Prostate Nodule detected - What's next?

[Buckeye]

Good question. I have no idea who was right, however, I believe the urologist has done a lot more DREs than my gastroenterologist. I am sticking with my urologist for now. My next PSA test is about two months from now. So far my highest reading was 3.1.

Worth going back and seeing if the first guy can find the nodule again? I agree the urologist is the guy to trust but I'd be tempted to go back to the first guy and say "find it again." His initial "find" has caused lots of activity and angst.

 

[Disappointed]

I have an appointment to see him this coming Wed regarding my gallstones, will bring this up and see if he wants to do another DRE?

I did think about a third opinion but will wait to see what my next PSA test (in six weeks) will show.

 

[lightspeed]

The DRE is very subjective. It's common to have experienced docs disagree on the presence of a small nodule. Also, not all nodules are cancer, and not all cancers present as nodules. PSA's can fluctuate, with infection, inflammation, recent ejaculation, even bike riding, so hopefully the next PSA will be lower. The PSA "normal" range is <4.0, however that must be interpreted in the context of previous PSA's and age. For someone 50 y/o, a PSA > 2.5 is high. A PSA of 3.5 might be ok in a 70 y/o, unless in was 1.0 the year before.

Hopefully, you will never be diagnosed with prostate cancer, but for those with early-stage (PSA<10, Gleason 6 or even 7) treatment may not even be needed. For those who want or need treatment, there are so many good options, surgically and with several forms of radiation therapy, that picking treatment is like picking your poison. Each option has pros and cons, and treatment should be highly individualized.

I would warn all about radiation centers that are privately owned by physicians, either the urologist or radiation oncologist. This is increasingly common throughout the country because of the profits one can make with a particular form of radiation called IMRT. There is inherent conflict of interest at those centers. Medicare will reimburse $35,000-$45,000 to a doc that prescribes a radiation called IMRT if that doc owns the machine. To do a prostatectomy, a urologist might only get $1200. To do a seed implant, a radiation oncologist gets reimbursed about $1200. Which treatment do you think a doctor who does not have your best interest in mind will recommend? Just one of the problems with US healthcare.

 

[Disappointed]

Thanks, I have another appointment coming up on May 14th, just a follow up (I hope).

mP

 

[Disappointed]

Just got back from my visit with my urologist, he wants to do a biopsy because my test result has elevated to 3.35 from 3.31.

The latest test was done on 05/03/12 = 3.35 - test performed using VITROS immunodiagnostics immunometric method.
Previous test performed on 03/10/12 = 3.1 - test performed using Siemens chemiluminescent method.

Not sure if there is a huge difference in the two methods? There is a note from the Siemens method "Values obtained from different assay methods can not be used inerchangeably".

Opinion anyone? I thought 3.35 is normal for 58 years old.

 

[grasshopper]

Lightspeed seems to knowledgeable about PSA tests, do you have any family history, have you had a PSA done earlier than March?

 

[braumeister]

That difference is not significant. I think there may be some other reason he wants to do a biopsy. Mine averages around 4, and has been anywhere from 3.6 to 4.5 for the last ten years. I've had three biopsies, all negative, during that time, and my urologist is quite content with this level of stability.

 

[Disappointed]

Lightspeed seems to knowledgeable about PSA tests, do you have any family history, have you had a PSA done earlier than March?

PSA history

2003 = 1.5
2005 = 1.3
2008 = 1.8
2010 = 2.3
2012 March = 3.1
2012 May = 3.35

My urologist said he does not like the trend. I read somewhere that the new cutoff point is now 2.5 instead of 4. Had it not been for my other doctor who supposedly detected nodule on my prostate I would not have gone to my urologist as I always thought that anything below 4 was OK.

 

[bbbamI]

Even tho I've been through (and am still going thru) the issues of my DH's prostate cancer (diagnosed in 12/10) I will not attempt to tell you what you should do. I am not a doctor, I only have experience with my DH's situation.

What I would like for you to think of is; do you feel comfortable/have faith with your urologist. How much would you worry if you didn't have the biopsy?

FWIW, DH had a biopsy and felt very little discomfort and had no problems after the procedure. Unfortunately he was diagnosed with PCa. His PSA had risen slightly over the years to a 4 (age 56). He had no other symptoms whatsoever.

 

[lightspeed]

I would agree with the urologist- the upward trend is worrisome, and 3.35 is high for your age. The different assays, or even day to day variation can account for that small difference, but in either case your psa is high. Braumeister's PSA is less worrisome because it has been within the same small range for a long period of time. The good news is, if you do have prostate cancer, it will likely be very curable at such an early stage. If you were 80 with that PSA, or even 70 with a lot of medical problems, you could live a with the cancer without treatment and you might die of something else. But you are 58, and assuming your health is reasonable (life expectancy of 10 years or more) the best time to treat it is now. If you wait 5 years and your psa creeps up to 7 or 8 due to a slow growing cancer, it would still be curable but less curable than if you got treatment now. Let us know how the biopsy turns out (or feel free to PM me for questions you don't want to ask publicly).

 

[Richard4444]

I have been dealing with the rising PSA for about 5 - 7 years. Age 62 now, at age 50 PSA was always around 1. Last few years, consistently around 6 -7. I had a biopsy and it was negative. Lots of controversy around the PSA, as we all know. However, the free PSA (fPSA) is somewhat more predictable and should be taken along with PSA. The higher (above 25 is best) the better. Google 'free PSA' BTW, with local anesthesia, (and anti-biotics before and during), my biopsy wasn't so bad. More emotionally fearful than the procedure, but if you are questioning what you have or don't have, I wouldn't hesitate with the biopsy to know for sure. Then, take your time deciding what you might do next. Best luck !

 

[lightspeed]

Richard4444 has a good point about the "free paa." Benign prostatic hypertrophy (BPH), a non-cancerous enlargement of the prostate that almost all men get to some extent as they age, causes a rise in "free psa" as a proprtion of total psa. Cancer cells release psa that is bound to an extra protein, or non-free psa, so the proportion of free psa is useful sometimes in differentiating BPH vs cancer as a cause of elevated psa. In many cases however, the free PSA is in the mid range, and biopsy is carried out anyway.

 

[Disappointed]

Thanks guys, although appoinment was made for next Thrusday for the procedure I am still debating. I was surprised that my doctor did not suggest additional tests or other alternatives. I think he feels that biopsy is a better tool than the alternatives and it is better to just get it done and over with.

 

[Richard4444]

Also, as it has not been noted in this thread yet, for the most accurate PSA, do not ejaculate for 72 hours prior as it would increase the PSA # and avoid heavy bicycle riding at least one day prior to PSA testing. Good luck with the biopsy should you do it.

 

[Disappointed]

Finally had my biopsy done August 3rd. The results are positive with low grade, low volume cancer in 3 out of 14 samples. I have been frequenting the Healingwell board and Healthboards.

 

[lightspeed]

By low grade I assume Gleason Sum 6. You have a lot of options to consider. Take your time, but keep the big picture in mind- you will probably do well.

 

[target2019]

Finally had my biopsy done August 3rd. The results are positive with low grade, low volume cancer in 3 out of 14 samples. I have been frequenting the Healingwell board and Healthboards.

I was diagnosed in 2006, and have similar low volume numbers. Have had 6 biopsies and am on watchful waiting. You have to trust your doctor. I left a smaller urology practice, went to a University cancer Center, and I feel there is a wider range of options when 'the day' comes.

That's just personal experience. No recommendation intended.

 

[bbbamI]

Finally had my biopsy done August 3rd. The results are positive with low grade, low volume cancer in 3 out of 14 samples. I have been frequenting the Healingwell board and Healthboards.

I'm sorry to hear your results. I assume you have a Gleason 6 score.

Continue to educate yourself and keep communicating with your doctor.

My best to you...

 

[Disappointed]

By low grade I assume Gleason Sum 6. You have a lot of options to consider. Take your time, but keep the big picture in mind- you will probably do well.

All three samples are Gleason 6, two right base 10% and 20%. One left apex at 20%. Forgot to ask about the stage. Cancer in three cores may not be suitable for active surveillance. Choosing the treatment(s) is probably the most difficult thing.

 

[Live And Learn]

Finally had my biopsy done August 3rd. The results are positive with low grade, low volume cancer in 3 out of 14 samples. I have been frequenting the Healingwell board and Healthboards.

I'm sorry to hear about the positive test results. You will be in my thoughts. DH had prostate cancer successfully treated with surgery. We opted for surgery rather than seed radiation because his PSA doubled in 6 months !

Hang in there. I know its scary. Research the treatment options and find a urologist that you trust.

WebMD's pca board was fantastic when I frequented it.

 

[marko]

Thoughts with you. Hang in there.

 

[lightspeed]

I think I may have alluded to this earlier in the thread--- go to a center that has the whole range of options. Make sure you see a radiation oncologist that does more than one type of radiation, in addition to your urologist. You do not want your choices limited because someone does not have all the skills or tools. Watch out for docs who own radiation machines-- more and more urologists own these, and get $40K for a pt they send for imrt if they own the machine, while they get approximately $1200 for prostatectomy or brachytherapy.

 

[Disappointed]

I think I may have alluded to this earlier in the thread--- go to a center that has the whole range of options. Make sure you see a radiation oncologist that does more than one type of radiation, in addition to your urologist. You do not want your choices limited because someone does not have all the skills or tools. Watch out for docs who own radiation machines-- more and more urologists own these, and get $40K for a pt they send for imrt if they own the machine, while they get approximately $1200 for prostatectomy or brachytherapy.

Lightspeed, thanks again for such kind recommendations. I read a few books on PCa. While I am aware of the treatment options, I am pretty clueless on who to consult with.
So far I have not been able to make an appointment with my Uro, his girl has not returned my phone calls despite the fact that he told me to call her to make an appointment. I called City of Hope today trying to make an appointment with a surgeon. His nurse has not called me back. I am cluless about radiation and so far don't know who to call, I was hoping my Uro would give me a contact. It is exhausting and confusing, my Uro office is so busy you get voicemail most of the time. I was trying to arrange for a second opinion on my pathology report but can't find anybody to speak to at my Uro's office. I did consider surgery but had my gall bladder surgery in April and not sure if I am up to another surgery.

Please feel free to contine to suggest, PM is also welcome.

Mp

 

[Disappointed]

Thanks everyone for all of your support, deeply appreciated.

Mp

 

[lightspeed]

Lightspeed, thanks again for such kind recommendations. I read a few books on PCa. While I am aware of the treatment options, I am pretty clueless on who to consult with.
So far I have not been able to make an appointment with my Uro, his girl has not returned my phone calls despite the fact that he told me to call her to make an appointment. I called City of Hope today trying to make an appointment with a surgeon. His nurse has not called me back. I am cluless about radiation and so far don't know who to call, I was hoping my Uro would give me a contact. It is exhausting and confusing, my Uro office is so busy you get voicemail most of the time. I was trying to arrange for a second opinion on my pathology report but can't find anybody to speak to at my Uro's office. I did consider surgery but had my gall bladder surgery in April and not sure if I am up to another surgery.

Please feel free to contine to suggest, PM is also welcome.

Mp

In that part of the country you have good choices. City of Hope would be my choice, so be persistent. They have one of the best robot-assist laparascopic prostatectomy programs in the world, and good radiation options too. If they continue to give you trouble, try UCLA. Both those places will request your path slides and have their own path department review. Good luck.