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High psa and surgery advised

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User
Posted 23 May 2023 at 21:00

Good evening all I'm localised early T2 Gleaston 3+4 grade 2 and urologist has advised surgery for removal . This is the road I'm heading down . However PSA is 52  seems this is rather worrying.  Can anyone advise on why its this high and is surgery the best way to go ... many thanks .

User
Posted 24 May 2023 at 21:24

A good urologist will advise you to seek an opinion from an oncologist. He is unlikely to advise surgery unless he is sure. rFor you peace if mind do get another opinion.


 

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate


 


 

User
Posted 25 May 2023 at 01:32
It is important not to raise people's expectations of things that are not generally available. PSMA scans are available at only a very small number of hospitals and clinics, even fewer if you can't pay privately. Also, PSMA is only approved by NICE for men with recurrence after radical treatment, it is not approved for men who are newly diagnosed and have not yet had treatment.

PSMA's optimum range is PSA 0.5 - 4.0 with either no prostate or a fried prostate.

No harm in the person asking whether PSMA scan would be possible but be prepared for a blunt 'no'.

With a PSA of 50+, the MRI scan would have been capable of picking up significant lymph node involvement.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
Posted 24 May 2023 at 01:12

What scans have you had to rule out distant spread? I think I'd be asking for a PSMA PET scan to rule this out, before going for surgery.


Having said that, a PSA that high can be local. I was PSA 58 and locally advanced, but I did have to have a full body scan (in addition to bone scan) to be sure it wasn't spread elsewhere first.

Edited by member 24 May 2023 at 07:40  | Reason: Not specified

User
Posted 24 May 2023 at 07:28
A urologist is a surgeon and will naturally be inclined to suggest surgery. Have you seen an oncologist to discuss non-surgical treatments? If not, you really should do.

I too had a PSA that was regarded as abnormally high for my biopsy results (my PSA was 31) and in my case a strong recommendation was made for "whole pelvis" RT because of a concern that the high PSA was due to undetectable spread into the pelvic lymph nodes.

Best wishes,

Chris
User
Posted 24 May 2023 at 21:02

Thanks sorry should have stated Mri Ct and full body bone scan all clear 

User
Posted 24 May 2023 at 21:08

Interesting and thanks , it's a little mine field for  treatment.  I'm just not shur what to do and feel if the Urologist recommends surgery and complete removal he must know what he's talking about . Or dose he ? 

User
Posted 24 May 2023 at 21:21

Difficult to advice but I would say surgery is not a bad option with Gleason 7 and if the cancer is contained in the gland. It provides you with a second line of defence if the surgery does not succeed. I had surgery over 12 years ago and all is well. For encouragement have a look at this link:


https://community.prostatecanceruk.org/posts/t28948-Re-establishing-Sex-Life

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate


 


 

User
Posted 24 May 2023 at 21:24

A good urologist will advise you to seek an opinion from an oncologist. He is unlikely to advise surgery unless he is sure. rFor you peace if mind do get another opinion.


 

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate


 


 

User
Posted 24 May 2023 at 23:24

Originally Posted by: Online Community Member
if the Urologist recommends surgery and complete removal he must know what he's talking about . Or dose he ?


On the basis of the scans you've had the urologist can't know if there's any spread, with lymph glands being the next most likely suspect. As Andy says, a PSMA PET scan will show up cancer areas, like the lymph nodes, where mets are developing. If you happen to have cancer in lymph nodes this can be treated by removing the nodes but it can also be targeted with RT.


You'd be in a better position to decide the best treatment if you have a PET scan and a chat to an oncologist.


Jules

User
Posted 25 May 2023 at 01:32
It is important not to raise people's expectations of things that are not generally available. PSMA scans are available at only a very small number of hospitals and clinics, even fewer if you can't pay privately. Also, PSMA is only approved by NICE for men with recurrence after radical treatment, it is not approved for men who are newly diagnosed and have not yet had treatment.

PSMA's optimum range is PSA 0.5 - 4.0 with either no prostate or a fried prostate.

No harm in the person asking whether PSMA scan would be possible but be prepared for a blunt 'no'.

With a PSA of 50+, the MRI scan would have been capable of picking up significant lymph node involvement.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 20 Jun 2023 at 20:44

Many thanks I've seen the surgeon and am seeing the oncologist tomorrow following many thorts on the matter 

 
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