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Elevated PSA

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Roger2Dodger
Roger2Dodger

I am a 75 years old. My PSA last year was 4.03 this year it has elevated to 5.83. This has me stressed and worried. My urologist has recommend I have a biopsy. I have been reading and go ogling about prostate cancer and biopsies. The more I read and learn,the more confused I get. I am 50- to get a biopsy and 50 not to get one. Taking my life span in consideration I could die of something else if I did have the cancer. This is what I have been finding out through my research. I am presently taking Flomax to help my frequent urination. I Have also learned that they are risks involved with the biopsy. I am going nuts thinking about my elevated PSA result. Any advice coming my way, would be appreciated.

2 likes, 114 replies

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  • dieter80046
    dieter80046 Roger2Dodger

    Posted

    Hi Roger, I'm pleased youu've got the biopsy behind you and that it was "a piece of cake".

    I also learnt something from the discussion (Craig & Stewart). Didn't know what an ultrasound biopsy was; and still don't know, whether this is what I had. It sounds to me though, that the ultrasound pinpoints the areas in the prostate that should be sampled.

    Look forward to hearing what the outcome of your biopsy was and what treatment your doctor(s) recommend, if any. Until then, don't stress too much. Most men our age, I'm told, either have or will develop PC, so in a way we must be normal.

    • Roger2Dodger
      Roger2Dodger dieter80046

      Posted

      Hello dieter80046,

      Yes, you have it right about the ultrasound biopsy. My Doctor scheduled an appointment for April 12, I assume this will be the time I get my results. I am sure it does not take that long to get a biopsy back, so I am going to try to get a result sooner than April 12. I will let you know the results. I just hope my results will let me go Active surveillance.  May I ask your results of your biopsy and treatment you had, if any. your psa score before biopsy..etc.

      Thanks,

      Roger

  • dieter80046
    dieter80046 Roger2Dodger

    Posted

    Hi Roger, much of the medical jargon of the histology report on my biopsies is beyond me. So I'll tell you what I understood together with some quotations from the report:

    Ten samples (called cores) were taken from the left hand side of the prostate, 10-15mm long, ten from the right, 15-20mm long.

    MICROSCOPIC EXAMINATION: "Histological examination of both specimens (ie left and right) confirms the presence of cores of fibromuscular stroma. The cores show extensive involvement by an infiltrating poorly differentiated adenocarcinoma. Five of the ten cores from the left side and all ten of the cores from the right side show involvement by the tumour. The tumour is composed of infiltrating malignant cells arranged singly. The cells are seen infiltrating between fibromuscular stroma indicating muscle cutting. The cells have enlarged nuclei and prominent nucleoli. In areas, occasional gland formations are noted. These are seen infiltrating in fused ragged masses. Perineural infiltration is noted and some vascular channel invasion is identified. There is no accompanying prostatic intraepithelial neoplasia."

    I'm sure you'll agree, this is too much for the layman like you and me! Here then are the conclusions, as I understand them:

    5 of the 10 left cores were malignant, all ten of the right cores were, so all in all 15 of the 20 cores or samples. The tumour volume as a percentage of the prostate volume was 43%. The Gleason score was determined as follows: Primary pattern: 5, Secondary pattern: 4, Tertiary pattern: N/A. Combined score: 9 (5+4). Prognostic grade group V.

    "Tumour necrosis" absent.

    Perineural infiltration: present. 

    Angio-lymphatic channel invasion: present.

    Seminal vesicles: absent.

    PIN: Absent."

    Etc, etc.

    The long and short of it is that the prostate was quite full of cancer (more than 40% of the enlarged volume) and quite aggressive with a Gleason of 9. The urologist wanted to treat it by starting immediately with hormonal (testosterone reducing) therapy (pills in my case, which I did start taking). Quite soo, he would have wanted to do brachytherapy (radioactive pellets imbedded into the prostate) together with a radiation oncologist. I consulted the radiation oncologist and two other urologists and then opted for the radical prostatectomy instead by means of robotic surgery on a DaVinci machine.

    Let me know your results, when you get them.

     

    • Roger2Dodger
      Roger2Dodger dieter80046

      Posted

      Dieter,

      So sorry you couldn't have got a more favorable score. Your next step is to deal with it and get well. Hope all goes well with the procedure. Yes, I certainly will share my results. It pains me to have to wait so long to get them.

      Take Care

      Roger

    • stewarta
      stewarta dieter80046

      Posted

      Good move. I too had Robot-Assisted Prostatectomy due to a similar Gleason score.
  • dieter80046
    dieter80046 Roger2Dodger

    Posted

    Thanks Roger and Craig for your empathy. But as I said previously, thanks to the hormonal treatment my PSA was down to 0.1 at end Feb / begin March and I feel perfectly fine. Hope it stays that way with the next checkup in about 2 1/2 weeks.
  • Roger2Dodger
    Roger2Dodger

    Posted

    My urologist called me and I lmformed me that cancer was present In my biopsy results. Unfortunately the call came while I was having dinner at at restaurant with family. He began by telling me options for treatment. I asked what the Gleason score was and he said 6 and a 7 . Will some body explain to me what that means? I thought there was one single number for a Gleason score. After he told me of the cancer, every thing he said afterwards just went into one ear out the other. He want see me until the 12th then i can get more of a detailed results. I am just confused on the 6 -7 Gleason score.

    • stewarta
      stewarta Roger2Dodger

      Posted

      Be sure to check out Proton Beam Therapy while you are investigating options.
  • charles61038
    charles61038 Roger2Dodger

    Posted

    Roger,

    Don't panic. A Gleason score of 6 or 7 is not too bad. The range from 2 to 10, so your score is in the middle. Look at a website called my prostate cancer coach dot org. There is some good information there. Also research your treatment options. You may want to take the active survailence that many men take... where you keep an eye on things. Or you can decided on a treatment and be done with it. I chose Brachytherapy as a one time treatment with few side effects. And everything still works that way it should. My gleason score was 6. If I were you, I would consider external beam radiation, Cyberknife or Brachytherapy. They all have side effects, but do your research and see which has he least side effects. Also discuss with your urologist and your radiation oncologist. If your general health is good, you might consider treatment options. The pathologist should have also identified the type of cancer cells. I understand acenocarcinoma is a slow growing kind. If that is what you have, you have time to consider your options. My urologist and radiation oncologist both told me that with low risk prostate cancer, it is very treatable and curable.

    Good luck to you... and do some research. There is a lot of information to read through.

    Charles

    • craig84609
      craig84609 charles61038

      Posted

      I think that makes sense. My uncle did the radioactive pellets and he seems good. In my case none of that will work. I have but one option and that is robotic removal. Men with Crohns Disease can be damaged by the radiation therapy.
    • Roger2Dodger
      Roger2Dodger charles61038

      Posted

      Thanks Charles, At present I just don't have enough information regarding the stage of my cancer. It's hard to comphrend things from a phone call at a resturand dinner table. All I got from him was treatment possibilities  and a 6 and 7 score. That in itself confuses me..How can you have two different gleason score?? Maybe I misunderstood. I have found out my cancer is in the intermediate category, meaning above the Gleason 5 or 6 and below the 8 or p, meaning not slow growing, and cancer that can grow and spread. I am going tto call me a cancer Doctor today aabd see if I can get in before April 12th. I will meed my pathology report, any suggestions How I can pbtain that for my urologist????
    • charles61038
      charles61038 Roger2Dodger

      Posted

      I've seen where gleason score that show two different numbers. I think it is probably from the different core samples taken from the biopsy. The 7 is in the intermediate range. Still, from what I have read, there are good and successful treatment options to treat low to intermediate prostate cancer. Getting a copy of your pathology report should be easy. I got mine from my urologist. I had to go in to his office and sign a release form. Then the receptionist made a copy for me to take with me. It seems like external beam radiation is a common treatment which to me sounds pretty easy to do and I considered it. No preparation, but many short treatments. My radiation oncologist explained 3 options that he said would work well for low to intermediate prostate cancer as I was diagnosed with. The external bean radiation would mean about 9 weeks of treatment, going each day 5 days per week. Side effects from that would not start until later into the treatment. There would be radiation burns to the skin, and the possibility of burns to the colon and bladder. He said with today's better technology, the chances for burning internal organs is less, but still possible. And any damage there would heal over time. The other treatment he discussed with me was the Cyberknife. It is really no knife, but another radiation treatment. The first part of this treatment requires 4 markers that are inserted into the prostate. That is done about a week or 2 prior to the cyberknife radiation treatment. The reason for the markers is that those markers help focus the radiation beam directly to where it is needed. That way there is less chance of burning other internal organs i.e. colon and bladder. He also told me that this treatment would be for 2 weeks, ever other day. And each morning before going for the treatment would require you to give yourself a fleets enema. After arriving for the radiation treatment, you would be given a glass of water to drink to fill your bladder. You cannot pee it out for the 45 minutes of radiation treatment. He said the reason for the full bladder was because that would help hold the bladder out of the way of the radiation. Still, there would be some possible burning to the skin - which would heal in time. The other treatment he discussed with me was for the Brachytherapy - the low dose radiation seed implants. This is the treatment I opted for. It is a one time treatment. You are anesthetised for this treatment which takes about one hour. They insert needles through the perenium into the prostate where the seeds are implanted.  The side effects start sooner from this treatment, but they will be over sooner too. You experience some discomfort that ibuprofen helps with. After waking up, they want you to pee a couple of times - which burns a lot... but gets better after the first few times you pee. After you pee a couple of times, you are released from the hospital. It is an outpatient treatment. You experience a bit of burning when you pee for a few days, but not terrible. Also, you are sore and bruised between your legs... and it is not comfortable to sit for long periods for a week or so. And some fatigue do to the radiation - but that is with any radiation treatment. That will disapate with time. I was told the half life of the radiation seed implants is 8 weeks. After that time, the side effects will start becomig less and less. Since the seeds are very low dose, they don't burn other internal organs. The radiation is consentrated only in the prostate where it is needed.  I am at my 6 week point since I had the treatment - and I feel pretty good. No incontenence, and no erectile disfunction. The radiation doc just told me to take it easy when I feel tired - and I do that. He said for me to listen to my body and rest when I need to. Do searches online for treatment options for low to intermediate risk prostate cancer. There are many and lots of good information. Talk to your doctors... I even talked to my primary care doctor for his opinion. He also told me the Brachytherapy had good results and good success rates. Just make sure your doctors have performed what ever treatment you opt for many times successfully.

      The best of luck to you,

      Charles

    • Roger2Dodger
      Roger2Dodger charles61038

      Posted

      I am going to wait until April 13.( Doctors office called and delayed my appointment another day. After I find my stage and if it is contained in the prostate capsule. I am think a removal of the prostate. ..or that Brachythearpy you talked about. I see what mean about two scores one core sample could be 3+3 another 3×4 or 4+3.

      Roger

    • craig84609
      craig84609 Roger2Dodger

      Posted

      That sounds like an accurate assesment. Whatever you decide we all support your decision and wish you the best.
    • stewarta
      stewarta charles61038

      Posted

      Charles: I looked into Proton Beam Therapy and found there are not the side-effects one gets from Photon Beam Therapy or Brachytherapy. Not available in the UK or Australia until 2018. Used in EU, Korea, and the USA. Hellishly expensive is one drawback.

      I didn't like the answers I got to such questions as the following for any radiation therapy:

      * What do I do if PSA or other tests show the PCa is advancing/ becoming more aggressive? Can I then have a Robot-Assisted Prostatectomy?

      * How long after radiation therapy will I know if my PSA is close to zero?

      * How do you check to see if the PCa is localised, and not in the lymph nodes?

      There are of course many other questions to which one needs answers.

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