Any New Info on PSA Screening?

[Rich_by_the_Bay]

Now that the problem has been noticed, I predict a solution will be found. If the needle is picking up bad s*** in the rectum and transporting it to the prostate, a prep of the sort given before a colonoscopy should be helpful. Or you can imagine a smaller clean needle that is unsheathed after a larger needle has already made its way through the rectum.

Just curious where you get your information for the stuff you post?

Colon prep does not sterilize the colon and sepsis following colonoscopic biopsy is a recognized risk.

Biopsy needles have a cannula that can push the contaminants into the underlying tissue. Probably the incidence of infection following prostate relates to the performance of many biopsies at one session.

The risk:benefit of PSA-screening-related prostate biopsy is very, very marginal. A few are winners (maybe), a few are losers and a whole bunch suffer the discomfort and fear with 6 chances out of 7 that the biopsy will be negative; it is not even known whether finding the occasional cancer this way saves lives or improves quality. Discuss carefully with your doctor before deciding.

 

[GregLee]

Just curious where you get your information for the stuff you post?

Colon prep does not sterilize the colon and sepsis following colonoscopic biopsy is a recognized risk.

My reasoning is that colon prep would reduce the harmful bacteria and hence the risk of infection, not make the colon sterile. Since there was no information in my post -- it was just a speculation -- I don't know how to answer your question.

 

[braumeister]

I still think biopsy has its place.
I've had three of them (all negative, thankfully). First one was with nothing (one of the most uncomfortable experiences you can possibly imagine), the next two with light sedation.

There was one rather funny side effect on my first one. Apparently they nicked a vein, and my first urination after the procedure was bright red. As was the next, and the next. After about three days, the blood was finally gone, but I thought it was hilarious.

 

[Rich_by_the_Bay]

I still think biopsy has its place.
I've had three of them (all negative, thankfully). First one was with nothing (one of the most uncomfortable experiences you can possibly imagine), the next two with light sedation.

There was one rather funny side effect on my first one. Apparently they nicked a vein, and my first urination after the procedure was bright red. As was the next, and the next. After about three days, the blood was finally gone, but I thought it was hilarious.

Uh.. glad it turned out OK, but what was it you found so funny?

 

[braumeister]

The sight of the deep red pee. I suppose some would have been alarmed, but I realized what happened and just thought it was amusing.

 

[Retire Soon]

Just curious where you get your information for the stuff you post?

Colon prep does not sterilize the colon and sepsis following colonoscopic biopsy is a recognized risk.

Biopsy needles have a cannula that can push the contaminants into the underlying tissue. Probably the incidence of infection following prostate relates to the performance of many biopsies at one session.

The risk:benefit of PSA-screening-related prostate biopsy is very, very marginal. A few are winners (maybe), a few are losers and a whole bunch suffer the discomfort and fear with 6 chances out of 7 that the biopsy will be negative; it is not even known whether finding the occasional cancer this way saves lives or improves quality. Discuss carefully with your doctor before deciding.

There will be no discussion with my doctor. I've decided not to have anymore PSA tests.

 

[LightningDawg]

One of my employees husband has had annual PSA's for years, all normal. All of a sudden, he gets one that is >90. His aches and pains that he thought was old age, is metastatic PC. After chemo, it is now >500.

 

[tjscott0]

http://http://www.northwestern.edu/newscenter/stories/2011/04/prostate-cancer-talk.html

In a large multi-center clinical trial, a new PSA test to screen for prostate cancer more accurately identified men with prostate cancer -- particularly the aggressive form of the disease -- and substantially reduced false positives compared to the two currently available commercial PSA tests, according to newly published research from Northwestern Medicine.

The only currently available Food and Drug Administration-approved screening tests for prostate cancer result in a high number of false positives and lead to unnecessary biopsies and possible over-detection and over-treatment of indolent cancer which never would have caused suffering or death.

The study, which will be published in the May issue of the Journal of Urology, followed 900 patients from 10 sites, including Northwestern. The results showed the new screening test, a simple blood test called the Pro-PSA test, is particularly useful for patients with a normal prostate exam whose PSA is 2 to 10, a range considered the diagnostic gray zone because most men with higher levels have prostate cancer and most men with lower levels do not. The Pro-PSA test measures a more specific PSA subform called (-2) Pro-PSA. The test becomes even more accurate when its results are analyzed with a mathematical formula that provides an overall Prostate Health Index. (The formula divides the Pro-PSA number by the free-PSA. Then the quotient of the two is multiplied by the square root of the total PSA. )
“The logic behind the formula is that the higher the Pro-PSA and the total PSA and the lower the free-PSA, the more likely the patient has aggressive prostate cancer,” Catalona said.
The new Pro-PSA test was recently approved for commercial use in Europe, Catalona noted. “The FDA is currently reviewing our data from the study, and I’m hopeful that it will be approved in the United States as well,” he said.

 

[tjscott0]

Don't know what happened. Lets try link again.

New Prostate Cancer Test More Accurate : Northwestern University Newscenter

 

[Zero]

I recently went from years of PSA levels of less than 1 to 3.6 last year and 16 this year. DRE procedure found a raised lump and hardness, best I can recall the words. That was with my primary care doctor. He scheduled me with a urologist for further testing/evaluation for next month.

If I read the charts correctly that PSA level (if it is valid and not caused by prostatitis or other cause) indicates a 50-75% chance of cancer.

My current inclination is to listen to the new doctor (urologist) and discuss how he thinks I should proceed. Then schedule a second opinion (with new PSA and DRE) with a prostate cancer specialist and get his opinion.

But after reading this thread I get the feeling that very knowledgeable folks are saying: "doing nothing may be just as effective in terms of life expectancy".

Did I read the thread wrong?

 

[kcowan]

Well I have heard that all men develop prostate cancer and if they survive heart problems and dementia, it will eventually kill them. I am going through the enlarged but soft prostate from the DRE and a PSA reading that has doubled in the last year, but still half the desired limit.

I have also had three friends who died of prostate cancer, all in their early 60s. So I am in a bit of a dilemma.

 

[bbbamI]

Please guys...talk to your doctor.

http://www.early-retirement.org/forums/f38/my-dh-has-prostate-cancer-53678.html

It was always my understanding that prostate cancer is very slow growing. That might not always be the case. In my DH's situation, the doctor called his cancer 'a garden variety type'. He said we had time to think about the treatment...but he didn't want us to wait longer than a couple of months.

A couple of DH's biker buds talked to him privately about their prostate conditions. They are both in their 50s and IIRC, both PSAs were around 6. Unfortunately one of the guys has cancer. The other one has an infection.

It's not always bad news...but IMO, you need to know.

 

[Rich_by_the_Bay]

I recently went from years of PSA levels of less than 1 to 3.6 last year and 16 this year. DRE procedure found a raised lump and hardness, best I can recall the words. That was with my primary care doctor. He scheduled me with a urologist for further testing/evaluation for next month.

If I read the charts correctly that PSA level (if it is valid and not caused by prostatitis or other cause) indicates a 50-75% chance of cancer.

My current inclination is to listen to the new doctor (urologist) and discuss how he thinks I should proceed. Then schedule a second opinion (with new PSA and DRE) with a prostate cancer specialist and get his opinion.

But after reading this thread I get the feeling that very knowledgeable folks are saying: "doing nothing may be just as effective in terms of life expectancy".

Did I read the thread wrong?

A level over 10 is higher than that on which screening recommendations are based, and a mass on DRE makes the scenario you describe "case finding" rather than screening. If it were me I would pursue it with the urologist.

Diagnosis of abnormalities is different from screening (by definition). Good luck with your sitiuation -- there are alot of good options available.

 

[target2019]

I recently went from years of PSA levels of less than 1 to 3.6 last year and 16 this year. DRE procedure found a raised lump and hardness, best I can recall the words. That was with my primary care doctor. He scheduled me with a urologist for further testing/evaluation for next month.

If I read the charts correctly that PSA level (if it is valid and not caused by prostatitis or other cause) indicates a 50-75% chance of cancer.

My current inclination is to listen to the new doctor (urologist) and discuss how he thinks I should proceed. Then schedule a second opinion (with new PSA and DRE) with a prostate cancer specialist and get his opinion.

But after reading this thread I get the feeling that very knowledgeable folks are saying: "doing nothing may be just as effective in terms of life expectancy".

Did I read the thread wrong?

To answer your question, I say that you really need to get a variety of medical opinions and tests as you go forward. I'm going back and forth over whether it is worth starting a new thread about my own experience. Urologists, Surgeons, Cancer specialists--they all have varying backgrounds. Internet buddies know so much. If I give you wireless router advice over the forum, and it turns out wrong for you, then we haven't lost much. OTH, I would not say that doing nothing is a good idea. If you are under the care of someone with credentials, and are "watchful waiting" or "active surveillance," then you may be on a prudent path.
The problem with internet buddies is that they see your situation as mostly like their own experience. Free advice is worth what you pay. Remember that.
One name in all of these threads stands out as a good source: Rich in Tampa.

 

[braumeister]

And at the risk of repeating the obvious, don't forget that there are a variety of reasons for an elevated PSA reading. In my case, one reading was somewhere between 9 and 10, and it got my undivided attention. However, it turned out to be just prostatitis, and some antibiotics brought it zooming back down again.

There is currently a billboard campaign with the line "This year thousands of men will die from stubbornness." Although not specifically addressing prostate screening, it does make the point that there are a number of screenings that most men should probably take advantage of.

If you're curious, following the link on the billboard takes you here:
Healthy Men

 

[Zero]

Thanks all, thanks Rich, that clarifies it for me. I have been reading online and am beginning to understand the options a bit better and the associated risks involved with each. Have also contacted a couple of friends that have had procedures but I do not know anyone that has had the prostatectomy.

So I will await the urologist visit and be armed with some knowledge to better understand what he is telling me and to ask the right questions.

BTW, I had no indications that I had issues.

 

[Nords]

There is currently a billboard campaign with the line "This year thousands of men will die from stubbornness."

... and they didn't stop to ask for directions, either!

 

[BTravlin]

My urologist found an abnormal nodule on my prostate a few years ago and my PSA level had jumped but was still in the acceptable range. Went in for the biopsy and I believe they took 12 core samples. Two days later I flew off to the Turks and Caicos for a weeks diving off of a liveaboard dive boat. Had some discomfort in groin area before we left but didn't think much of it. Pain level increased moderately on travel day. Spent night in hotel and the next day exploring the island before boarding boat for a week at sea the next day. Anyway, we spend Friday having fun but I notice I'm getting downright sore now. By late afternoon I tell my DW I have to see a doctor. Call a clinic listed in phone book at about 4:30 pm. Nurse says doc is leaving for the weekend so come in Monday morning. Explain my situation, she puts me on hold and comes back a few minutes later to say come on over NOW. Jump in a taxi and head over. Doc sees me right away. Turns out he's a retired urologist from Great Britain working part time at clinic to supplement his income. Shoves a finger up the rear while I'm holing a slide on the front end of the plumbing. He's really pushing on the prostate and I'm ready to hit the ceiling. He takes the slide and runs off to his lab. Comes back a little while later and says my system is full of nasty little bugs that are reproducing rapidly. Says because I'd had a vasectomy all the little nasties were traveling down the tube but hitting a dead end and then piling up there and creating all the pain. Anyway, he calls the pharmacy next door and tells them not to close just yet. Gets me setup with Rx for strong antibiotics plus some pain meds. Said I was smart to come in and lucky I caught him or they'd have had to medevac me from the boat in a day or two. Followed his orders and only missed one day of diving.

I took all the antibiotics prescribed by my doc prior to the biopsy. Some before, day of biopsy and after so not sure why I got the infection. Doc there in the Turks said it just happens.

Had my PSA tested this week and it came in at .39. Yay!

 

[lynxville]

What's the sense of having a psa test if it doesn't prolong your life?
My urologist says an increase in psa of .6 or more requires further tests.
I went from 4 to 5.4 in 12 months. Went to urlogist and he wanted to do biopsy. Found better urlogist and he put me on ciprol for two weeks and then another psa test. I am 62 and had one bad experience with biopsy 7 years ago, negative. My new Url does biopsy's while under anisthetic, sounds good to me. But is all this necessary if I die from something else first?

Update after ciprol I waited 3 days and had another psa, now it's up to 6.1. Went back to the urologist and because I was returning from Florida to the Midwest he decided to put me on Finasteride, 5mg. He also gave me scripts for two more psa tests, at 3 month intervals.

In the fall when I return to Fla. it looks like biopsy time.

Lets look on the dark side and they have to remove the prostate, my Url recomends robotic surgery, which he doesn't do, but knows of a specialist that has done thousands of them.

Does anyone have an opinion on this type of procedure?

Thanks in advance

 

[braumeister]

The robotic surgery is becoming much more common these days, so that shouldn't be a problem.

But I think your immediate goal should be a good long conversation with your urologist to discuss all your options, so you understand the pros and cons of each.

 

[TromboneAl]

I'm glad to see that this panel agree with my evaluation:

Panel Opposes PSA Prostate Test for Healthy Men - WSJ.com

 

[kcowan]

I am going through the enlarged but soft prostate from the DRE and a PSA reading that has doubled in the last year, but still half the desired limit...

Good news. This year the PSA results were just 10% above last year.

 

[GregLee]

Good news. This year the PSA results were just 10% above last year.

That's good. After rising to 5.11 last March, my PSA result has gone back down to 4.72 in June and then to 4.5 in September. And, probably unrelated, I switched from taking plain saw palmetto to a product called "Prostate Health Complex" which also contains zinc, lycopene, and pumpkin seed. I don't know anything about it -- just grabbed it off the shelf at Costco. I did tell my urologist about the change -- he had no comment.

 

[playaman]

My PSA results have consistently been in the range of 1.0, plus or minus a tenth or so.
Yet, I have active-surveillance-level PC found as the result of a TURP. My view is that the PSA has little validity.

 

[Mulligan]

I'm glad to see that this panel agree with my evaluation:

Panel Opposes PSA Prostate Test for Healthy Men - WSJ.com

I just read this in my morning newspaper today, also. Since I am only 3 years from 50, TromboneAl could you fetch me up and article saying colon checks aren't needed anymore, too? A certain part of my body would greatly appreciate being left alone the rest of it's normal life.