Prostate biopsy for hi PSA level
Posted , 20 users are following.
Greetings all
I seem to be having chronic problems with a raised PSA level. I have a urologist but have turned down just about everything he wants to do to me, just because cic seems to be solving my problem. I'm not having any symptoms of prostate cancer - actually I don't think there are any symptoms - but my yearly blood tests for medicare and some other ones I've had lately keep showing a high PSA. It's been 5.7 and now my doc says its 6.4. About a year ago we tried antibiotics to bring down this level. He said normal for me would be between 0 and 4. So he has made another referral to my urologist and I suspect they are going to recommend a biopsy.
I am doing cic on average about 4 times a day depending on how much water I drink. I understand from reading these forums that this can raise PSA levels. My doctor (GP) concurs but apparently doesn't think that can account for that much of a raise??? I know he doesn't really like me doing cic and thinks I should have gone with my urologist's plan for Green Light laser so he is not real helpful with the cic thing. He wanted to give me another round of a/b to see if that brings it down as it did before. I was surprised it brought it down because I did not have a UTI; at least not like the prostatitis I had when all this started. He says I have chronic prostatitis but I corrected him on that; so, anyway, I take this doctor's advice with a grain of salt.
So my question is: should I do a biopsy based on a fluctuating PSA blood level? It mostly has been spiking up. I am using a hydrophilic coude catheter and don't have a problem getting into the bladder with it but I suppose it is nudging the prostate on the way in.
0 likes, 53 replies
timothy81571 keith42667
Posted
my Uro recommended a biopsy with a PSA 4, nothing found. Several months later is was up to 7.5. 3T MRI found nothing. I had Rezum in December and will get another PSA in October, hoping that it will be back down again. Irritated big prostates obviously cause numbers to go up, so its hard to know w/o an MRI.
keith42667
Posted
Thank you gentlemen. Your advice is so very helpful. Collectively, and individually for some of you, you are much better informed than my Family Physician. Communicate better too. I need a new doctor. I live in a very small area and I guess we are lucky to have a clinic at all.
tom86211 keith42667
Posted
Keith,
From one who has been there, done that. In 2012 my doctor called and told me my PSA was 4.0 and referred me to a urologist. I didn't even know the lab was taking my PSA. Anyway, I had a 12 core biopsy and the result came back positive for cancer - but low grade Gleason 6. Went on "watchful waiting". A year and a half later had another 12 core, and this time there was "progression" - still Gleason 6, but more cores positive and a higher percent of each core with the cancer. A few months later I had radiation and recently had a TURP where the prostate tissue was sent to the lab - and came back negative. My PSA is usually 0.1 but recently 0.2 - within the test range. So, the cancer is gone.
Now, and this is a big issue, NOT knowing if you have cancer or not can cause a lot of anxiety. After I got treatment I felt a huge emotional relief, because not testing and not treating IS a form of treatment. I agree with many here - a non invasive MRI first, if that is possible, then a 12 core biopsy is necessary. If you ever decide to get the biopsy take a few Tylenol capsules before and the level is pain will be greatly reduced, or, you could ask to be sedated or "twilighted".
My very best,
Tom
tom86211 keith42667
Posted
Fusion Biopsy From Cleveland Clinic:
A fusion of MRI and ultrasound
Recently, researchers have developed software that “fuses” those detailed MRI scans with live, real-time ultrasound images of the prostate. A patient first undergoes the MRI scan. A radiologist reviews it and marks suspicious areas.
Later, in an outpatient setting, we insert an ultrasound probe into the patient’s rectum. As we move the probe around the prostate, the fusion software shifts the overlaid MRI image accordingly, giving us a detailed 3-D ultrasound/MRI view. We can use the fused image to guide the biopsy needles precisely to the lesion we want to sample rather than poking around and hoping we find something. It’s like using a GPS to reach your destination rather than driving without directions.
keith42667
Posted
Yes, it appears to me now that I should at least get the non-invasive MRI first; if nothing else just to see the size of my prostate. My family doctor (GP) told me last week when I was in for yearly checkup, that I have a fairly enlarged center part of my prostate. He had previously told me after doing a DRE that my prostate "wasn't that impressive", which I assumed to mean didn't seem huge. He also told me that he knew this because it showed on the ultrasound. The only ultrasound I remember having was one of my bladder when I was in the urologist office two years ago. They ran that ultrasound over my bladder area and I was not aware that they could see the prostate in that way. Am I wrong? So that's confusing.
I have an appointment next week with my urologist and maybe I can get some of this straightened out and schedule the 3T-MRI if I can get it with my insurance.
rdemyan keith42667
Posted
Keith:
3T MRI costs have come down significantly. I recently self paid (i.e. no insurance reimbursement) and spent $1500 for a 3T MRI at UCSF. For me it was worth it, especially when I considered that the year before I spent over $2,000 on a root canal with crown. San Francisco is more expensive. I've seen preliminary costs for 3T MRI as low as $700 to $800 in Florida and Houston. I don't have any referrals for Florida, but for Houston you could try Dr. K, who is well known on this blog for focused laser ablation (FLA).
I don't know your financial situation, but for me I weighed the amount of time I spend thinking about and suffering with my prostate against what I was willing to pay for a root canal (which tooth also could have been pulled) and decided that $1500 wasn't that much all things considered. Good luck with what you decide to do.
keith42667 rdemyan
Posted
Thank you rdemyan. I'll take that to my appointment Friday so I know what to tell the Urogist just what I want. A good summary. I love the internet and the good gentlemen that help out here. In my case it has been invaluable. Now he might resist because I may have to go to a different kind of specialist than him. We'll see. I know he wants to do another DRE which .. I've already had 3 in the last two years so I am hoping to get an idea of the size and location of my prostate enlargement. Surely even here in Idaho they know what a TAUS and a TRUS is. I am on medicare and have a medigap plan to cover the other 20% so I'll have to investigate the cost.
rdemyan keith42667
Posted
Whatever you do, don't trust a DRE size estimate. For years my former uro said my prostate size was about 40 grams as estimated from the DRE. Then in July of 2018, my GP ordered a TAUS and the size was 145 grams. I hit the roof. A subsequent TRUS estimated 100 grams, but I could see that the uro had to estimate the location of end points in completely black areas on the image (probably because my prostate size was at the upper limit of the ability for TRUS to measure). The 3T MRI from last month yielded 103 grams using 3D modeling from images in 3 dimensions.
The actual MRI is known as a 3T multi-parametric MRI of the prostate. "T" stands for tesla.
Good luck.
lee56659 keith42667
Posted
Here's a few things to think about. My uro told me that at age 70, a PSA of 6 was normal. My PSA shot from 3 to 11 in one year. A prostate biopsy came back as prostatitis. I had a TURP in February (worked great) and the pathology showed prostate cancer in about 15% of the sample. I will get a PSA reading this month and that will be my new baseline. I see my uro again on July 1. The PC was not aggressive (Gleason score of 6) so we are in the "active surveillance" stage. I suspect he will want a PSA test more than once a year until a new trendline is established.
A friend had his PSA go from 2 or 3 to 7. Not only did he have PC but it had spread to his hip bones. He had to undergo chemo and hormone treatments but they worked and he is now cancer-free. Pretty scary for a while though.
tom86211 lee56659
Posted
Lee,
My issue with the active surveillance was that I knew that the biopsies were only samples and may have missed some more aggressive tumors. When prostates are completely removed they are sent to the lab for analysis, and that lab work may find some Gleason 7 or higher tumors. So, after the second 12 core biopsy I decided to move forward with treatment, despite no Gleason 7 tumors being found. The uncertainty was consuming a lot of my emotional energy.
Tom
derek76 keith42667
Posted
Mine was 9.8 before I had GL in 2004 and then down to 5.0. Later up to 7.6 as my prostate regrew to 135 grms. And now 0.70 after another laser procedure in 2013
TKM keith42667
Posted
Keith,
I have the same situation as you. My PSA has been around 5 or 6, and I use catheters five or six times per day. Before using the catheters it was 2.4. I figure it is because the catheters irritate the prostate and raise the PSA, just like bike riding, sex, DRE etc. I was using Coloplast Speedicath at the time of the PSA test, They are quite stiff and cause considerable irritation of the prostate. The next time I get a PSA I will use the red rubber/latex catheters with external lube, for a few weeks before, as they are the least irritating to the prostate.
If they want me to have a biopsy, I might do the 3T MRI instead, even if I have to pay for it.
Instead of taking antibiotics to lower PSA, even without UTI, try D-mannose. It is a natural product and will not cause antibiotic resistance.
Thomas
frank27027 keith42667
Posted
Keith, Your PSA does go up when you do CIC,also with your age. HOw old are you?
frank,
keith42667 frank27027
Posted
I'm 67. Been doing cic for about two years now.
frank27027 keith42667
Posted
Keith, ,Do you have a natural void? I have been doing CIC almost 3 years and do not have a natural void,i have to do CIC . I was told PSA is higher for us that do CIC?I don't think your PSA is that high?What does your urologist say??
frank,
keith42667 frank27027
Posted
Thanks for asking Frank. I'm going to see my Uro tomorrow as a matter of fact. It's been two years since I've seen him.
I always try to have a natural void when I get a strong enough urge. I usually only get out a few dribbles but sometimes maybe as much as 30ml. The main thing that has changed in the last two years of doing cic is that my urges are more distinct and come at a lower bladder retention volume. I used to have to have at least 430 ml or more in tow before I would feel anything. Much above that I would start getting overflow incontinence expecially when I fell asleep. Cic has changed all that. Improvement is slow. I think one reason I don't get much flow is because I'm not drinking enough water. My GP told me I was dehydrated and should drink at least 1 1/2 quarts of water a day. I like to drink coffee so drinking that much water also every day makes for more catheterizing and also more frequent natural voids.