7th March 2008
[QUOTE=Bill1321;3476420]Having not been to a Dr. in a million years I took the advice of a nurse friend and went in and had some blood work. It was my first PSA test and it came back at 4.4. I went to a urologist who asked if I had any symptoms (I didn't). He gave me a DRE and said everything felt normal. He scheduled me for a biopsy. Being the chicken I am, I began reading all I could to avoid such test. My research told me that it wasn't that high and that for a first reading I shouldn't rush into such an invasive procedure. I was treated with an antibiotic for two weeks and re-tested 4 wks after that. The Dr. called today and said my number had dropped to 4.2 but was still above "normal." He recommended I go forward with the biopsy. I'm only 47 and the thought of surgery, with all the side effects, is pretty frightening. Is there such a thing as "watchful waiting" before a biopsy? Would I be crazy to monitor my PSA level every few months to look for a jump before letting them "dive in?" Any advice or personal experiences would be greatly appreciated.
Bill
Hi Bill,
daff and Kemahsabe gave some good advice, and I would like to emphasize that surgery is not the only or even necessarily the best option. At least one leading doctor is comfortable with active surveillance for low-risk cases for men your age, and from the details re PSA and DRE that you have so far, you appear to be in that category.
I have only two suggestions to add: you could have a PCA3Plus test done, and you could try some tactics involving nutrition, lifestyle and mild medication. One of us just had the PCA3 test and initiated a thread called PCA3 Results with some first hand information. The PCA3 test is strong where the PSA is weak, and vice versa, so using both is helpful and provides information in addition and independent of the information you get just from the PSA and free PSA.
It's good that your PSA went down, and it might have been due to the antibiotic, but on the other hand, PSA varies by up to 15% day-to-day as I recall. Antibiotics are tried because infections can boost PSA from a little to a lot, but it's a crap shoot trying to find the right one to control an infection unless the doctor does a culture and figures it out ahead of time, and even figuring out how to do the culture is chancy. In other words, your PSA could still be due to an infection that the particular antibiotic was not designed to target. Also, the size of the prostate makes a big difference. A healthy prostate will produce about .066 ng/ml of PSA for every cc of prostate tissue. At age 47 your prostate would usually not be large, but it could happen. A healthy prostate of 63 grams, a bit more than double the normal size for your age I believe, would generate a PSA of 4.2 using the rule-of-thumb (based on research). If your prostate were large, you would probably want some treatment for BPH, but not for cancer.
You could also try some of the nutritional and lifestyle tactics and see what effect they have on your PSA. A recent thread gives an overview and leads to resources.
You could also try finasteride (formerly Proscar) for six months and see if your PSA falls by 50% or more. If not, that is an additional clue for the presence of prostate cancer, meriting careful monitoring and perhaps a biopsy, but if it does fall by 50% or more, that's an additional clue for the absence of cancer. (I'm not a doctor and have had no enrolled medical education. I'm getting this from the September 2006 issue of the Journal of the National Cancer Institute, based on comments from some leading doctors, such as Dr. Eric Klein of the Cleveland Clinic.) Finasteride is also useful for reducing BPH. It's a mild drug, but there are some occasional side effects, including growing hair in the male pattern baldness areas, a side effect I have gratefully lived with. ;) Avodart might even be more effective, but it has not been as thoroughly studied regarding cancer impact.
By the way, my first ever PSA, also when I was unaware of any symptoms, came back 113.6 in December 1999, so don't feel too bad! Congratulations on getting it done! :)
Good luck,
Jim
Bill
Hi Bill,
daff and Kemahsabe gave some good advice, and I would like to emphasize that surgery is not the only or even necessarily the best option. At least one leading doctor is comfortable with active surveillance for low-risk cases for men your age, and from the details re PSA and DRE that you have so far, you appear to be in that category.
I have only two suggestions to add: you could have a PCA3Plus test done, and you could try some tactics involving nutrition, lifestyle and mild medication. One of us just had the PCA3 test and initiated a thread called PCA3 Results with some first hand information. The PCA3 test is strong where the PSA is weak, and vice versa, so using both is helpful and provides information in addition and independent of the information you get just from the PSA and free PSA.
It's good that your PSA went down, and it might have been due to the antibiotic, but on the other hand, PSA varies by up to 15% day-to-day as I recall. Antibiotics are tried because infections can boost PSA from a little to a lot, but it's a crap shoot trying to find the right one to control an infection unless the doctor does a culture and figures it out ahead of time, and even figuring out how to do the culture is chancy. In other words, your PSA could still be due to an infection that the particular antibiotic was not designed to target. Also, the size of the prostate makes a big difference. A healthy prostate will produce about .066 ng/ml of PSA for every cc of prostate tissue. At age 47 your prostate would usually not be large, but it could happen. A healthy prostate of 63 grams, a bit more than double the normal size for your age I believe, would generate a PSA of 4.2 using the rule-of-thumb (based on research). If your prostate were large, you would probably want some treatment for BPH, but not for cancer.
You could also try some of the nutritional and lifestyle tactics and see what effect they have on your PSA. A recent thread gives an overview and leads to resources.
You could also try finasteride (formerly Proscar) for six months and see if your PSA falls by 50% or more. If not, that is an additional clue for the presence of prostate cancer, meriting careful monitoring and perhaps a biopsy, but if it does fall by 50% or more, that's an additional clue for the absence of cancer. (I'm not a doctor and have had no enrolled medical education. I'm getting this from the September 2006 issue of the Journal of the National Cancer Institute, based on comments from some leading doctors, such as Dr. Eric Klein of the Cleveland Clinic.) Finasteride is also useful for reducing BPH. It's a mild drug, but there are some occasional side effects, including growing hair in the male pattern baldness areas, a side effect I have gratefully lived with. ;) Avodart might even be more effective, but it has not been as thoroughly studied regarding cancer impact.
By the way, my first ever PSA, also when I was unaware of any symptoms, came back 113.6 in December 1999, so don't feel too bad! Congratulations on getting it done! :)
Good luck,
Jim