PCA3 test, when should this be carried out?

Hi JimJames, Yes I have been given a lot of very good advice and everyone has been great in sharing their experiences. I have read each and every reply over and over again. There will be a PSA test in mid january, this one will determine whether biopsy will go ahead or not. It is not my partner who is urging urologist for a biopsy, it is the urologist who suddenly is saying it is the next step and has to be done. Believe me, my partner does not want a biopsy but of course it will help find out what is wrong with his prostate then he will follow the urologists advice and have the  biopsy. His  urologist is saying the end of next month, there was no option given to wait for another PSA a bit down the line.

A PSA in mid January sounds like a good idea. If you still are conflicted as to how to proceed then, a second (or third) opinion is always a good option. Never feel pressured into anything by a doctor. That is not to say you will always be happy with their suggestions, but you should feel at certain comfort level that what they are telling you is correct.

Jim

I think that's good advice too. You do not say his age.  I was 49 when sudden onset LUTS led me to the GPs, I asked for a PSA test as I had read about them and she said don't be daft, at age 49 you won't have P Cancer, but you are likely to have high PSA, get worried, have a rectal biopsy (that is what the NHS does), there is a 2% risk of sepsis with that and, for that 2%, a small morbidity fraction, and yet your high PSA will just be prostatitis.  P Ca grows slowly so, I now know, sudden onset LUTS vastly more likely to be due to prosatitis.  Mind you, it may not be sudden onset LUTS that led him to a doctor, it may be just a regular over-50 PSA test as part of a company medical or even at a GP.  Or you may be in USA. 

I said to my GP that I wanted to insist on the PSA test, and she said no, firmly.  The proposed treatment for the other problem was nuts - do nothing for 2 weeks until I have a renal ultrasound (I was peeing 10 times a night at this point...) so I got a referral to a private uro', who turned out to have a bee in his bonnet about GP's declining symptomatic men a PSA test - he'd even written about it in the Daily Mail this January.  A doctor friend pointed out since that, contrary to that article, GPs pay nothing for blood or stool tests - the daily courier goes off regardless, at zero marginal cost, and the pathology dept of the local hospital does the costs for free - no marginal per-test charge to the GP's surgery.  So it's not because of costs that GPs are often reluctant to do a PSA test, it's because it's inaccurate and leads to bother.  But it does save a few lives, too.  Conundrum !

The uro I saw did the PSA test, 16.92, a repeat 5 days later came out at 9.77 (the LUTS symptoms improving in parallel over this time, to a degree).  I guess that should have indicated, it falling like a stone, that it was prostatitis but I went ahead with a strongly recommended transperineal MRI-guided biopsy after a preceding MRI indicated possible cancer (4 out of 5).  Had the MRI been clear I could have dodged the biopsy.  A transperineal MRI-guided biopsy has almost zero risk of sepsis as the sampling needle doesn't go through rectum, but it has to be done under general.  As I said all 13 cores taken, guided to the dodgy area on the MRI, just showed chronically inflamed tissue, and when they removed the middle 55% of my prostate, the tissue showed the same result.  Then PSA went down to 0.66 so I knew all was well. 

I am not sure this maps perfectly to your experience as you said he's had a steadyish 3 readings a little below 10, last one being 2 points down.  If those are a year or more apart especially if not due to sudden onset LUTS then .... maybe that is a bit dodgy.

If it's any reassurance about 40% of men get P Ca, the cure rate is vastly higher than any other cancer at 95%.  And it's the slowest growing one, too.  I know several men who've had it and been cured; I know none who had it and weren't (although within that is one man who was advised not to get it treated as his was low grade, so treatmetn would be overkill - he just has an occasional PSA test).  The average all-cancer cure rate (10 year survival rate) is only 47% in GB.  If you get stomach cancer, the cure rate's 10%, for comparison.  Pancreatic : 3%.   

I bet it's not cancer.  It so often isn't.  But if he's had three readings of nearly 10 over 3 years (I am guessing annual ?), and not even had sudden onset LUTS, that might be a bit less likely to be prostatitis, and if it was me I'd have the biopsy.  The transperineal MRI-guided biopsy I had was no bother at all, but I am not sure if you can get it on the NHS (if you are in the UK).  In and out the same evening.  A friend had two rectal biopsies, one didn't hurt at all, one did a bit (but not unbearably) - done by the same doctor at the same hospital, so that explains why you get differing accounts.  If he can get the transperineal MRI-guided biopsy done, that's slightly better (eliminates a small, 2%, sepsis risk), as long as he doesn't mind being made unconscious (I was glad to be !). 

Ah, I just followed the link to your earlier post and the chain around it.  His path is broadly similar to mine.  I am not sure now what he should best do.  I guess the MRI first, for sure.  Mine did still indicate a possible cancer issue - I just don't know how often you get that "bad" result with an MRI scan on a prostate with prostatitis and no P Ca.  At my final consultation with my uro', discussing my PSA=0.66 after HOLEP, I said how come the ruddy MRI said 4/5 clinically significant cancer and how come the %free/non-free test gave such a nasty result, and he just said oh, they're all inaccurate really.  So I guess MRI's are only so good.  How often do they give a false negative, one wonders ? But the MRI did say WHERE the possible issue was (it didn't just say, "bad all over", so he could aim the needles there.  The friend age 56 that just had two random rectal scattergun biopsies, had them because the first found nothing, yet his PSA was still at 8, so they said have another 2 months later.  He had no MRI (NHS, = basic state medicine in Britain; some people love it, and some think it sucks.  Politicians have to say they love it).  He declined a third random/scattergun rectal biopsy as it seemed OTT, and is on finasteride now to shrink it, which is a slow business.  Before HOLEP, during the acute phase, I pee'd hourly, and not a lot each time.  Before the acute thing, for years I'd been peeing 2 to 3 times a night, and many times a day.  Today I went 12 hours between pees, then pee'd 580 ml.  Last 2 nights I didn't get up to pee at all.  So somehow, with no antibiotics, the prostatitis cured itself and/or if it's still there, it has space and causes no issues either on bladder base (causes the frequency issue) or urethral compression (causes slow flow).  I think it went away though, as my PSA couldn't be 0.66 if it was still there (much) - even tho' my 22 cc prostate was cut down to 10cc of remaining tissue, the last PSA of 9.77 wouldn't have logically gone down that far just from less tissue.  I never know why antibiotics weren't tried on me first, but I've read that they are very often ineffective on prostatitis, so I guess that's why.  Pleased with the surgical cure, overall.  Another friend is on flowmax; works, but he thinks it has damaged his eyesight slightly. 

I think I would wait for the January PSA; Prostate cancer is rather rare at his age (my GP actually said "impossible" at age 49, which isn't literally correct, but I know what she meant, and .... there is no such thing as risk after the event, of course, but the outcome wasn't at odds with her stance in the end), and is - important to remember this, very slow growing compared to all other cancers. 

 

If you want to do positive stuff in the meantime on a precautionary basis, don't let him eat any eggs (see THE TIMES 19th April this year, I have pasted the key points into an earlier post of mine here....), and feed him a few almonds, other nuts, broccoli/cabbage/cauli/sprouts, and some orange, or red, peppers.  Also at least slightly reduce his chicken and red meat.  Fish is fine.  Chicken weirdly enough, isn't. That TIMES of London article explains ....

Eggs increase P Ca risk by 82% (if eat 3 hens' eggs a week) and make it grow faster if you already have it. Those sort of statistics aren't perfect but the general sense appears correct. 

What procedure was used to remove the 55% of your prostate?

HOLEP

Thank you Paul for the reassuring reply. He cannot get the transperineal biopsy, the standard is the rectal one! Also the 3T MRI report will be in the hands of his urologist who will be carrying out the biopsy but the biopsy won't be a guided one. His readings range from September until now, started in the 7's, rose to 9.5 and dropped to 7.6 at the minute. I thought if it was anything sinister the levels wouldn't drop they would keep climbing but maybe that's wishful thinking?

That sounds more like a Daily Express article to me :-) I think that most men eat a lot more than three eggs a week. In Canada they blame milk for PCA!

Diabetic diets say that eggs are the best breakfast and which came first the chicken or the egg?

I had PVP in 2004 and Thulium/Holmium in 2013. That like HoLep saves tissue for testing.

Hi Caz,

As for "no option given ", your partner can simply refuse to have it! At least follow Jim's good advice , wait a while, have your partner take it easy, then have his PSA tested again even if you have to pay for it, then YOU AND YOUR PARTNER decide what, if anything, to do. It's your partner's body, and he, not the consultant, who decides.

Neal

Caz, Are you saying you won't get a copy of the mpMRI report?  That's crazy.  You, not the consultant must make the decision of whether to biopsy or not.  And the PSA dropping, as it did in my case, should be reassuring.  And an unguided biopsy is a bit crazy when the technology exists and is widely available to at least create a TRUS-overlay of the mpMRI image.

Harvey

We will have a copy on disc as far as I know, the same will be sent to urologist. The biopsy will be guided by ultrasound only, bit like an antenatal baby scan. This will show where the needle is being placed only. The urologist will have reviewed the 3T MRI images by this stage and will have in mind certain areas, if any, on which to concentrate the biopsy on. I do not think he will be creating an overlay but really don't know. We will be asking a lot of questions prior to biopsy. We haven't really been told much except it's TRUS.

caz, Are you getting an MRI or an mpMRI?  If just an MRI looking at anatomical features, that's pretty useless compared to an mpMRI.  And even the mpMRI can have additional parameters added.   This is complex stuff that requires a lot of experience for a radiologist to interpret.  Is the urologist determined to perform a biopsy even if the mpMRI (if it is an mpMRI) does not show any suspicious areas?  That seems senseless to me.  And I strongly suspect the radiologist would have to indicate on the image what the suspicious areas are.  The interpretation of the meaning of each parameter's image is what's difficult.  If there are no suspicious areas shown, where would s/he biopsy?  Anyway, the biopsy is not a benign procedure.  It does not leave the prostate exactly as it was before, and it has risks,  I wouldn't have it done for no good reason!

This makes so little sense, there must be something critical missing from the information you've received.

Harvey 

Hi Caz,

I agree completely with Harvey.

Neal

It's a 3T MRI he is having. The other one you mention is not available in UK at the moment. I don't know why they are pressing ahead with biopsy. If they had felt something with DRE we could understand but they didn't. Level has come down and they have said that only if this lowers and stays lower will they postpone biopsy. They have us really worryied that something really serious is wrong. A 3T is superior to a normal MRI and we thought the results would have some influence but it seems this is not the case.

caz, with two different threads going on this, this is getting tricky.  I believe that the 3T mp-MRI IS available in the UK.  Please see the website that you can find by searching on prostatecanceruk  .  THis seems to have the complete scoop on what's going on with mpMRI in the UK.  On the right side of the homepage is a box with a link to mpMRI status.   

Harvey

<<I believe that the 3T mp-MRI IS available in the UK.

 - yes, I had mine at the Nuada Clinic, West Central London.  There were two other choices, too. My urologist said Nuada was the best. I think he has a loose business relationship with them (net suggests) - may just be collaboration.  I found them quite kind and professional at Nuada.  He can't easily change choice of radio channel once chosen so don't be a fool like me and choose radio 4 - listening to a roman emporeror being gruesomely assasinated for 30 minutes whilst contained in a small space, trying to keep breathing slow and steady (it is SO HARD not to suddenly pant short suffocating panicky breaths!!) was not fun. 

>>I don't know why they are pressing ahead with biopsy. If they had felt something with DRE we could understand but they didn't.

 - DRE can only detect cancers on middle to outer layer of prostate at sides or front.  Maybe top, depends on length of doc's fingers.  Not anterior (front) and not middle.  DRE detects 60%.  DRE alone is absolutely not determinative.  If it were there'd be no need for PSA tests (at risk men normally have both PSA and DRE at same time), for instance. 

 

>>DRE can only detect cancers on middle to outer layer of prostate at sides or front

 - I meant in above post to write, "DRE can only detect cancers on middle to outer layer of prostate at sides or BACK" - (wrote front in error)