Dealing with prostate cancer
Hey folks, I have been dealing with prostate cancer since 2014.
I have had my prostate removed, my cancer was gone for four years, then it came back. So then I went on hormone therapy and I had radiation treatments. If anyone has any questions about prostates and/or cancer, I have become fairly knowledgeable on the topic.
I would like your opinion. Jan. 2014 psa went from 1 to 7.3 and had first biopsy showing 2 of 14 samples low grade ca. Watch and wait was course of action. Psa every 6 months dropped ranging from 4 – 5.5 and second biopsy in June 2016 was negative. (Only God knows where the cancer went) Last month psa was 4.53 but since it’s been almost 3 years my urologist wants another biopsy. Fyi, the prior biopsies were done while I was under general anatheisia for other procedures so I have no idea what they are like. My dr. told me to take a look at my calendar and call the office to schedule. I feel like a convicted criminal sentenced to be shot but the judge told me to go home and let his office know when my exicution would be convenient.
Is my urologist being cautious for my benefit or just protecting himself. No way to know but do you think it’s time for a second opinion? My dr. is also treating me for bladder cancer so we’ve built a great relationship and I do trust him. Still it’s my rear end on the line.
GraceHusband- Your PSA is fairly low, so obviously your cancer is not expanding. There are risks with doing biopsies. There is a new imaging procedure done with ultrasound, I would ask for it instead. Yes, your urologist is being a bit aggressive, but that is what you pay him for. I think I would delay the next procedure a year. If you want to shift to a new urologist, find one that uses the ultrasound imaging device.
Thanks so much for the input. My city has a medical school so based on what you guys have said I’ll check there for latest methods. Duke or John Hopkins are other possibilities. Today a friend from my gym told me about a PHI blood test he had at Hopkins being far more accurate than psa. Dr. Google should have info on that.
Thanks again for taking time to respond.
I was in the same boat as you for 10 years.. After 3 biopsies nothing was found. (I was awake when these were performed.) PSA was UP and DOWN. Eventually, I had a 3T MRI performed (with the probe) which mapped the prostate and surrounding areas looking for tumors. Thankfully no tumors were detected. For the past two years my PSA has been stable. I have a check up every 6 months with a PSA and rectal exam. My PSA is around 6.5.
If a MRI is an option for you it is a little uncomfortable but much better than the “shotgun” approach of a biopsy. I found a clinic that performed them, accepted my insurance, and scheduled it myself. If everything remains stable, my PA believes we can move the exam frequency to 9 months.
PSA is a useful test, but other things (such as infection) can cause elevated PSA. That’s why it’s most useful to track the PSA levels over time – if they go up and stay up then it’s likely to be cancer, whereas if they go up and down it might be infection (could still be cancer, though).
MRI also has its place, although biopsy may still be needed for staging if they find something. If you have the option, template biopsy is preferable to TRUS biopsy as it’s a more systematic way of sampling the prostate.
I’m a medical physicist, and am actively involved in prostate treatments, so I come at this from a technical viewpoint. One thing I would advise is to shave your perineum (or get your wife to do it) before a biopsy – it’s preferable to having a nurse do it for you!