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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.

David - UK, Northants (I should have said)

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.

The corollary of that of course is that PCa IS identified in men with what is regarded as a ‘normal’. The study published as PSA. Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level ≤4.0 ng per Milliliter showed that 6.6% of the men with a PSA lower than 0.50 ng/ml were diagnosed with PCa.

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.

Good luck on your path

Terry in Australia

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.

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