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Help required - do I or dont I have PCa - & how will we find it - if I do?
I should appreciate any helpful advice & suggestions from the very knowledgable & experienced contributors to this forum.
My details are as follows:
Brief Time & Event Line:
Age: 65/Health: excellent
Country: UK
Medical system: State funded
22 April 2010 Hospital A & E – Urinary Retention – Overnight stay
Catheterised DRE - normal but enlarged Initial Diagnosis - BPH
Prescribed: Tamsulosin (Flowmax) No subsequent issues
6th October GP - DRE- normal - enlarged
22 December 2010 GP - PSA Test: Result 25.6
DRE - normal - enlarged
Referred to Hospital Urology Department
4th January 2011 Hospital Urology Department
Urodynamic Test - ok
DRE - normal - enlarged
11th January 2011 12 Core Biopsy - Pathology result: no evidence of PCa -
only HG PIN
11th March 2011 GP – PSA Test: Result 25.9 - no significant difference
29th March 2011 MRI Scan - result – “indications” of - tumour within prostate
- & possibly enlarged seminal vesicle & obturator lymph node
26th April 2011 Saturation Biopsy
Pathology result: 48 cores of prostate & seminal vesicles
59 samples tested
no evidence of PCa
Currently there are no further recommendations for action other than a possible follow up MRI & PSA test when the Biopsy inflamation has died down.
Re: Help required - do I or dont I have PCa - & how will we find it - if I do?
How I wish I had had such good biopsy results, but I appreciate your concern in the light of your PSA reading. Even at this level BPH is still possible; indeed what else could it be? The MRI "indications" are not proof of PCa and after such a comprehensive biopsy it is hardly credible that any PCa there could have been missed. If you have a tumour it must be very small. At such a size it is unlikely to have spread to your seminal vesicle or lymph node, unless it sits on the edge of your prostate adjoining the seminal vesicle. But after your scan results, I would have expected the samples taken to have concentrated on this area and if they showed nowt then you should be a happy man.
The recommendations for action seem pretty sound to me - you must have a pretty bruised prostate - and waiting three months before retesting PSA sounds like a good idea.
You don't say if you have been given anything to shrink the prostate, assuming it is BPH. You might ask why not.
Good luck - and don't worry too much. With a PSA more than double yours initially, getting on for four years later, I'm fine and I do have PCa, so from experience I'd say you ain't gonna die tomorrow!
But at 65, you deserve to put this in the back of your mind and live every day for the value it brings. Make the most of every one because some idiot driving a bus may waste your life long before PCa ever casts its baleful shadow.
Re: Help required - do I or dont I have PCa - & how will we find it - if I do?
I appreciate you taking the time to reply - & believe me I am not complaining that no one has found "anything in the woodshed" - & I am totally sympathetic to all of my fellows out there where someone has.
As perhaps you may have considered I am presently statistically within a very small group of people in that technically the size of prostate & the PSA figure do not correlate & the usual explanation is normally found on biopsy - or extenxsive re-biopsy - but it hasn't been.
So the possibility exists that something might be there - but - how to find it....& this does not go away - so much as I will continue to live my life - I have still to think about whther its there because none of us want to be taken by surprise & think we could have done something yesterday that may be more of a problem tomorrow.
So I will explore all avenues.
Many thanks again - & good luck to you - too!
Re: Help required - do I or dont I have PCa - & how will we find it - if I do?
Alan,
Nice to hear from you again but the guy you're advising at the start of this string is mcgerk not me! As you know, biopsies of lymph glands should not be lightly undertaken. Infections are easy to come by, can quickly spread and may be hard to treat as a friend of mine with Non-Hodgkins Lymphoma has found. Also, sampling always carries the risk of missing something, as may have happened to our friend with the sieving of his prostate. Terry as always had it spot on. There are no rules to this disease. It is particularly difficult when the problem is most complex, perhaps unique, and at the edge of each of our experiences (and probably that of the consultants involved, too!) I certainly think your suggestion is worth a discussion with mcgerk's Urolist. I add my best wishes and good luck to him as he takes this forward.
Re: Help required - do I or dont I have PCa - & how will we find it - if I do?
G’day to you,
There are two things to bear in mind:
1. The Golden Rule of Prostate Cancer: There Are No Rules
2. The PSA test is NOT prostate cancer specific
It is unfortunate that an elevated PSA is initially assumed to be generated by PCa when all available evidence shows very clearly that in the substantial majority of cases (about two thirds) there is no evidence of PCa in men with an elevated PSA, hence the statement made in #2 above.
Although there are no studies that I know of that have established the ‘normal’ range of PSA – that is what PSA levels are not associated with a positive PCa diagnosis, I have read an anecdotal submission by an Australian doctor who had a man with a PSA level of over 300 ng/ml with negative biopsy results whose condition responded to antibiotic therapy with a resultant PSA level reverting to below 4.0 ng/ml.
So perhaps it could be said that the range of ‘normal PSA’ levels is from zero to 300 ng/ml?
The saturation biopsy procedure you have recently undergone is the best evidence that there is not a significant tumour in your prostate gland. It seems far more likely that the PSA levels measured in your tests are from some condition other than PCa, although of course we have to bear in mind point #1 above.
You say you have an enlarged gland but do not mention how big it is estimated to be. What is the cause of the enlarged gland. Is it BPH (Benign Prostate Hyperplasia)? That condition can produce some very unusual PSA readings. What was the cause of your urinary retention that required hospital admission last year? Could that have a bearing on your PSA levels? Bladder infections are a primary cause of non-PCa related PSA levels and are notoriously difficult to deal with. Have you had all the tests that might identify bladder problems? HG PIN is often associated with inflammation of the gland and with elevated levels of PSA - how many needles were positive for HG PIN? Could this be a source of PSA.
You can, of course have multiple conditions that all contribute in some way towards the PSA levels. It is possible that one of those conditions may be PCa, given point #1 above, but it seems the least likely source to me.
Re: Help required - do I or dont I have PCa - & how will we find it - if I do?
Many thanks for the contributions - yes - we do have a very curious scenario - in view of the PSA & the MRI - & no meaningful Pathology - & yes - we will be looking closely at the current facts - if we can access them - due to the manner in which the UK NHS operates - & will be trying to get more detail - & then will try to establish what to do next.....
Re: Help required - do I or dont I have PCa - & how will we find it - if I do?
Thanks to all contributors. This is the UK - so things move slowly - & I am awaiting the further input of the Urology Department's "Multi Discplinary Team" - who meet up every Monday to discuss matters & then communicate their views "in due course". If anything interesting arises I will post the info - again - "in due course" - but I have no idea of timings at present.
