risk in its own right and can have a mortality rate of over 1%.
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    • Posted

      Different studies have thrown up different figures and my 1% is a kind of metanalysis if you like. The point is though that prostate biopsy does carry a significant mortality rate -- mostly from septisemia, and that this mortality rate may well mean that the risks of prostate biopsy outweigh the benifits.

      Emis Moderator comment: I have removed the link as it went to a site requiring a login. If users want this information please use the Private Message service to request the details.

      http://patient.uservoice.com/knowledgebase/articles/398331-private-messages

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    • Posted

      Crikey, that's alarming Andrew. I suppose that relates to infections? Fortunately, despite having 100 biopsies in total I didn't get an infection but the template procedure was not without short term complications.
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    • Posted

      Endoscopy carries a far greatr risk.

      From  American Society of Clinical Oncology (ASCO)

      Background: With the widespread use of PSA testing for prostate cancer screening in population, more prostate biopsy are being performed and seem set to increase in number. The safety of this diagnostic procedure needs to be ascertained. Only one study evaluated the mortality following prostate biopsy and reported an increase of 2 deaths per 1,000 biopsies. Our objective was to re-evaluate the risk of death following prostate biopsy in a large, well-conducted randomised trial ,

      We extracted data from the PLCO study on all men participating in the study with a follow-up until 31/12/2009. All biopsies performed since randomisation were included. Cause of death was defined by ICD9 classification. Results: Among 12,300 prostate biopsies, 36 deaths occurred within120 days: 17/8390 in the intervention arm and 19/3910 in the control group. Only 17 deaths had neoplasm listed as the underlying cause of death. Thirty-two deaths out of 9,124 (0.35%) occurred in the positive biopsy group compared to 4 out of 3,176 (0.13%) in the negative biopsy group. In this latest group, this represents 1.3 deaths per 1,000 biopsies. Deaths occurred in all age groups from 55-69 to 70-74, and there was no difference identified in age between study arms (p=0.45) nor between those with a prostate cancer diagnosis and those not (p=0.73). Conclusions: The mortality rate at 120 days following prostate biopsy of 1.3 deaths per 1,000 biopsies, in a population free of cancer, is a serious concern for the computation of benefit risk associated with PSA testing. This figure is in line with the risk reported by Gallina et al (2008) and is now based on a properly monitored population. This prostatic biopsy mortality would occur earlier than any benefit from a screening program and could reverse any potential gain from screening such as recorded in ERSPC study.

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  • Posted

    I suppose the only assurance would be an occasional rectal examination.  At the hospital they insert a small probe (quite painless) and a reading shows on the computer giving the exact size of the prostate and whether it is smooth or has nodules etc., this would be a better assurance than monitoring PSA levels alone.  A colleague of mine had a PSA level that was within normal parameters and it turned out that he had aggressive cancer present.  In his case a biopsy saved the day and the prostate was completely removed.  It saved his life probably.
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  • Posted

    Incidentally, Combodart does interfere with PSA readings, they decrease by about 50% after 6 months treatment according to the manufacturers and doctors will take this into consideration when interpreting the result.
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  • Posted

    I would encourage every man with a high PSA to let a little time pass and get a retest before opting for the biopsy.  Who knows all the factors that can affect a PSA test?  I know that recent sexual activity will, as will some medications.

    I had a prostate biopsy at age 58 after a test showed a PSA of 9, and it was probably the most unpleasant experience I've ever had.  There were no complications, and the test came back negative.  I was recovering from a hernia surgery at the time, which means lots of blood, anesthetics, and antibiotics in my lower abdomen.  I'm convinced those factors influenced my PSA level or the test itself, because every subsequent test has hovered around 4.

    It is not heard of for a prostate biopsy to result in retention so serious that a TURP is required - it happened to a close friend of mine - so be sure you need one before you agree to it. 

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    • Posted

      I agree with Thimas1947, I am 52 and had a number of bladder / prostate investigations in 2013 and finally had a PSA test which came out at 8.6.  I was immediately referred to the urology oncologist who did an MRI which came back negative.  My PSA was measured again 3 times over the following 3 months and reduced to 6.8, 6.5 and 5.9. It is measured every 6 month now, the most recent PSA test done in May 2015 was 2.1 which I was told was normal.  Wait a while and retest as urologists poking around near your prostate can cause the PSA to rise.
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  • Posted

    Hi,

    I had an enlarged prostate,, and the urologist suggested i have a turp surgery

    which I did.I had my turp surgery on the 19th Septemper last month..After three days of my surgery I went home..I was experincing a burn sensation which the doctor told me that its normal...Ok Three days latter im having off balance in my walking I went to the emergency unit and I got admitted..Two different doctors came to see me about my swaying here and there..According to them they didnt find anything.One doctor was a ear specialist and the other one was a doctor for stroke patients. I had a ct scan and my urologist doctor says that theres nothing found in my brain to cause my off balance..Iam very worried as this walking problem has coused me to stay indoors and iam not able to do my normal routines.I have a boat and I love fishing. Gardening and lots more work I do around the house..By the way Iam 78years old.My review was last thursday and my doctor i.e. the urologist hav stopped giving me antibiotic but instead told me to drink lots and lots of water. He asked me to come back in three weeks time..If any one could please help me and tell me what is the cause of my walking off balance? Before this turp surgery I was fit and happy..And now Iam a miserable man..

    Thank you.This is all

    Jack

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    • Posted

      Off topic slightly but a few years ago I suffered a short bout of dizziness that I self diagnosed from Google as an imbalance of the fluid in the inner ear. There are various simple exercises available freely onlinethat worked for me. Might be worth a try? Hope the TURP has solved your other problem.

      Ian

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