My TULSA prostate cancer adventure

[bmcgonig]

Koolau

I’m copying this from an old thread about how one urologist handles high PSA results. In sum there’s a few steps to get over before you ever do a biopsy. I had a high PSA for a couple months a few years back, and I followed these steps. Never got to the biopsy step.

First he determines the size of your prostate. That is measured in grams or CCs. If the PSA is less than 10% of the size he does nothing saying that you have BPH and the PSA just reflects that. If it more that 15% hes concerned. Eg if your prostate is 60cc and your PSA is 4 that is fine. If the PSA is 9 hes concerned. he might be concerned between 6 and 9 as well i.e., 10-15%.

There are also biomarker tests like 4KScore that does a very good job as prediction if you have a cancer worth worrying about. He will do that after the PSA test.

If concerned then he will order an MRI to see if he can see anything. If its clear he again does nothing.

If the MRI contains something that seems ominous then he will do a prostate biopsy using the MRI as a guide.

The issue and controversy around the PSA test is not the test itself but what we do with the results. Yes, if your doc immediately orders a random biopsy after a couple of high PSAs e.g., two 5s. Thats a big problem. But if you have a urologist that follows a procedure like this then you're in better hands.

Also theres no such thing really as a false positive PSA. Thats a misunderstanding of what PSA is. Its just a protein made by prostate cells. Not a positive or negative for cancer. But if theres a cancer the prostate will make a lot more PSA.

 

[aja8888]

Heh, heh, suddenly I'm picturing Alfred E. Neuman. "What, Me worry?"

Not sure at this point, and age, why I should be worried?

 

[Car-Guy]

Not sure at this point, and age, why I should be worried?

From Google AI

Prostate cancer is the most common cancer in men in the United States, aside from non-melanoma skin cancer. It's also the second-leading cause of cancer death in men, after lung cancer

- About 1 in 8 men will be diagnosed with prostate cancer in their lifetime.
- The risk of prostate cancer increases with age, and most cases are found in men over 65

Have a nice day <----- Not from AI

 

[Koolau]

Koolau

I’m copying this from an old thread about how one urologist handles high PSA results. In sum there’s a few steps to get over before you ever do a biopsy. I had a high PSA for a couple months a few years back, and I followed these steps. Never got to the biopsy step.

First he determines the size of your prostate. That is measured in grams or CCs. If the PSA is less than 10% of the size he does nothing saying that you have BPH and the PSA just reflects that. If it more that 15% hes concerned. Eg if your prostate is 60cc and your PSA is 4 that is fine. If the PSA is 9 hes concerned. he might be concerned between 6 and 9 as well i.e., 10-15%.

There are also biomarker tests like 4KScore that does a very good job as prediction if you have a cancer worth worrying about. He will do that after the PSA test.

If concerned then he will order an MRI to see if he can see anything. If its clear he again does nothing.

If the MRI contains something that seems ominous then he will do a prostate biopsy using the MRI as a guide.

The issue and controversy around the PSA test is not the test itself but what we do with the results. Yes, if your doc immediately orders a random biopsy after a couple of high PSAs e.g., two 5s. Thats a big problem. But if you have a urologist that follows a procedure like this then you're in better hands.

Also theres no such thing really as a false positive PSA. Thats a misunderstanding of what PSA is. Its just a protein made by prostate cells. Not a positive or negative for cancer. But if theres a cancer the prostate will make a lot more PSA.

Thanks. That's very helpful.

I'm sure my PCP would follow a similar protocol. He just thinks I'm at that delicate age where the risks of things like biopsies outweigh the benefits as I'll likely die of something else.

In all of this, my big fear is dying of prostate cancer (not so much "having" it.) I've known guys who did die of PC and it was not a good way to go. Both lived for about 15 years with it and slowly their quality of life degraded to the point that I think I would have been looking for another way out though YMMV.