Health Scare Starting Right After Retirement

[watchman3135]

So I just early retired not to long ago and earlier this year I had my routine bloodwork and my PSA was nearly doubled in the high 3's from my previous years. Had another PSA follow up 12 weeks later and it was 3.97 so my primary sent me to a Urologist. I'm 55 but the protocol for most any age is to next do a random prostate biopsy but I did a lot of homework prior to my visit and requested a 3T Multi Parametric Prostate MRI be done first which in the past several years is becoming the Gold Standard rather than biopsy first and can be used with mapping if anything is found. The MRI report showed nothing of concern.

As Prostate 3T Multiparametric MRI is becoming the "Gold Standard" I was hopping it remove the need to do any further testing since nothing was found with a PIRADS 1 however on the Doc's insistent recommendation, I did the biopsy and the lab found 2 of 12 cores containing 3+3= Gleason 6.

The Urologist advise was not to do radical surgery or radiation at this time with the current guideline for low risk Gleason 6 which is still considered a cancer but a non aggressive is observation with retesting in 6 months. In his own words "If you going to get prostate cancer, this is the one to have" but when one hears they have any cancer all they can think of is get it removed asap but as many men know, a radical prostatectomy is nothing to be taken lightly though with a Gleason 7 or higer I think treatment becomes more clear.

After a few days further researching his advise moving forward and Confirming Gleason 6 is a very gray area in regards of the need for treatment with many respected Urology in the field advising 6 needs a different definition as is scares patients into more radical and unnecessary treatment with some saying it should not be labeled as a cancer at all which makes treatment options very confusing. All this makes me now think of the timing of my early retirement.

It's been confirmed that 40% - 50% of men above 50 have some form of Prostate Cancer and don't know it and because it's mostly slow growing most will never die from it but from other age related illness.

Anyone else having similar Health discoveries after retiring and wonder what the heck is going on with life?

 

[braumeister]

I know what you're saying. The first PSA measurement I ever had (a long time ago) was over 9. What could be scarier than that? My doc immediately referred me to a urologist.

As it turned out, my urologist thought it was just prostatitis. He gave me some heavy duty antibiotics and the follow-up test proved him right. Needless to say, I spent a few very anxious weeks!

 

[watchman3135]

I know what you're saying. The first PSA measurement I ever had (a long time ago) was over 9. What could be scarier than that? My doc immediately referred me to a urologist.

As it turned out, my urologist thought it was just prostatitis. He gave me some heavy duty antibiotics and the follow-up test proved him right. Needless to say, I spent a few very anxious weeks!

Thanks and good to hear you had nothing serious. The day of the visit for the results felt like the room was closing in on me. Probably like many here I am a fact based researcher so a few days later I am a little more composed but like many still unsure what to do next.

 

[PaunchyPirate]

Don’t let it panic you. But don’t let your guard down either. For the last 6 years, my PSA has ranged from 3.5 to 10.4. Usually in the 4.0 area. I’ve had 2 random biopsies and one of the ones electronically guided by a 3D MRI. My MRI showed a minor lesion. But they found no cancer in the biopsy. And my PSA went back below 4 as well. I had PSAs done every 6 months for a while, but we went to once a year for the last 2 years. According to my urologist, I’m one of those guys whose PSA moves up and down. Unfortunately, between ages 35 and 53 or so, I never had any blood work done. So we don’t know what my PSAs used to be. My urologist wants to do another round of PSAs and an MRI-based biopsy in January, just because it’s been 4 years since my last one. That will be 6 months after my last PSAs, which had risen back up to 5.3.

We monitor things closely and will react when needed. The bottom line is that it’s a wide spectrum of possibilities. With a wide spectrum of reactions.

 

[2HOTinPHX]

https://www.imaware.health/blog/preparing-for-a-psa-blood-test

Can I have sex before I take a PSA test?

No. You should abstain from sexual activity - anything that includes ejaculation - for at least 48 hours before the test. A recent ejaculation might cause a slight rise in PSA levels.**

Were you aware of this?

 

[bmcgonig]

There are bio marker tests that you can take where a positive result correlates well with serious cancer. One is the 4K test, another is SelectMDX. You might look into these to give yourself more confidence.

I went thru something similar a few years ago when mine jumped from 4 to 5.7. I did a SelectMDX and a mpMRI and both were negative that gave my urologist some confidence.

 

[watchman3135]

There are bio marker tests that you can take where a positive result correlates well with serious cancer. One is the 4K test, another is SelectMDX. You might look into these to give yourself more confidence.

I went thru something similar a few years ago when mine jumped from 4 to 5.7. I did a SelectMDX and a mpMRI and both were negative that gave my urologist some confidence.

Thanks. I'll look into that and have my doctor order. What I'm trying to put my finger on (no pun intended) is we now know a 3T Multiparametric Prostate MRI is now the preferred modality after a back to back verified high or elevating PSA and a digital recital exam (no lumps felt) yet no tumor was found with the MRI yet two cores pull a 3+3=6 Gleason.

 

[watchman3135]

https://www.imaware.health/blog/preparing-for-a-psa-blood-test

Can I have sex before I take a PSA test?

No. You should abstain from sexual activity - anything that includes ejaculation - for at least 48 hours before the test. A recent ejaculation might cause a slight rise in PSA levels.**

Were you aware of this?

Thanks. Yes I was and it may surprise many other men that ejaculation within 48 hours, Prostatitis, BPH and any other recent injury or even bike riding (surprising) can have a significant effect on PSAs.

 

[watchman3135]

Don’t let it panic you. But don’t let your guard down either. For the last 6 years, my PSA has ranged from 3.5 to 10.4. Usually in the 4.0 area. I’ve had 2 random biopsies and one of the ones electronically guided by a 3D MRI. My MRI showed a minor lesion. But they found no cancer in the biopsy. And my PSA went back below 4 as well. I had PSAs done every 6 months for a while, but we went to once a year for the last 2 years. According to my urologist, I’m one of those guys whose PSA moves up and down. Unfortunately, between ages 35 and 53 or so, I never had any blood work done. So we don’t know what my PSAs used to be. My urologist wants to do another round of PSAs and an MRI-based biopsy in January, just because it’s been 4 years since my last one. That will be 6 months after my last PSAs, which had risen back up to 5.3.

We monitor things closely and will react when needed. The bottom line is that it’s a wide spectrum of possibilities. With a wide spectrum of reactions.

Thank you. So they did see a minor lesion on your MRI ? The one common thing we know is most prostate cancers are slow growing which is good and why active surveillance is becoming the preferred protocol on low risk candidates.

The fact that nearly 50% of men over 50 are walking around with some form of prostate cancer was surprising to learn.

My wife however is freaking out and was initially pushing into RP surgery, however like me after a few days of researching has calmed down a bit but she is of the ideology of if it were me and I was newly diagnosed with any cancer that could be removed, I'd cut it out without question no mater the side effects.

 

[Aerides]

Anyone else having similar Health discoveries after retiring and wonder what the heck is going on with life?

I forget who said it here, but something to the equivalent of: it's all fun and games in your 30's and 40's, but once you turn 50, the check engine light starts to come on.

 

[watchman3135]

I forget who said it here, but something to the equivalent of: it's all fun and games in your 30's and 40's, but once you turn 50, the check engine light starts to come on.

Boy it certainly does seem that way doesn't it? Seems like every time I go for the yearly tests now, it leads to more tests.

The irony is when I was younger I never understood older people who would say "I'm no longer seeing the doctor because everything leads into more tests" but now at 55 I get it 100%.

 

[PaunchyPirate]

Thank you. So they did see a minor lesion on your MRI ? The one common thing we know is most prostate cancers are slow growing which is good and why active surveillance is becoming the preferred protocol on low risk candidates.

The fact that nearly 50% of men over 50 are walking around with some form of prostate cancer was surprising to learn.

My wife however is freaking out and was initially pushing into RP surgery, however like me after a few days of researching has calmed down a bit but she is of the ideology of if it were me and I was newly diagnosed with any cancer that could be removed, I'd cut it out without question no mater the side effects.

Yep. My lesion was 9mm in size if I recall. Of course I’m choosing to believe that the guided biopsy actually found that tiny lesion. The doctor was confident. I’m not sure if my biopsy was exactly the same as the one you had. I was never told its official name. My doctor just refers to it as a guided biopsy. But it might be the same. They find the area of interest in the MRI. Then the software constructs a 3D render of the prostate and lesion location(s) from the MRI. Then during the biopsy, they use something similar to GPS to track the location of the biopsy needle on the 3D diagram as it gathers samples from the prostate. Pretty cool stuff.

We will see how this next one goes in January. It is what it is.

 

[donheff]

I have 3+3=6 also. Many/most urologists believe that 3s are not really cancer. Also, most believe 3+3 cells do not gradually become worse. It is, of course, possible that some undetected 4s or 5s are lurking around and could become an issue. Watchful waiting is what the doc prescribes. Decades ago your prostate would already be on the cutting room floor.

 

[watchman3135]

Yep. My lesion was 9mm in size if I recall. Of course I’m choosing to believe that the guided biopsy actually found that tiny lesion. The doctor was confident. I’m not sure if my biopsy was exactly the same as the one you had. I was never told its official name. My doctor just refers to it as a guided biopsy. But it might be the same. They find the area of interest in the MRI. Then the software constructs a 3D render of the prostate and lesion location(s) from the MRI. Then during the biopsy, they use something similar to GPS to track the location of the biopsy needle on the 3D diagram as it gathers samples from the prostate. Pretty cool stuff.

We will see how this next one goes in January. It is what it is.

Right and a MRI overlay mapped ultrasound guided biopsy is more accurate than random 12 point poking of the prostate in hopes of hitting the target and why everyone reading this and going through similar should do their research and be advised of the benefits of a 3T Multiparametric Prostate MRI before a random core biopsy which many tumors are missed.

With two elevated PSA's My Urologist initially wanted to move directly to the random ultrasound biopsy first but I pushed for a 3T MRI. He agreed but said it's hard to get some insurances to pay for a MRI as a first test. I said that is fine either way as I can pay out of my own pocket if not.

This reminded me of an article I read a while ago where it said the vast majority of Americans cannot come up with $400 in a months emergency and reminded me of how grateful I was to the FIRE community for all the advise and sites like this for finding myself in this situation where I am retired and having the ability to pay out of pocket for better testing if needed.

The insurance did pay though with higher out of network deductible of $639 since it my first out of network test for the year.

 

[bmcgonig]

Thanks. I'll look into that and have my doctor order. What I'm trying to put my finger on (no pun intended) is we now know a 3T Multiparametric Prostate MRI is now the preferred modality after a back to back verified high or elevating PSA and a digital recital exam (no lumps felt) yet no tumor was found with the MRI yet two cores pull a 3+3=6 Gleason.

Apparently it is highly dependent on the skill of the operator and the radiologist that reads the MRI. Also if we believe the following its aim seems to be to discover “clinically significant “ cancer which is higher Gleason than what you have.

http://www.urotoday.com/library-res...-and-utilization-of-multi-parametric-mri.html

 

[watchman3135]

I have 3+3=6 also. Many/most urologists believe that 3s are not really cancer. Also, most believe 3+3 cells do not gradually become worse. It is, of course, possible that some undetected 4s or 5s are lurking around and could become an issue. Watchful waiting is what the doc prescribes. Decades ago your prostate would already be on the cutting room floor.

Yes this is very true. A radical prostatectomy seems as it was the preferred treatment years ago. I watched Actor Ben Stiller talk about being diagnosed at 48 with Gleason 7 and three months later he and his doctor decided on a radical prostatectomy which so far seems to have worked out for him but the surgery is no walk in the park.

The first time you are told you have any cancer in your body invokes a immediate response of "cut it out NOW". Research advancements are proving different with lower grades. I just hope as we follow the watch and wait protocol that we are not part of some further research statistics.

 

[bmcgonig]

Right and a MRI overlay mapped ultrasound guided biopsy is more accurate than random 12 point poking of the prostate in hopes of hitting the target and why everyone reading this and going through similar should do their research and be advised of the benefits of a 3T Multiparametric Prostate MRI before a random core biopsy which many tumors are missed.

With two elevated PSA's My Urologist initially wanted to move directly to the random ultrasound biopsy first but I pushed for a 3T MRI. He agreed but said it's hard to get some insurances to pay for a MRI as a first test. I said that is fine either way as I can pay out of my own pocket if not.

This reminded me of an article I read a while ago where it said the vast majority of Americans cannot come up with $400 in a months emergency and reminded me of how grateful I was to the FIRE community for all the advise and sites like this for finding myself in this situation where I am retired and having the ability to pay out of pocket for better testing if needed.

The insurance did pay though with higher out of network deductible of $639 since it my first out of network test for the year.

My urologist told me that he recommends the mpMRI before biopsy. He also told me that Kaiser doesn’t and goes straight to random biopsy. It’s also normal procedure over in Europe as the MRI costs only €400.

 

[watchman3135]

My urologist told me that he recommends the mpMRI before biopsy. He also told me that Kaiser doesn’t and goes straight to random biopsy. It’s also normal procedure over in Europe as the MRI costs only €400.

In Europe, the 'Gold Standard" is if the MRI shows nothing of concern, you are done. American Urology physicians are not in agreement and say a Biopsy is still needed (even with a PiRADS 1 - nothing significant detected). They explain this is in part due the known small percentage of the individual reading Radiologist and their experience in reading and missing certain areas on the MRI.

To me and all my research, a 3T Multiparametric Prostate MRI image quality is so good at soft tissue disease and with a experienced reading Radiologist, it would seem logical as the last stop to avoid further unnecessary evasive testing yet in my case, nothing was found on the MRI, not even a lesion yet two out of twelve cores found Gleason 6 on the left upper and lower.

https://www.health.harvard.edu/blog...a-prostate-biopsy-its-debatable-2019062017176

 

[watchman3135]

Apparently it is highly dependent on the skill of the operator and the radiologist that reads the MRI. Also if we believe the following its aim seems to be to discover “clinically significant “ cancer which is higher Gleason than what you have.

http://www.urotoday.com/library-res...-and-utilization-of-multi-parametric-mri.html

Right and that is with both the MRI and biopsy pathology reading.

 

[chassis]

@watchman3135

Thanks for posting and it seems you are very educated and proactive with your practitioners. This reinforces for me that there is alot of gray area related to PSA testing and prostate cancer. Unwanted and serious side effects are possible from both biopsies and treatment, whether radiation or surgery. The patient needs to put himself in the driver seat on this.

There is another recent thread on the possible dubiousness of PSA testing: https://www.early-retirement.org/forums/f38/psa-test-false-positive-rate-70-a-109687.html

 

[watchman3135]

@watchman3135

Thanks for posting and it seems you are very educated and proactive with your practitioners. This reinforces for me that there is alot of gray area related to PSA testing and prostate cancer. Unwanted and serious side effects are possible from both biopsies and treatment, whether radiation or surgery. The patient needs to put himself in the driver seat on this.

There is another recent thread on the possible dubiousness of PSA testing: https://www.early-retirement.org/forums/f38/psa-test-false-positive-rate-70-a-109687.html

Well thanks. I am a researcher and a huge believer in backable scientific facts but I can tell you this is day 3 of waking up knowing I now have cancer in my body and the phycological worry factor is a bit beyond description.

While I understand the Gleason 6 PC is low grade and active surveillance makes more sense now having done nearly 3 days of research corroborating of what the Urologist explained the fear doesn't fully leave and while I hate to sound negative, prior to diagnoses I planned for a early retirement of 33 years out for money to last however now the future doesn't seem so clear or so long.

I do know this is a bit of expected negative fear we all get with any cancer diagnosis and It comes down to trusting the science.

 

[Teacher Terry]

At 49 my husband was impotent even with viagra. He went to a urologist and his PSA was higher than it should be. A random 12 point biopsy found one spot of cancer. He did watch and wait for 4 years and then it was much worse so had radiation seeds. Now my ex is 62 and still cancer free. Our friend was 14 years older and in denial about his high score for years because he had to digitally manipulate his colon to poop because of losing his colon. He blamed the high score on that. At 75 he’s in bad shape and almost died recently.

 

[watchman3135]

At 49 my husband was impotent even with viagra. He went to a urologist and his PSA was higher than it should be. A random 12 point biopsy found one spot of cancer. He did watch and wait for 4 years and then it was much worse so had radiation seeds. Now my ex is 62 and still cancer free. Our friend was 14 years older and in denial about his high score for years because he had to digitally manipulate his colon to poop because of losing his colon. He blamed the high score on that. At 75 he’s in bad shape and almost died recently.

Thank you for sharing. It helps hearing others experience when trying to decide on the next step of either treat or do active surveillance and to confirm the doom and gloom feeling is mostly unwarranted. I'm now on day 5 of my diagnosis and it is getting a little bit better to to deal with. Speaking with others who have gone through it helps greatly.

The obvious point of Active surveillance on low grade PC is to keep doing periodic 6 mo. re-testing so if it changes to a higher grade, active surveillance is no longer an option.

 

[googily]

Thanks. Yes I was and it may surprise many other men that ejaculation within 48 hours, Prostatitis, BPH and any other recent injury or even bike riding (surprising) can have a significant effect on PSAs.

My father used his daily bike riding (along with persistent UTIs) as the lynchpin of explanations for his higher than desired PSA, which the doctor agreed with. Eventually he had to have a biopsy, and he I think ended up with a Gleason of 6, but this was all happening in his 70s and into his 80s and everyone agreed to just keep watching. And now he's 88.

Obviously different in a younger man, and I'm sorry you're going through this. Watchful waiting can be a tough decision to make.

 

[watchman3135]

My father used his daily bike riding (along with persistent UTIs) as the lynchpin of explanations for his higher than desired PSA, which the doctor agreed with. Eventually he had to have a biopsy, and he I think ended up with a Gleason of 6, but this was all happening in his 70s and into his 80s and everyone agreed to just keep watching. And now he's 88.

Obviously different in a younger man, and I'm sorry you're going through this. Watchful waiting can be a tough decision to make.

Thanks. Yes If I were 15 or 20 years older I would better be able to deal with AS I think. Still haven't decided but they say you have plenty of time to make a decision with Gleason 6. Obviously if I did wait and say the next MRI and biopsy in six moths showed advancing changes, then I'd have no choice but to treat.

I've seen Gleason 6 referred to as the hard six and it actually lives up to that name because while it qualifies for Active Surveillance due to its low grade not known to spread nature, you still have prostate cancer so making a decision for treatment become a gray area. Obviously this is the point of Active Surveillance retesting. It doesn't mean you aren't doing nothing. The problem I'm seeing is take someone my age of 55. Lets say in AS the numbers advance as we all know they likely will. Do I want to wait until say 65 or 67 when I may be less healthy to have a major surgery?

The thought of possible incontinence, erectile disfunction dry ejaculations scares me. My wife hasn't done as much research on the subject and looks at it a bit more simply. Are you more concerned with sexual function or living.