Posted , 8 users are following.
Hello guys, new here. African American male age 49. Just got the news that my PSA was 4.74 it was 5 back in Sept but my urologists told me to give it 3 months and come back because I had prostatitis at the time. My prostate is actually fine but that psa level. So now I need to get a biopsy done. I'm just here for info and support. This is scary and frustrating at the same time.
0 likes, 18 replies
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Light1 BigWillG
Posted
4.74 is high, but not that high. How fast it is increasing matters too.
Before having a biopsy, you might want to ask for either a 4K test or an MDX test, both alternatives to a biopsy.
I would lean towards the 4K test. Biopsy has many risks and if I had it to do over again, I would avoid if at all possible.
Good luck,
Fred
BigWillG Light1
Posted
rich22 BigWillG
Posted
way too young and PSA way too low for biopsy. the prostatitis jacked up the reading, in all likelihood. PSA between 7-10 is 25% chance of PCa, over 10 is 50% chance. get the 4K score blood test first... much more accurate than PSA - pretty sure PSA will be phased out soon. if you're peeing ok, no pain, normal sex, i would just get 4K every few months.
n-mac rich22
Posted
Way bad advice. First, 49 is not "way too young", especially for men of African ancestry, which happens to be the most at risk ethnic group for PCa.
Second, it is totally foolish to claim that any PSA score above 4.0 is "way too low", especially in a man who is only 49 years old. For example, in my case (outlined above), my PSA stood consistently at 0.4 - 0.5 from my mid/late forties through almost all of my late 50s. Then, within a month after turning 60 years, my PSA was 4.4. Things can change fairly quickly (i.e. in a year of two). Approximately 5-months after that, my final post surgery diagnoses was G=4+3 with some ECE and PNI, but thankfully 100% negative margins with no other involvement found (lymphs, bladder, vesicles, etc.).
Conclusion: It would have been foolish, if not near insanity for me to have decided that my PSA 4.4 score was "way to low", and have stopped there. Getting a 3T MRI under the care of the best PCa experienced men's urologist that you can find is IMO the best next step for BigWillG. After that, a second opinion as suggested by rolf61809 is highly recommended. My first MRI & analysis was done locally. After that, a second analysis of the same MRI media was done at MSKCC that concluded there was a clear risk (probable) of ECE that in the end turned out to be the more accurate case.
Thanks,
n-mac.
rich22 n-mac
Posted
ok, points taken. but wouldn't you agree that a 4K and MRI should be done before going straight to biopsy? i'm about to start a new thread about this, since i'm sure in cases where malignant neoplasm is seen in the MRI scans, by a good radiologist, a biopsy is redundant at best and near unneeded at worst. cellularity within lesions is mostly what determines how malignant they are; vascularity, arterial enhancement, if all indications are visible in the scans, what earthly good is biopsy... besides putting $$ into somebody's pockets?
Pepasan BigWillG
Posted
Not to contradict, but maybe to balance with Light1, I've had 2 biopsies through the rectum, one was while awake, then a saturation biopsy under general anaesthetic, and both were fine for me. I was given preventive antibiotics, so apart from a little discomfort and a bit of blood in the urine afterwards, I had no problems. Cancer was found, but of the mildest form. No treatment needed.
Supertractorman BigWillG
Posted
I have been PSA 10 for 10 years now, and 3 months ago it went to 7 and have been on what they call Active Surveillance and had 2 Biopsies. Have had a TURP and after one Biopsy got Sepsis. Currently waiting for Prostate to be removed because of problems with Prostatatitis and that the Prostate has grown again and keeps stopping me passing water, Surgeon says he can justify taking Prostate out because there is Cancer there but it does not seem to be active.
My advice to you is have your Biopsy which is only a little uncomfortable without Anaesthetic and no problem with. The beauty of without is you see the Antibiotics they give you, but under general you don't and that was when I got Sepsis and will never know if I had them or not.
If Prostate is fine then Active Surveillance can be the way to go and if it gets worse then have it removed, would never recommend TURP, if it needs that, get it out as it has grown back for me in 2 years, the only thing that grows in a man at 74. Best of luck.
Davey22 BigWillG
Posted
Prostatitis will give a high psa reading. I would recommend waiting for 6 months than get your psa results. Hold off on that biopsy for now.
BigWillG Davey22
Posted
Davey, I have been going to this particular urologist for 3 years. I haven't had then say anything in regards to my PSA in the past. However I went in early Sept and they called me saying that it was high, they said it was 5 and asked me to come back and get another reading in Dec but we had to postpone it until Jan and it was 4.74. Granted when they took it in Sept I had some prostatitis going on. Now I had some other issues going on before in August to where my testicle area was swollen but every time I passed gas it felt better. (I know TMI) the urgent care, my primary care and the urologist all said it was probably gas.
I also asked them could my PSA be high due to my vasectomy or could it be complications from my vasectomy and my urologist said no.
Davey22 BigWillG
Posted
BigWillG,
I have read that men who have had a vasectomy have a greater risk of getting prostate cancer. Since your last psa reading was lower than your previous reading, I would wait at least 3 to 6 months before getting another psa test. Don't get a biopsy yet.
BigWillG Davey22
Posted
I read the same thing. After I had the high PSA reading in Sept and they said they wanted me back in Dec I said ok but I definitely asked when I went back could the high PSA have anything to do with my vascetomy, the dr almost immediately said no. Not sure if they were covering themselves.
I am gonna go get a second opinion, and keep these test that everyone mention wrote down to ask about.
rolf61809 BigWillG
Posted
I would also recommend the 4K test. And if your insurance covers it definitely get a 3T MRI to see what the pi Rads scores are. If you do you eventually need a biopsy then you will be able to get a fusion biopsy which is a lot more accurate in picking up cancer. If you live in the United States you're probably stuck with having to get a transrectal biopsy with all the attendant heightened risks of infection and sepsis. However a trans perineal biopsy would be much preferred as it does not puncture the rectum. This does seem to be available in Europe in Australia but not in the United States, except at a very few facilities one of which I think is in Florida. I don't think a 4.74 PSA is on its own sufficient reason to get a transrectal biopsy. Over the past 10 years mine has usually been in the 5 to 6 range, with it once going to 9 and now at 3.74. if you have any other symptoms like difficulty in urination from possibly an enlarged prostate you don't mention them. I would also recommend getting a separate opinion from a different urologist.
BigWillG rolf61809
Posted
Funny thing is when i told my primary dr my number of 5, they said that wasn't high either. But It think the fact that my father had it may be a concern.
n-mac BigWillG
Posted
Exactly what rolf61809 said. His advice is spot on, although trans perineal may not be an option. I had 2 trans rectal, and no problem at all either time. My dad had PCa also (G=4+4), and that is a big red flag for any adult son. Get that 3T MRI with the score. I came out a 4 (75% likely), and ultimately turned out to have G=4+3. If possible in your situation, MSKCC in NYC is IMO one of the best places to go for evaluation and treatment.
Best,
n-mac.
rolf61809 n-mac
Posted
rich22 rolf61809
Posted
looked up transperineal biopsy, seems just as uncomfortable, can also pierce rectum, same risk of infection, sepsis, etc. i'm about to start a new thread, since it seems MRI scans are so definitive in many cases, that biopsy isn't even a better diagnostic and is less than redundant. they use MRI during RP so why biopsy what they already know is there??
Pepasan rich22
Posted
rich22 Pepasan
Posted
yes, that's what my urologist is telling me, but the MRI report is specific enough to have the exact coordinates of the 2 lesions and possible metastatic iliac lymph nodes located, all of which need to be removed. also, the report identifies the type of tumors as malignant. what more information does the surgeon need, really?