Increased PSA level

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I have Benign Prostatic Hypertrophy ( enlarged prostate ) and have been on Tamulosin for many years. On my annual PSA check I had a reading of 6.5. On re check back down to 4 but my consultant says if my recent test is back up again I will need to have biopsy. Problem is that with my BPH and prostatitis raised PSA can be normal. So you go for the uncomfortable biopsy to check for cancer and highly likely no problem. Maybe better to be safe than sorry but I have been trying to avoid surgical intervention for a long time. Any advice or past experiences shared would be greatly appreciated.

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  • Posted

    I would go ahead with surgical intervention.  I am just starting on this journey, but hoping to have the good luck like my dad had.  Prostate cancer runs in my dad's family.
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  • Posted

    Hi Andy

    My hubby had the same problem as you.  He had been 'warned' about biopsies by family members but the reality was that it hardly hurt at all.  In fact, his words were 'a little uncomfortable but not as bad as the first DRA!'.  He ended up having HoLEP, where all the tissue that had been removed was checked for cancer cells, as opposed to the dozen or so with a biopsy, and all was clear.

    It's a personal choice I suppose, all I can say is that my hubby (and the guy who went in before him) were not screaming in pain when they came out.  Good luck.

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  • Posted

    Hi Andy,

    I've been on Combodart for 4 or 5 years now, following a routine 'well man' PSA test that came out at 9.6 (apparently at that time, late 40s, I should have been 3.8).

    I had the standard 10 biospies, follwed by another 25, followed by another 65 by template - all clear of cancer (very unpleasant and arguably unecessary).

    Since then my annual tests have been 3.8 and my GP tells me they double it to take into account the drugs but are really only looking for changes. Your change of 2.5 could be of concern BUT as I understand it there are a lot of things that can affect your PSA test results (recent orgasm, infection etc). Personally I would leave it for a month and have another test. If it's back up investigate further. If it's still down realx and programme in another test for 6 months time.

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  • Posted

    I've had a biopsy under local, which, whilst uncomfortable was no problem if you don't get embarassed easily. Cancer not found, but suspicious signs were. A couple of years later, a saturation (multi-sample) biopsy under general anaesthetic found definited cancer cells, but minimal number and completely contained. Worst aspect was an overnight observational stay in hospital, because I tend to get retention problems after a general. Personally I'd rather know what can be known, and I haven't needed treatment - just active surveillance with level psa scores at around 8. Now the enlargement is much more the problem, and because the cancer is well monitored, I've easily been able to live with it.
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  • Posted

    In my case the larger the prostate the higher the PSA. When my prostate was 35grams and my PSA just over 5.0 I had two clear biopsies about two years apart. By the time my prostate was 75 grams my PSA was over 9.0. After my PVP it went back down to 5.0 

    My prostate regrew to 130 grams and my PSA went up to 8.0. I then had a Thulium laser procedure and the tissue sent to the lab was clear.

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  • Posted

    It is always your choice, not the surgeons/doctors.

    I know surgeons who do not even ot psa tests any more - they are too unreliable.

    Biopsies are very variable, and others have probably given you a decent range of experience.

    I too would not have one done with your readings, especially where there was a drop. In the ranges, surgeons often do 'watchful waiting'.

    I'd get at least one other opinion, preferably at a nationally recognised cancer centre. If you live in the UK, you can self-refer to either the Royal Marsdeon if you live in the South of England, Christies in the North.

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  • Posted

    OK Andy where to start.  I shan't bore you with the usual "been there got the tee-shirt" stuff but make some suggestions that you may wish to consider.

    Bouncing PSA could be as you've already guessed down to infections and or the BPH but to remove the infection scenario from the equation, ask your GP to put you on a course of antibiotics with a follow-up PSA test. A reduction in PSA would suggest an infection and no reduction would point at something else.

    Why have a biopsy that does have inherent risks when a state of the art 3T multiparametric MRI scan would give a far better picture of what is going on within the prostate. The advances in MRI scanning have improved significantly over the last 5 years and it is now possible to grade and stage prostate cancer on the results of a 3T MRI scan alone, not that you need to worry about such things at present.  If your consultant refuses to refer you for a 3T MRI it may be that the NHS Trust area you reside in doesn't have that facility or he is one of those Urologists that believe the biopsy route is the gold standard for diagnosis and won't open his mind to new and improved methods at arriving at a diagnosis.

    If this is the case then insist that you be refered for an MRI and keep insisting and if he still refuses go back to your GP and ask to be refered out of the Trust area and into one that does have the facility and forward thinking Urologists.

    If all else fails you can go private for a 3T MRI scan but you'll need to budget for around £300 and you will get faster peace of mind.

    As for treatment, if its just BPH and the Tamsulosin begins to be less effective as the  years go by then see if Avodart can be prescribed to help reduce prostate volume, with surgery in the form of a HoLEP a few years down the line if and when medication starts to fail. HoLEP is a breeze, out the same day with no catheter and it can be done using a spinal anaesthetic (you can then watch your own rebore taking place on the big screen).

    Finally and if and when PCa is discovered get yourself under the care of a top notch Prostate Cancer hospital like Addenbrookes which is a centre of excellence for all things urological. 

    I can only emphasis you have the right to be refered to the hospital of your choice and although it may prove difficult to get that referal now that GPs have a tighter grip on the purse strings, it is your right and you should push hard to achieve it.  Good luck

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    • Posted

      Hi Rogcal,

                         Thank you so much for taking the time to send such a comprehensive reply. So useful.

      Andy

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  • Posted

    Hi Andy, on advice from my urologist I had a 12 core biopsy. It was a bit embarassing but I was treated with care and consideration by the team at my local hospital. It was unfomfortable rather than painful. The results were not really conclusive so having six months checks.

    Down side, I have regular pain and discomfort from this procedure. Hot baths, walking and ibuprofen releive it.

    If I had known that i could have had a scan thats what i would have gone for ,Rogcal says you can have this as a private patient for about £300. Bet the information from it would have been more accurate.

    All the best mate, but keep on top of this condition

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  • Posted

    Thank you all so much for your invaluable knowledge and advice. I am going to the consultants on Wednesday to discuss results from my PSA test done last week. I am going to ring the doctor tomorrow to get the PSA value so I have this before meeting the consultant. I am currently under Harlow Hospital and Epping Hospital, but useful to know that Addenbrookes has some specialism as i am only half an hour away. I will let you know how I get on. Without Forums like this we would be far less knowledgeable and less able to make informed decisions. Thanks Again.
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  • Posted

    highly recommend Addenbrookes, it's where my hubby had his HoLEP, Mr Tev Aho, lovely and brilliant man.
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    • Posted

      Tev 'Aho, the Godfather of Urology.  Took the trouble to ring me when in Boston A&E following post HoLEP haemorrhage and spent 30 mins talking me through the issues and treatment plan he envisaged would be put in place. I echo the sentiments already expressed. A truly brilliant and gifted man.
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  • Posted

    Andy, my pas got up to 9. I already had BPH 

    My GP told me to see a urologist...that's when my problems started. He convinced me to have a 30core perineal biopsy. 

    It came back clear, no cancer but I couldn't urinate properly anymore. Uro said it would right itself ...it didn't so went onto flomax. So I didn't have any issues before the biopsy but now I did. 

    Anyway after a year of this I saw three other urologists. One wanted to do TURP, the other Holep, and the other (a woman) wanted to do open surgery on me, God forbid. I wasn't looking forward to a significant chance of incontinence and or impotence. 

    Then I discovered Prostate Artery Embolisation (PAE) performed by an interventional radiologist. Long story short, I now pee like a horse and have better erections (30% of PAE patients report improved sexual performance).

    I am in remission from Lymphoma. My oncologist tells me he refuses to have a PSA test as it leads to so much unnecessary treatment. I'm doing the same...no more PSA tests for me. 

    A very large study showed no difference in long term mortality rates between men who had regular PSA tests and men who did nothing. 

    In my opinion PSA testing is just a funnel pouring money into urologists pockets.

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  • Posted

    I just lost a former boss to prostate cancer after a 4 year 'battle'. Do not fool with this type of disease. Do whatever you can to stay alive. Being 'uncomfortable' and having to carry the "possibility' around are quiite different. I really do not understand some of the posts I have read on here, quite alarming in fact. To think that ejaculation is more important than making sure your health is taken care of is beyond me. Good luck and all the best.

    May the flow be with you.

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    • Posted

      Mike, no one is saying that ejaculation is more important than being alive. All I'm saying that the treatment can sometimes be worse than the disease. How many serious (sometimes life threatening) infections and complications are caused by biopsies. 

      The long term studies show that there is very little difference in mortality rates between those who regurlarly get PSA tests and biopsies and those who do not get PSA tested.

      My oncologist is not a fool. He has made a decision not to be PSA tested. I have met several GP's who have made the same decision. Are they fools as well?

      In my case PSA testing caused me a lot of trouble and expense because it led to a biopsy which caused a lot of trouble and expense. 

      I'll take my chances and that's an informed decision. 

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    • Posted

      No one is saying it directly, but "infering" that ejaculation is not something they want to lose, I agree, but faced with uncertainty about one's health, trust me its the last thing I would consider. I was not making any reference to you or anyone, but having read a ton of posts on this site, and comments that they do not want to lose that ability, I have to wonder about the importance of it. Once again, depending on age, yes, it is a factor. Your doing the right thing obviously listening to the oncologist about your condition. He is the expert.

      All we as patients on here  can offer is our opinions, and results we have had, and everyone one of us is different with different results. What will work for one will not work for the next.

      I wish you well and good luck with your health as well.

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    • Posted

      Thanks Mike. 

      All the best for you as well. 

      I don't have prostate cancer. I am in remission from lymphoma of the lung. That's what my oncologist is treating me for. I get on very well with him and we shoot the breeze about anything and everything. 

      I guess he's fairly informed about cancer and it's interesting that he has chosen to go the no testing route for his prostate. 

      For men the prostate gland becomes very personal...that's something a female uro I went to didn't really understand. 

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    • Posted

      Your welcome

      Reading all this information on the site just makes us all want more out of every day we are standing up and healthy. Life is short, we have to take responsibility for our own health, Make the right choices and enjoy what little time we have on this planet, focus on what makes us happy. Yes the "wild weed' known as the prostate is every man's nightmare when it wants to be. All the best, and may the flow be with you.

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