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Brand New Here

In November, my psa was 3. In February, it was 5. Then the doctor put me on antibiotics for 10 days. Just got the next psa results, it is 9. What should I expect to do next? Should I go to a second urologist? Thanks for any and all advice.

Re: Brand New Here

JW; Hopefully what you have is just an aggressive infection and it sounds as if your urologist is on that trail right now- but- not to worry you, but if it is from cancer, it appears to be very aggressive so definitely keep on top of this. Second opinions never hurt and most doctors are in agreement with doing that. If it appears to not be infection then scans and biopsies are in order next. Always go for the least invasive tests first. Scans seem to be improving yearly. Biopsies are usually the definitive test however but not usually done unless there is sufficient reason to believe it is needed since it is an invasive procedure that stabs this small organ many times and removes tissue from it. It is tolerable but certainly not something to be done without good reason. Most medical folks downplay the procedure but then they have probably never had it done to them.
At this point all you can do is to find the cause for the high PSA and go after it in the way that suits you best. Best of luck in what lies ahead. Keep active on here as there are many knowledgeable folks on this site able to help you with advice and encouragement. Many have been through what you are just beginning. Jon.

Re: Brand New Here

JW,

A couple of suggestions:

1) Get a 4K blood test....much better than the PSA for predicting PC.

2) Your PSA test should have included free PSA. If not, make sure they measure it next time.

3) If one or both of the above tests are suggesting PC, do not get a standard blind biopsy.

4) Get a 3T-MP-MRI followed by a fusion biopsy if the MRI suggests PC.....PIRAD score 4 or 5

If your Urologist doesn't know what you are asking for....get a new Urologist.

Fred

Re: Brand New Here to Fred

Fred; That sounds like good solid advice. Too late for me but could you give a short definition of that MRI scan and what a fusion biopsy is? I am not familiar with either and would like to know more detail. Thanks, Jon.

Re: Brand New Here

Generally in agreement with prior replies.

When I did have a real infection - there were embarrassing symptoms, like wet pants after peeing; just could not shut off the flow once started, and even when I felt empty, I'd still leak: sometimes profusely. The uro-doc took a seminal fluid sample (prostate massage until I dripped onto a microscope slide) - my culture was positive; he placed me on Cipro for 30 days; symptoms receded. The prostate does not absorb antibiotics like other organs - so a 10 day course of antibiotics is not recommended (according to most readings).

Also, Free PSA is critical in understanding PSA. Under 25% Free is a fair indication of something other than infection.

If the urologist took blood immediately after a DRE, your PSA level can be higher than it should be. Always draw blood for a PSA BEFORE DRE, or wait three days or more to draw blood.

If your urologist didn't feel any lumps when he did the DRE, then a standard biopsy will have a good chance of being meaningless. An MRI, preferably transrectal, will show if you have any nodules. The MRI is much better at finding places to take biopsy cores.

The MRI guided biopsy doesn't happen in an MRI machine; rather, they use the MRI picture along with an ultrasound guided biopsy. Some uro-docs use software to help fuse the MRI image with the ultrasound (Fusion Guided Biopsy). Other good uro-docs can visually identify and mentally merge the MRI with the ultrasound while doing the biopsy. In both cases the skill of the urologist is key to either technique working well.

The Transition and Anterior zones of the prostate are generally not included in normal biopsies. These are the riskiest places to punch with a needle. More nerves, the urethra; more things to accidentally hit that cause lasting side effects. Unfortunately, also where many cancers form. An upside, transition zone cancers seem to have better cure rates.

Next step: MRI. Transrectal if you can get it; otherwise a good pelvic MRI can suffice. The transrectal 3T (stronger magnet) MRI gives the best resolution and is the current state of the art; usually needs a med school or similar front line medical center. A 1.5T pelvic MRI will show noduules, but it may be hard to differentiate benign versus malignancy. In either case, a biopsy will be required to diagnose and stage any cancer. Getting a 3T won't save that step.

You next step is a biopsy. After an MRI, the uro-doc will have a much better idea of where she/he needs to sample the prostate tissue. While a 12 core may suffice, a saturation 24 core may save you some worry -- yes, it is riskier, but more places sampled means higher degree of finding a tumor.

Once the biopsy cores are reviewed by a pathologist, and if cancer is found, your urologist will give you a list of options depending on the grade and stage of the cancer.

Re: Brand New Here

Hi JW,

When my PSA climbed to almost 11 a few years ago, I found myself in pretty much the same place as you now are now, facing difficult decisions and in a steep learning curve.

May I suggest you read my story (Sundog), where you will not only be able to read of my experience (what I did and how it worked out for me), but also see comments from our original host of this website, Terry.

All the best to you, let us know how things work out, and remember the main point of this wonderful website – Don’t Panic!

Re: Brand New Here

Hi Sundog, Thanks so much for sharing your story. I read it the other day, but was so crazed, it didn't register. After reading it again, it has helped calm us down so much. My doctor is on vacation so I haven't spoken to him since I got the 9.0 results. He won't be back till the 13th, but we've made 2 appointments with specialists for mid June(first we could get), just in case. My prostate is also enlarged and I start medication on Monday. Hopefully, we'll copy your results. Again,thanks for sharing. We'll let you know what happens.

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