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Concerned Daughter - Update on Father

Posted , 12 users are following.

karlee13
karlee13

Hi.  I posted earlier this month about my father's PSA results after he went for a yearly physical.  The results were:

2011 - PSA 1.83

2013 - PSA 2.92

2017 - PSA 4.24

My father does have symptoms of BPH, and has for a couple years, but he was never definitely diagnosed with anything.  I would hate to jump to the assumption that he has cancer, but it is definitely a worry of mine. He was placed on Flomax earlier this month from his GP and his symptoms have gotten better. 

Anyways, he went to the urologist two days ago.  The urologist was concerned with the rise in the PSA numbers.  He placed him on three weeks of levofloxacin in case it is an infection or inflammation of some sort.  If the numbers don't come down, he was considering doing a biopsy.  The urologist also did a DRE and didn't notice anything remarkable. 

I'm just nervous and was looking for input on this latest news.  Thanks.

0 likes, 26 replies

26 Replies

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  • geoff90305
    geoff90305 karlee13

    Posted

    karlee, A rising PSA needs investigation. Many experts say above 4 becomes an issue. My urologist said to me he has several patients with a PSA of less than 2, and aggressive prostate cancer. BUT, the average man who presents with a rising PSA is due to prostatitus and BPH and his prostate is increasing in size. I did not see your fathers age! If they did a detailed biopsy on your grandfather, (due to his age) they would most likely find cancer, and it will be the 'common' variety that is very little, and slow growing. Many 80+ year old men die with prostate cancer, but not from prostate cancer. It is just one of those things most men get.

    The problem your Father has, as is common to us all, how to work out what the PSA test is saying. According to the inventor of the test, it is saying how healthy the prostate is. A PSA reading never says he has cancer, just how much the prostate is stressed and leaking PSA for some reason. There are many tests to try and help determine if cancer is present, some very invasive like a biopsy, others not so invasive like a 3TmpMRI. My PSA went from a 13 year average of 2.4 to 13 in 4 months. ( I doubled way too quick) A 3TmpMRI said no meaningful cancer found. My doctor said I could have had several negative biopsies looking for the cancer, and of course the complications it potentially brings on.

    As for other blood tests, I had the PSA free and PHI. Both said I had a very high chance of cancer!! My urologist said while he trusts these tests, he also said my Prostatitus and BPH(seen on the MRI) was probably causing the false positive blood test results. So, while possibly very expensive for you, the MRI seems to be more definitive. If it finds something, then you get the targeted biopsy, rather than a blind fishing expedition. In summary, it is what your father can afford to do.

    Geoff 

    • karlee13
      karlee13 geoff90305

      Posted

      My father is 57. Sorry for not including that. Thanks for your info. This is something we're definitely not ignoring. I was just looking to see what other people's thoughts are and to see if there was any way to put my mind at a little bit of ease as we go through this process of seeing what is definitively wrong.

    • geoff90305
      geoff90305 karlee13

      Posted

      Karlee, Prostate cancer diagnosis is a stressful time. But, 75% of rising PSA is usually not cancer, but prostatitus or BPH related. Maybe your dad had a UTI and this is the cause of the rising PSA. When I graphed your fathers PSA rise, it seemed a pretty consistant rise over 5 years.This is the dilemma we all face. I chose the 3TmpMRI because i could not see a urologist for 2 months. My general doctor said do not worry, prostate cancers are usually slow!! Not very helpful. Anyway, the MRI result allowed my blood pressure to settle before specialist visit, as no major PCa lesions were found. Here in Australia, 3TmpMRI cost about $AUD500-750. We have no Government or health insurance cover for prostate MRI. My specialist said the biopsy may need to be repeated a few times if PCa not found. The cost, time and illness risk for repeat biopsies convinced me to go the MRI route.
    • barney34567
      barney34567 geoff90305

      Posted

      May I ask, was your 3T MRI reported on by a specialist on prostate imaging or a general radiologist!
  • rocketman42
    rocketman42 karlee13

    Posted

    Karlee-

    I realize this is a lot of information to absorb. It is like drinking from a fire house. But it is very important for you father to do his due diligence. He should be actively involved in this process and not just you.

    Please be aware that the MRI and blood tests are merely tools. They help to indicate and predict if further investigation is warranted. They are also meant to minimize the number of men that have unnecessary biopsies. ( another issue altogether ). BUT...also realize that a biopsy is the only definitive way to diagnose prostate cancer. 

    It is not a perfect sceience and the field is still in its infancey. However, it is improving rapidly both with the means of testing and the means of treatment. A negative biopsy doesn't mean there might not still be cancer since it might have been missed. But a positive biopsy is a clear indication that cancer is present.

    Then the question becomes what is the Gleason score of the positive biopsy and what is the volume within the core ( biopsy sample ). All these things influence what, if anything, has to be done. If treatment is indicated then you will be faced with the multiple choices of treatment options available.

    My point is there is a lot that you AND YOUR DAD have to become educated about. It is essential that you both spend time researching everything you can about the disease process so that you can make educated choices. There is a specific order in which to do things in order to find out what is going on and what to do next.

    At 57, your dad is young and has a rising PSA. Rather than sit around worrying if your dad has PCa it is in your dad's best interest to take the next step and have both a 3T MRI and either a 4K or PCA3. This will arm you and your urologist with additional information and guide you toward the next step

    Your dad and only your dad can decide what is best for him but sitting around wondering seems to be the least productive option.

    • karlee13
      karlee13 rocketman42

      Posted

      Thanks for your reply. He's not ignoring the rising number, just trusting what his urologist wants to do, whereas I'm looking into alternatives before jumping into a biopsy right away, such as the PCA3. I think my family is just used to be looking into everything, since I am currently in graduate school to become a physician assistant. Unfortunately, despite about to become a healthcare provider, I've learned how sometimes you can't always trust what the urologist says, so that is why I am looking more into it than my father.

    • rocketman42
      rocketman42 karlee13

      Posted

      Totally agree with the need to be proactive when dealing with prostate cancer. You can't always depend on what you are being told by the doctors and you need to familiarize yourself with all your options. 

      Also totally agree that further testing is needed prior to proceeding with a biopsy. This does not exclude the fact that he may need the biopsy but at least it will have been confirmed with the other tests first.

      Where do you and your dad live ? I'm curious because it might be best to visit a top teaching institution for the further evaluation that is needed.

    • karlee13
      karlee13 rocketman42

      Posted

      We're from Pennsylvania. Closest top teaching institution is Penn, which is two hours way from home.

    • rocketman42
      rocketman42 karlee13

      Posted

      That's exactly where I would go if I were in your shoes. You should find out who the top urologists are at Penn and get an appointment with one of them. I would not depend on a urologist in a small local practice to make decisions beyond this point.

      Send or bring a copy of all his medical records pertaining to this situation. When making the appointment explain that you live two hours away and that you would like to have all your appointments for ancillary tests (blood and MRI's) coordinated with this consultation appointment so they can be done either the same day or the next day (in which case you might need a hotel room). Get it all set up beforehand and take the bull by the horns.

      Good luck with whatever you decide.

       

  • auntiebeanie
    auntiebeanie karlee13

    Posted

    Hi Karlee, I can give you both views. A brother in law who kept getting raised PSA's and everytime it was due to inflammed bladder or infection and once treated settled. My husband no symptoms, GP did a routine check on PSA, came back as 12, fastracked to Cancer clinic, they did an MRi and ultrasound biopsy. First thoughts low grade PCa small area. Gleason 3+3, However Consultant urologist from another hospital in the group decided to upgrade to Gleason 3+4, saw him he said thought active surveillance but wanted to do a further targetted biopsy, Came back more agressive cancer in the top of the lobe. No other treatment suitable than robot assisted radical prostatectomy. Once removed and analysed they found cancer was in both lobes of prostate and had spread more than first thought. Thankfully all contained in prostate so clear of cancer. 

    • karlee13
      karlee13 auntiebeanie

      Posted

      I'm happy for you both that everything was able to be removed! Thank goodness for the more proactive urologist you had.

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