PSA slighlty increased. Free PSA next?

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I have been posting on this forum for a few weeks now regarding my partners prostate issues. His brief history is PSA 7.6, 9.5, 7.6, 7.7. The last one was a week ago, the first mid to late August 2016. The highest one came approximately 10 days after acute retention and catheter fitted for 3 days. He has had the usual antibiotics but only for 5 weeks. I have read here that many men take them for up to 12 weeks so I don't know why he wasn't given them for longer. Symptoms appeared to ease off strangely enough when the PSA was at its highest. He has burning mostly when not urinating. Pain at top of shaft on underside, a feeling of sitting on something all the time, no problems with stream or dribbling etc. He had a 3T MRI last week and will be meeting with his consultant at the end of this week to discuss results and options. The consultant is determined that with this PSA not normalizing a biopsy is the only option. What I wanted to ask is should we push for a test which shows the level of free psa. I would have thought that this would then determine if a biopsy was definitely necessary or not. I know they are not widely available where we live and have the feeling that the consultant won't be forthcoming with where we can have one done. I still feel that he may have BPH. I suppose the detailed scan will show everything anyway so we will just have to wait a few more days. Any advice much appreciated. x

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  • Posted

    Hello  Caz   Sorry that your partner is having a problem.  At the meeting the best thing is to ask questions They should be able to tell you something.  But it is also best to have a second opinion.  Good luck to both of you  Ken  
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  • Posted

    Hi caz, The symptoms you describe sound like severe prostatitus. I did read that when you put a catheter in a man's bladder, it irritates the bladder and prostate and usually raises the PSA and not to repeat the PSA test for several weeks. If you have an inflamed prostate, it will raise the PSA. If you have a UTI, it will raise the PSA. Some of these conditions can take many months to reduce the PSA. You might even have an 'event' while recovering, which puts it back up again.

    Be interesting to see what the 3TMRI indicates. Remember to ask your urologist for a copy of the radiologists report. It will tell you like it is, not the urologists interpretation of what he thinks the radiologist says etc. You need to get the PIRAD score 1-5. 1= you have no serious issues, 5= you have problems. If they find evidence of a lesion, they will report on its location and if it has invaded the outside areas of the prostate. And if outside, where it is. Usually, if you have a lesion, then a guided biopsy is the best way to determine the Gleason score.

    The PSA free test may be useful. I had the PSA free and the PHI, both said high probability of PCa, but my PSA reduced slightly and my 3T MRI was scored at PIRAD2, sort of the best result for a 68 year old prostate, and the MRI indicated BPH and prostatitus with no lesions anywhere. I am waiting for 6 months and will redo the PSA, meanwhile getting a urethra stricture repaired.

    Geoff

    Geoff

     

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  • Posted

    Hi Caz,

        Just a note that even if the 3T MRI comes back with a high PIRADS, it does not necessarily mean PCa. I had a PIRADS of 4, but biopsy came back negative. When I asked the uro doc what could have caused the high PIRADS, he said BPH can look like PCa. (Wish he would have told me that when the MRI report came back!).

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    • Posted

      Good point rich, uro said to me similar that a prostate with BPH and suspected prostatitus, can hide or even look like a 'general' PCa if it is still in the early stages. I bet the PIRAD 4 score gave you a scare. As you say, maybe if he had said that first, you may not have had the biopsy!

      Geoff

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    • Posted

      Sure did cause me concern. I was already planning to have Photon Beam Therapy at Loma Linda in CA! (Even looked at long term lodging.) I probably would have still gone forward with the biopsy, but would have been considerably more relaxed.
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    • Posted

      I can imagine....Saw a paper the other day saying the benefits for the Photon Beam (and higher cost)were not stacking up against EBERT, as results were similar.

      Geoff

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    • Posted

      Hi rich, Sorry, I do not have the link. It was maybe me following a story on medscape and there may have been a storey leader, which I then followed. Thinking about it further, it may have been 'proton beam' and not photon beam' which maybe different?

      As I recall, the paper was saying after a few years use with a similar number of patients, they compared the outcomes of using the photon(proton?) beam and conventional radiation techniques. They looked at several things, including PSA return, incontinence and ED, as well as damage to surrounding organs, bowel etc. They said that the outcomes were very similar, and considering the high cost for the photon(proton?) use, its use over the conventional method may not be proved yet.

      Here in Australia, we have been planning for our first proton setup for many years, and maybe financed and built during 2017. All the ads for it look very flashy. They must be super expensive things to build and operate?

      ?Geoff  

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    • Posted

      Hi Geoff,

          My mistake. Yes it is proton beam therapy. Photon is the usual type x-rays. The units are very expensive to build, Last I heard in the $ 150 million (USD) range, since it requires a building to house the machine. Everything I've read (which was from a couple of years ago) indicated that there should be far less damage to surrounding tissue. See "You Can Beat Prostate Cancer and You Don't Need Surgery To Do it)" by Robert Marckini (c) 2006." Don't know if there's been an updated edition. The author also started a very active support group which now has 8000 members.I can PM a link if you're interested. So I'd be interested in more recent studies like the one you mentioned. Guess I'll poke around when I have some time.

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    • Posted

      Good morning.  We had a center that opened up in Florida. 2006 - 2015 - 2016  I looked into it but the information I got I did not like.  I for one do not want to end up with any sexual problems.  I got a reply from a Deborah Hickery on the Proton Procedure.  You do have to have many of them.  With this procedure They typically report up to 40% of the men who choose protron therapy may experience some level of ED  But the doctor there say that Vigra, Levitra or Cialis work fine.    As for retro-ejaculation occuring as a result of proton therapy we have never heard of this happening.  Howerer, it is common for the the volume of the ejaculation to decrease signficantly and sometimes disappear completely following proton therapy.   To me it causes retro.  If you would like her e-mail I would be happen to sent it to you if you need to ask some questions.  That you.  Have a great day   ken
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    • Posted

      Hi Rich, Yes i saw some of the costings and the need for a special building to be constructed...No wonder here in Australia we have been having issues trying to 'prove' a financial benefit to get the technology here

      The idea is, if using any form of radiation, is to remove the prostate cancer with causing the least damage. Proton therapy apparently seemed more accurate and supposed to cause less problems. The paper said they did not see any difference in the after problems percentages. 

      Maybe like most highly technical equipment, it is also about the technicians experience to harness the abilities of the machine. It seems mapping of the prostate, its PCa lesion and the surrounding organs needs to be thought out before the actual treatment begins.

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    • Posted

      Thanks Ken. I've communicated with Deb Hickey in the past. Not really a current issue for me as biopsy (third!) came back negative. Now just dealing w/BPH, and headed to VA and Dr Bagla to take care (hopefully!) of that.

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    • Posted

      Yes, my undersatnding is that there is a very detailed procedure for the mapping of the target area that is done before actual treatments are started.
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  • Posted

    Thanks guys. The clinic supposedly were meant to give us the results on a disc as well as sending report to urologist. I don't know if the disc maybe wasn't ready at the time we were there but we as yet haven't received one. We definitely need one if going for a second opinion before biopsy. I don't really understand the PIRAD score, didn't even know we would get one. Will we get one considering the clinic didn't use a contrast dye? I'm thinking if this is part of a standard protocol and they don't do it will the score we get be accurate? Apologies if this sounds a bit mixed up. They did 3T scan with diffusion weighting thats all. I'll make sure I go with him and ask the questions, I have done a lot more research than he has and am keen to hear his urologists view on free PSA.

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    • Posted

      caz,

      A PI-RADS v2 score is given according to each variable parameter. The scale is based on a score "Yes" or "No" for Dynamic Contrast-Enhanced (DCE) parameter, and from 1 to 5 for T2-weighted (T2W) and Diffusion-weighted imaging (DWI). The score is given for each lesion, with 1 being most probably benign and 5 being highly suspicious of malignancy. Amongst other findings reported, you should get a PIRAD score.

      Geoff

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    • Posted

      Thank you, Geoff for explaining that. It's all so confusing to a lay person like myself. I want to understand as much as I can and be as informed as possible and thanks to all of you on here I know so much more than I did a month ago. I had no idea we would be told a score. As he had the DWI we will be looking for a score as low as possible. Hopefully there won't be any lesions to score. As the day for results gets closer we are getting more worried and stressed, it's the not knowing that is the worst.

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    • Posted

      Yes, I recall my meeting about the MRI...but I cheated, as my urology appointment was two weeks away, I went to my general doctor, who I knew had been sent a copy of the MRI report, and, being a doctor, had access to the actual images at the radiology centre as well. When I walked in, he was smiling, which said it all....We just hope the images are correct.

      Before I left the radiology centre, I was told to wait for 30 minutes or so while the images were placed on a DVD.

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    • Posted

      I was able to go home with the DVD (had to wait a little), so I had it if I decided to go for a second opinion.
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    • Posted

      We contacted the clinic today and they are sending the  disc out in the next post so hope to have it early next week. Apparently we had to ask if we wanted one! Anyway, results tomorrow night so fingers crossed. I will post afterwards.
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    • Posted

      Yes, I believe that's the case for any digital items where I am (ultra-sounds, MRI's, cat scans). Have to specifically ask, and sometimes even sign paperwork. Fingers crossed here also.

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    • Posted

      Caz, When I got my images, the first thing I did was dive on line for prostate MRI images to compare. It was scary loading the images. One part of me did not want to look, the other part said..."well, it is done now, you had better look"....they seemed ok, thankfully, the radiologist also agreed when I got his report via my doctor. The problem is for us non professinals, the prostate is a very grainy organ with many lumpy type shapes that should be there.

      The idea is to have the skill to work out what should and should not be there. Usually though, if there is anything there reportable, it will be seen.

      Geoff

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