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Watch and wait - or not?

User
Posted 25 Aug 2021 at 11:42

I am 72, and have had an enlarged prostate for over 10 years. On a couple of occasions in that time, I had the DRE treatment (not my favourite) and was told that the prostate was smooth, and that there probably wasn't a problem. More recently, I had a PSA as well, which was a bit high (over 10), though the consultant wrote this in my notes: "Your PSA level for the size of your prostate is comparatively low (PSA density) which is reassuring."

So - first question: Is the PSA high or low? Where can I find out some table to indicate how size of prostate affects the interpretation of PSA scores?

Three months later (recently), I had another PSA test - the figure had gone up to over 11 - a small increase, or a cause for concern?

I also had an MRI, with this comment: "(the) MRI detected at least one equivocal area which may indicate an underlying abnormality. This might represent a small early prostate cancer or a benign process such as inflammation... we are not able to establish a definitive diagnosis..."

I am not sure how worrying that is, in conjunction with the rest!

The current plan is to monitor the PSA level and repeat the MRI in 6-12 months after the first - in other words, in 3-9 months form now. I have been told, though, that I can have a biopsy sooner if I want it.

My current feeling is that I'd rather wait on the biopsy until the next set of results (in December, probably) - is that a sensible approach? I know there isn't a 'correct' answer here, but I have low platelets as a result of leukaemia and treatment for that, so it seems to me my risks of bleeding and/or infection are greater than average.

I don't expect any miracle answers here, but just a little discussion. Any advice or comments will be much appreciated (even if I don't necessarily follow the advice ;-) )

User
Posted 25 Aug 2021 at 12:49

About three quarters of men your age have prostate cancer, of course, so the odds are that you do have it. Prostate cancer is just part of the normal aging process for a man.

With a PSA of 11, I think personally that further investigation is warranted. If it were me I'd have the biopsy. Looking at cells under a microscope is the only way to ascertain whether or not you do have prostate cancer and, if you do, how aggressive it is.

Best wishes,

Chris

Edited by member 25 Aug 2021 at 13:23  | Reason: Not specified

User
Posted 25 Aug 2021 at 13:53

Hi You may or may not of read my journey  but i needed a private medical for the renewal of my 7.5 ton licence in 2016 and blood tests picked up microscopic blood in my urine and my doctor asked me to have a PSA test that came out at 2.19  very low but the doctor said he would like more investigations ,so after samples where taken i had 5 out of 20 cores cancerous  but with no symptoms at all.

My Gleason was 3+4 =7 that still gave my some choice of operations ie robotic removal or Brachytherpy and  i took the latter. A 3+4=7 Gleason is better than a 4+3 Gleason and if i had left it till i had symptoms  it could have been to late for the Brachytherapy.I am not telling you what to do but i think a Biopsy could put your mind at rest.

If you click my Avatar you can see my journey so far.

Good luck John. 

User
Posted 25 Aug 2021 at 16:05

Haha! Thanks, Dave... I like the idea of dying form something else - do you know Roger McGough's poem "Let me die a young man's death" - very amusing. 

The advice about having a biopsy via the perineum is especially valuable, and if/when I opt for one, I'll definitely go that route.

User
Posted 25 Aug 2021 at 17:07

I didn't know the poem, but I do now, and I like it.

TRUS biopsy is being phased out, but it is still 50/50 which one you will get. Now you know there are two types (actually there are about six variations of each) you will at least be primed to ask the consultant which one is in use at your local hospital, and consider a referral to a different hospital if you don't like the sound of what is being offered.

Dave

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User
Posted 25 Aug 2021 at 12:49

About three quarters of men your age have prostate cancer, of course, so the odds are that you do have it. Prostate cancer is just part of the normal aging process for a man.

With a PSA of 11, I think personally that further investigation is warranted. If it were me I'd have the biopsy. Looking at cells under a microscope is the only way to ascertain whether or not you do have prostate cancer and, if you do, how aggressive it is.

Best wishes,

Chris

Edited by member 25 Aug 2021 at 13:23  | Reason: Not specified

User
Posted 25 Aug 2021 at 13:53

Hi You may or may not of read my journey  but i needed a private medical for the renewal of my 7.5 ton licence in 2016 and blood tests picked up microscopic blood in my urine and my doctor asked me to have a PSA test that came out at 2.19  very low but the doctor said he would like more investigations ,so after samples where taken i had 5 out of 20 cores cancerous  but with no symptoms at all.

My Gleason was 3+4 =7 that still gave my some choice of operations ie robotic removal or Brachytherpy and  i took the latter. A 3+4=7 Gleason is better than a 4+3 Gleason and if i had left it till i had symptoms  it could have been to late for the Brachytherapy.I am not telling you what to do but i think a Biopsy could put your mind at rest.

If you click my Avatar you can see my journey so far.

Good luck John. 

User
Posted 25 Aug 2021 at 15:40

Originally Posted by: Online Community Member

So - first question: Is the PSA high or low? Where can I find out some table to indicate how size of prostate affects the interpretation of PSA scores?

Three months later (recently), I had another PSA test - the figure had gone up to over 11 - a small increase, or a cause for concern?

An average prostate is about 25-30cc, mine is 58cc and no one considers a large prostate even double the average size to be troublesome. Anyway on your MRI report it may say the size of your prostate in CC as a PSA of 4 with a prostate of 30cc is considered worth investigating a PSA of 8 would be the threshold. I would take all this with a pinch of salt, maybe someone has a large prostate because half of it is cancer, maybe PSA goes up with age because the amount of cancer goes up with age. I get the impression from you post you just want to get a feel for where you stand and that is very sensible.  

 

Originally Posted by: Online Community Member

I also had an MRI, with this comment: "(the) MRI detected at least one equivocal area which may indicate an underlying abnormality. This might represent a small early prostate cancer or a benign process such as inflammation... we are not able to establish a definitive diagnosis..."

I am not sure how worrying that is, in conjunction with the rest!

With your marginal PSA an "equivocal" PSA. and age 72, you are more likely to have prostate cancer than not, but is it aggressive enough to warrant treatment? 

I would agree with your current plan keep monitoring, and in the light of the low platelets etc. no biopsy yet, and when you do have a biopsy do not have a TRUS biopsy have a transperineal, far less likely to get infection.

Originally Posted by: Online Community Member

I don't expect any miracle answers here, but just a little discussion. Any advice or comments will be much appreciated (even if I don't necessarily follow the advice ;-) )

Very sensible. We are all amateurs we only know our own stories and what we did. I would never have made the choices some people on here made, and no doubt vice-versa it depends on your own attitude to risk, and quality of life.

I guess I would say if you don't have radical treatment by 75 your health will at some point decline for other reasons and you may not be able to tolerate radical treatment, 75 is not a cut off, but it is where people start asking is it worth treating this. 

Take up motorcycling, skydiving or get a job on a trawler. Doing any of these reduces your chance of dying from cancer. 

Dave

User
Posted 25 Aug 2021 at 16:00

Thanks, Chris.

User
Posted 25 Aug 2021 at 16:01

Thanks, John.

User
Posted 25 Aug 2021 at 16:05

Haha! Thanks, Dave... I like the idea of dying form something else - do you know Roger McGough's poem "Let me die a young man's death" - very amusing. 

The advice about having a biopsy via the perineum is especially valuable, and if/when I opt for one, I'll definitely go that route.

User
Posted 25 Aug 2021 at 17:07

I didn't know the poem, but I do now, and I like it.

TRUS biopsy is being phased out, but it is still 50/50 which one you will get. Now you know there are two types (actually there are about six variations of each) you will at least be primed to ask the consultant which one is in use at your local hospital, and consider a referral to a different hospital if you don't like the sound of what is being offered.

Dave

User
Posted 25 Aug 2021 at 20:55
A man with a very large prostate can have a PSA up to 60-80 and no cancer; your consultant urologist has the benefit of many years' experience plus all of your medical info so if his professional view is that a PSA of 10 is quite low for your prostate size, I think that he probably knows what he is talking about.

The equivocal finding on your prostate MRI results suggests that they graded the suspicious area as a PIRADS 2 or 3 - it might be cancer but there are other possibilities. You have mentioned that you bleed easily as a result of the low platelets, and it may be that the equivocal area is bruising or inflammation - if they had scored it as higher than a 3, they would more than likely be doing the biopsy now.

If your prostate was large because half of it was filled with cancer, this would have been felt during the MRI.

PSA tests in 3 and then 6 months, with another MRI between 6-9 months seems very sensible. If the area of concern has reduced, happy days - if the PSA is continuing to rise and the MRI gives a higher PIRADS score, a biopsy would be the next step.

If you do get to the stage of considering a biopsy, do keep in mind that although it is true that the old style TRUS biopsy (stick a few needles in randomly and hope you spear the cherry) is somewhat discredited, that is not what you would be having. Even if it was a TRUS biopsy, with at least one MRI to work from, the urologist would target the equivocal area.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 26 Aug 2021 at 08:00

Thank you very much for your detailed advice - it is much appreciated!

I don't know that I 'bleed easily' as it is rarely put to the test, fortunately. I definitely have low platelets, which in theory means that should be the case.

Edited by member 26 Aug 2021 at 08:03  | Reason: Not specified

 
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