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Hi PSA, Aging Patient

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carl05115
carl05115

I am a new member to the forum.  I am 69 years old and at the age of fifty had a blood PSA test that came back as a 10.  Three biopsies later (the first two were 8 needle random and the last was 8 needle color doppler guided and was positive) I was diagnosed.  My PSA at the time of diagnosis was 20 and the Gleason score was 3 + 3 in one of the core samples and (3 + 4) in one of the other core samples.  Because of grade creep with pathology readings I have considered my cancer either slow growing or intermediate.  I also had it reviewed and learned that the cancer is diploid, not haploid.  I have opted not to have treatment, have no symptoms, and the cancer is not palpable on a digital-rectal.  My PSA doubling time is approximately five years and has remained consistent and my present PSA is 86.  Is there anyone out there with very high PSA and no symptoms?  

1 like, 6 replies

6 Replies

  • Whiteplume
    Whiteplume carl05115

    Posted

    Hi

    Don't undetstand your thinking if your biopdy is pos 3 3 & 3 4 psa 86 I know what I would do. You seem to be an unusual rare case.

    Good luck!

  • Whiteplume
    Whiteplume carl05115

    Posted

    When you get the symptoms it may be to late, worth thinking about!
  • david41094
    david41094 carl05115

    Posted

    86 is very high but a 5 yr doubling time and your biopsy results would put you in the low/intermediate risk bracket. I would have an MRI scan which would confirm that the cancer is confined to your prostate. Other health factors would be a factor if you were considering Watchful Waiting. I wish you all the best.
    • carl05115
      carl05115 david41094

      Posted

      Thanks David.  Yes, I believe that my cancer is low or intermediate and that I have lived with it for about 19 years.  The doubling time is very long and I find that to be a conceptually more sound measure than PSA velocity which, over time, will inevitably increase and scare many people into treatment (because doubling time acknowledges growth whereas increased PSA velocity does not take into account normal cancer growth).  Oh, by the way, I did have an MRI last year and it was negative for cancer outside the capsule of the prostate.
  • carl05115
    carl05115

    Posted

    carl05115 »dudley

    Hi Dudley,

    Nineteen years ago when my PSA was tested and came in at 10 a biopsy was ordered.  Eight random needles (in a haystack) found no cancer.  About three years later the same doctor did another eight random needles and found no cancer.  Looking for the proverbial needle in a haystack, I believe, does far more harm than it does good.  At that point the capsule of my prostate had been penetrated 16 times (through the rectum) and "needle tracking" undoubtedly spilled cancer cells out into my system where, hopefully they did not find a home.  In 2005 I finally contacted a urologist who could direct guided biopsy needles via color doppler.  I watched on a screen as he located "hot spots"......blood infused areas where the cancer likely was present.  He hit the spots directly and out of eight needles found cancer in two core samples.  One was about 3 mm of Gleason 3 + 3.  The other core was about 5 mm and was graded as 3 + 4.  I live in the United States where malpractice pressures pathologists to upgrade these things (it is called "grade creep" [wink] so I felt that my cancer was probably low risk and possible intermediate risk.  My PSA at that time was 20.  Throughout that time I had been tracking PSA doubling time as a measure of rate of growth (PSA velocity seems to me to be flawed conceptually) and it was steady at right around 5 years.  I then read three urology textbooks, Stephen Strum's book, along with several others and concluded from SEER data that intervention did not generally prolong life in cases such as my own.  I decided at that time to wait, although I did get a second pathologist to read my slides and also asked that they determine whether the cancer cells were haploid or diploid (haploid being an indicator of aggressiveness).  The second pathologist made the same Gleason call and found that the cells were diploid.  I continue to track my doubling time and it has remained constant, an indication that the cancer is not becoming more aggressive.  I suspect that I have had identifiable prostate cancer approximately 24 years now.  I have had two bone scans and neither reveal any evidence of metastasis.

    I have researched androgen deprivation and have spoken directly with Dr. Strum.  It is my opinion based on journal reading that I have done that androgen deprivation (continuous or intermittent) tends to provoke androgen dependent cancer to mutate (it wants to live too) into androgen independent prostate cancer.  My reading further suggests that androgen independent prostate cancer tends to be far more aggressive and deadly.

    So, for now, I am simply waiting.  I anticipate that my PSA will continue to double approximately every five years.  I have searched to find readings on untreated people who died of prostate cancer to ascertain what their PSA was when symptoms presented as well as what their PSA was at time of death.  I suspect that there is a great deal of variance, although the actual data is largely unavailable.  I am not sure why.

    As it is, life goes on.  Interestingly, were it not for PSA testing, I would never have been biopsied and would never know that I have prostate cancer.

    As far as professionals in the field are concerned, I have fired two of three urologists, the two never having asked the relevant questions and only justifying their recommendations with the comment that many men are scared and "simply want the cancer out."  I don't believe that anxiety is best treated with a scalpel.

    At some point I will likely consult with an oncologist at Oregon Health Sciences University where my son-in-law is a surgical resident.  I have also consulted with my son who gains access to medical journals for me.  He is an emergency physician.  

    You asked my philosophy in the 1990's.  I've never given that much thought, although I suspect that it is "live and let live."  Over the years, I have come to view my cancer less as an enemy to be rooted out and killed at all cost and more as a companion that I neither wish to enable, nor to whom I feel hostile.

    I would not recommend my strategy for everyone.  Some would be thoroughly unnerved and simply want their cancer out (the view of two of the three urologists - actually one was old, wise, felt that prostate cancer was far and away overtreated and finally retired).  As yet the verdict is out for me as it is for anyone who pursued treatment and has yet to live into their mid-eighties.  

    I am hoping for a long life (into my mid-eighties), have a beautiful and loving wife, two adult children who are both physicians, and am about to be graced with a grandchild.  

    Thanks for asking about me, Dudley.  I wish you the best with your journey with cancer.  Are you in a similar situation, might I ask? 

    _ 0 votes F Report g Share < reply[dudley="" 70181]="" ★3="" h="" dudley="" 70181="" »carl05115="" •="" 2="" days="" ago="" hi="" carl,="" thankyou="" very="" much="" for="" taking="" the="" time="" and="" trouble="" to="" construct="" a="" post="" of="" that="" quality.=""  it="" is="" very="" likely="" to="" remain="" as="" one="" of="" the="" most="" if="" not="" the="" most="" helpful="" contribution="" ever,="" to="" this="" debate.=""  very="" wisely,=""  you="" do="" not="" say="" whether="" you="" yourself="" are="" a="" physician="" but="" i="" have="" permitted="" myself="" a="" slight="" suspicion.="" thanks="" due,=""  additionally,=""  for="" asking="" about="" myself.=""  ="" i'm="" going="" along="" o="" k.,="" all="" things="" considered.=""  i="" swim="" in="" the="" ocean="" most="" days.=""  bought="" myself,=""  to="" quote=""  wikipaedia="" :="" '="" the="" fastest="" production="" motorcycle="" on="" the="" planet="" '="" (="" 2006="" suzuki="" gsxr="" 1000,=""  with="" just="" over="" 8000="" klms="" on="" the="" clock.=""  and="" having="" ridden="" a="" further="" 5000="" klms="" since="" may,=""  i'm="" loving="" it="" !="" ).="" i="" sincerely="" hope="" that="" you="" will="" continue="" to="" manage="" all="" health="" issues="" that="" may="" arise="" in="" the="" future,=""  as="" well="" as="" you="" have="" in="" the="" past.="" regards,="" dudley="" (="" psa="" 10,=""  gleason="" 7="" [="" 3="" +="" 4="" ],=""  t2b.=""  mini-turp="" &="" bni=""  feb'14.=""  42="" x="" ebrt. ="" benign="" iatrogenic="" urethral="" lesion="" excised="" jan="" '15.=""  possibly="" have="" had="" p="" c="" for="" 20="" yrs.=""  senior="" urologist'="" s="" prognosis="" :="" "="" with="" treatment,=""  you'll="" see="" 10="" yrs,=""  but="" you="" won't="" see="" 20="" ".=""  don't="" you="" just="" love="" it="" !="" )=""  ="" so="" anyway,=""  now=""  i'm="" off="" to="" the="" beach.=""  see="" ya.=""  ="" _="" 0="" votes="" f="" report="" g="" share="">< reply to dudley 70181[david41094] ★3 h

    david41094 »carl05115 • 2 days ago

    marvellous post carl. for the life of me i cannot understand why anyone would have a blind biopsy when mri is such a painless operation and enables a targeted biopsy. i had an mri which identified pca in the left apex. further research has shown me that the apex is a difficult part of the prostate to biopsy and almost all false negatives arise due to pca in the apex. i am convinced that i would have had a false negative if i went straight for a blind biopsy. like you, i am opting for active surveillance. i wish you well.

      reply="" to="" dudley="" 70181[david41094]="" ★3="" h="" david41094="" »carl05115="" •="" 2="" days="" ago="" marvellous="" post="" carl.="" for="" the="" life="" of="" me="" i="" cannot="" understand="" why="" anyone="" would="" have="" a="" blind="" biopsy="" when="" mri="" is="" such="" a="" painless="" operation="" and="" enables="" a="" targeted="" biopsy.="" i="" had="" an="" mri="" which="" identified="" pca="" in="" the="" left="" apex.="" further="" research="" has="" shown="" me="" that="" the="" apex="" is="" a="" difficult="" part="" of="" the="" prostate="" to="" biopsy="" and="" almost="" all="" false="" negatives="" arise="" due="" to="" pca="" in="" the="" apex.="" i="" am="" convinced="" that="" i="" would="" have="" had="" a="" false="" negative="" if="" i="" went="" straight="" for="" a="" blind="" biopsy.="" like="" you,="" i="" am="" opting="" for="" active="" surveillance.="" i="" wish="" you="" well.="">

    david41094 »carl05115 • 2 days ago

    marvellous post carl. for the life of me i cannot understand why anyone would have a blind biopsy when mri is such a painless operation and enables a targeted biopsy. i had an mri which identified pca in the left apex. further research has shown me that the apex is a difficult part of the prostate to biopsy and almost all false negatives arise due to pca in the apex. i am convinced that i would have had a false negative if i went straight for a blind biopsy. like you, i am opting for active surveillance. i wish you well.

     >

    • georgeGG
      georgeGG carl05115

      Posted

      I agree with Dudley, that is a marvellous exposition for low and intermediate risk prostate cancers. To get a balance and to bring high-risk prostate cancers into view various of Dudley's notes are well worth consulting.

      My thanks to both you Carl and to Dudley.

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