PSA of 20, consultant thinks it's cancer but I am not sure.
Posted , 13 users are following.
I've had prostate issues for about 3 years alongside bad gut problems, which turned out to be a parasite and fungal infection (maybe more than one).
I have had quite a lot of antibiotics over the past year, some of which have eradicated my prostate symptoms, but they have come back. My working hypothesis has therefore been that I have an infection of some sort.
I had an MRI 2 years ago and it showed no cancer, my PSA was 8 then. I have another lined up next week - my PSA is 20 now, but the consultant is determined that I should also have a biopsy. I am not keen to do that, but at the same time I want to be sensible.
The consultant seems very reluctant to acknowledge that my symptoms could be caused by anything other than prostate cancer.
Can anyone offer any practical advice please?
0 likes, 34 replies
rdemyan PiersCV
Posted
Hello Piers:
I've had the 3T mp MRI but never a guided biopsy. My only comment is to make sure that if you do get the 3T mpMRI first that the results can, in fact, be used for a subsequent guided biopsy if needed. I wouldn't just automatically assume that this is the case, especially if the urologist doing the biopsy has not done MRI guided biopsies before. Maybe others will comment or you can do some research on the internet on exactly how this works. I remember vaguely reading somewhere that a "syncing" process is required. My point is to not assume that everything will just automatically work.
Also, is the PSA of 20 the only reading that you have that is that high? I've had a few high readings (around 7) and when that happened, another PSA test was done to try and rule out lab error.
Good luck.
tom86211 PiersCV
Posted
A high PSA can be caused by BPH - more prostate, more PSA. However, your PSA is rising at a fast rate, and you absolutely need to know what's going on. Get a second MRI. The next step would be a 12 core biopsy - not fun, but bearable for a few minutes. The tissues are sent to the lab for analysis and if cancer is present you will know how many cores, the percent of each core and the Gleason grade. Then, you can decide what to do. Hopefully, the biopsy would come back negative.
Silvak PiersCV
Posted
Taking too much antibiotics can aggravate gut problems.
The problem with specialists is that they do not see the body as an integrated whole, of mind , body, and spirit.
Consider seeing an integrative doctor or alternative practitioners like chiropractors or acupuncturists. They can provide a different perspective. and you can connect the various issues you have.
DrDavidB PiersCV
Posted
Piers,
My suggestion is to go ahead and do the biopsy. I know it is odious but just take a pain pill, grin and bear it. That said, the biopsy is not 100% accurate but it can rule out obvious cancer. My various UROs have all rattled my cage with fears of the dreaded cancer because of my elevated PSA. Each one has been humbled after 3 (count them) negative biopsies, a negative MRI and a negative bone scan.
I am a guy with chronic prostatitis and a PSA or 15, so I can relate! If you graph your PSA values over time (as I have) and see a straight line, you probably are dealing with advancing, chronic prostatitis. Hang in there and show the graph to your "consultant". If, however the graph shows an acceleration over time (excluding the odd 20 value), you need to be less cavalier about this.
David
PiersCV DrDavidB
Posted
One of the reasons I have avoided the biopsy so far is that an acquaintance of mine developed prostatitis after one and has never shaken it off.
Given that I THINK the problem is coming from my gut I don't want to inoculate my prostate with whatever it is. So if I go with one this time I will go transperineal I think.
william10248 PiersCV
Posted
A biopsy is the best orocedure to diagnose cancer and that is why antibiotics are prescribed or should be to prevent infection.
JerryR PiersCV
Posted
No, I've read recently that the 3TMRI is the best procedure for diagnosing Prostate Ca.
PiersCV JerryR
Posted
I've read that biopsy only misses 30% of cancers.
MRI misses 10%.
I am not sure what the hit / miss rate is if you have an MRI followed by a biopsy, if the MRI shows nothing.
Anyone know?
tom86211 JerryR
Posted
The MRI may show possible lesions but it can't tell the Gleason grade and that is critical for diagnosing what you may have and what to do next.
oldbuzzard PiersCV
Posted
Don't get a biopsy!!! They are unnecessary now. Many things can elevate a PSA. First, get another PSA test before doing anything. Then, if its still high, get a 3t mri. If it shows something there are higher resplution MRIs that do a better job of diagnosing cancer than biopsies. And then, if you have cancer, the likelihood is the best course of action is to keep an eye on it but do nothing. 95% never cause any problems and gleason scoring can up the odds beyond that.
Prostate cancer is over treated. There are so many incontinent/impotent men who didn't have to end up that way because they had their prostates removed for essentially no reason.
JerryR PiersCV
Posted
Tom86211 - The 3TMRI is just to see if there are any suspicious lesions in the prostate. If it all looks good, you're home free. But if there's anything suspicious looking in the prostate, you need an MRI guided biopsy.
william10248 PiersCV
Posted
Guys: I can not believe the number if people playing Dr in a situation like this. Great forum to ask questions as to results, but we should really not be second guessing Dr's!
nick67069 william10248
Posted
would you consider asking for second opinion as "second guessing Dr's"? You have to keep in mind that doctors are humans and DO make mistakes... Nothing wrong if you use common sense and question results... Like in anything else, you have doctors from the top of the class and from the bottom. After all it is our body and our decision what to do.
rdemyan nick67069
Posted
Absolutely right, Nick. My ex-uro told me for years that my prostate was 40 grams in size based on a DRE. I didn't realize how inaccurate estimates from DREs are until an ultrasound scan indicated a size between 120 and 140 grams. Malpractice in my opinion that a urologist would provide a size that could be so inaccurate. I'm on dutasteride now, but would have started a lot earlier if I had known what the true size was. The dutasteride and alfuzosin have helped and I'm sure if I had started earlier I would be in much better shape. My ex-uro's answer to everything was have a TURP. SOB!
oldbuzzard william10248
Posted
Actually...we should be second guessing them. The docs who tell you how big your prostate is via a digital rectal exam, the ones who go straight to a needle biopsy after one psa test, the ones who say the only option for BPH is TURP - should all be questioned. I'm actually shocked how much dated and outright misinformation is being peddled by piddle docs.
JerryR oldbuzzard
Posted
"Here, Here!" oldbuzzard. I agree with you completely. The only thing I would add is if you have a disagreement between your doctor and Dr. Google, I would believe Dr. Google - assuming you're referencing a credible website like Mayo Clinic, Cleveland Clinic, NIH, etc.