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My I think my case is very strange

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User
Posted 26 May 2023 at 10:51

At the end of January, I had a psa test of 3.7, the previous year it was 0.7, a disciplinary jump, the family doctor asked for a urine culture and gave a referral to a urologist, the urologist sent me for an mri test, the urine culture showed bacteria, I received antibiotics and the psa dropped back to 0.75 when the mri answer came, the findings were a 1.5 mm lesion, Fridays 4 On the right side, everything else without involvement, the doctor referred me to a fusion biopsy before the biopsy, an MRI revision was done and another 5 mm tumor was seen on the left side. And without leaving the box I will return again before the biopsy psa 0.75 with such a value I would not get a biopsy +mri. The results of the biopsy only on the left side of the lesion 5 mm Freuds 3 Gleason 3+3 2 rolls out of 18, volume in 2 rolls 60/40 percent adenocarcinoma. A gps oncotest test showed a score of 23. Low risk, one of the consultants asked me to do a pet psma test. Another consultant said that it is not effective with low psa, despite this I did everything and it came out clean even in the prostate there was no absorption. All the oncologist and urologist consultants offered me active follow-up and I was told that I am at low risk, I am mainly concerned because of the low psa, and I will mention again that I found out because of a one-time psa jump due to a bacteria in the urine. I am worried because I heard that there are types of cancer that do not produce psa and it is difficult to monitor, I would do prostate removal surgery but again what will we monitor, I feel helpless and do not know what to do. Has anyone here heard of prostate cancer with such a low psa, or maybe I accidentally discovered more before it's enough to produce psa and also why a 0.5 mm touch with psa 0.75 is not visible in pet psma the doctors say that I'm fine and that I'm just anxious, but I think my case is very strange and different, please help me understand

User
Posted 26 May 2023 at 13:28

There are a number of different types of PCa. From your biopsy you have been identified as having adenocarcinoma, which is the most common variety and not associated with showing a particularly low PSA that a small variety of PCa produces. PSA itself is not a great indicator of PCa, more particularly at diagnosis. It is better with your sort of cancer at indicating changes after treatment. To get a more accurate assessment of PSA you need to be free of UTI and this  can take quite a time in some cases. You have had biopsy and different scans, (you don't mention DRE that is Prostate felt with finger through rectum which is usually general practice in the UK). Be aware that that scans do not always show exactly everything and are subject to interpretation. In your situation I would ask to discuss your situation with your Urologist and if there is doubt obtain a second opinion. Generally speaking, PCa is a slowly developing disease and sometimes in certain situations it can be just monitored, at least for a time.

Edited by member 26 May 2023 at 19:25  | Reason: Not specified

Barry
User
Posted 26 May 2023 at 13:41

I underwent a biopsy, it is listed in the post, and also a rectal examination.

User
Posted 26 May 2023 at 20:22

Yes I acknowledged you had had a biopsy in my reply. I can't see you mentioned a DRE but you now confirm that was the case to. You have even had a PSMA scan which few would have in the UK, particularly with Gleason 3+3 as many Urologists in the UK feel that with this Grading the tumour cells are not sufficiently different from normal cells to be considered cancer. However, your Urologist has the results of tests and scans and experience to come to a considered opinion in your case which may not relate to a case of a member here. So as previously suggested, I would go back to your Urologist for an opinion and preferably get it confirmed in writing, also how it should be dealt with. If you are unhappy you could get a second opinion based on sight of your histology, tests and scans . You can't rely on the case of anybody here specifically relating to yours which may have aspects responsible for differences.

Edited by member 26 May 2023 at 21:02  | Reason: spellig

Barry
User
Posted 27 May 2023 at 06:46
Sounds like active surveillance is the correct choice of treatment.

The template biopsy would have picked up the dangerous low PSA type of tumours - try not to worry about that.

PSMA PET is best at detecting spread beyond the prostate not within the prostate, again good news.

Relax forget about PC until your next checkup.

User
Posted 27 May 2023 at 14:04

In the meantime I am not doing anything, no treatment, I feel pain in the leg bone, and I feel pain in the clavicle bone on the right side and also in the pelvis on the left side, I also feel like burning at the tip of the penis, a constant feeling

User
Posted 27 May 2023 at 14:58
You don't need treatment because you are on active surveillance.

It is quite common to have aches and pains after diagnosis and to panic that they are somehow related but they are not. You might be a bit tense or sleeping awkwardly because you are worrying?

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

User
Posted 28 May 2023 at 13:06

What is the best test to know when the cancer worsens besides psa. Because I always had a low one
2020  0.5

2022      0.72

2023     0.75

may 2023      1         Two months after the biopsy

 

 

 

 

User
Posted 28 May 2023 at 17:11
PSA is the best way to monitor adenocarcinoma. Your PSA is low because you only have a very small non aggressive tumour. If that changed- it became bigger or more aggressive, your PSA would rise and that would flag up your doctors to do new scans.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 28 May 2023 at 17:31
You have had the various tests and scans and your Urologist should have a good understanding of your case. You are being Actively monitored and whilst it is unlikely that you would experience any symptoms of PCa, at least for some considerable time, as PCa progresses rather slowly early on, your Oncologist will see your future PSA checks and in the light of these, and your histology, may call for more frequent PSA tests and an MRI. It is usual in the UK for men on AS to have regular PSA checks and probably an annual MRI scan. However, frequency of PSA tests and time between them can change depending on the individual case as considered appropriate. I don't know how the medical system works where you are but if you are unhappy to trust the judgement of your present Urologist, you could seek the opinion of another for which you might have to pay. Another Urologist will want a full report on your histology, scans and tests, but may also want a repeat of the tests/scans. As regards Active monitoring, the same tests may be given but possibly at different intervals by an alternative Urologist.

Burning at the tip of your Penis is more associated with a UTI. These can be long lasting and difficult to be rid of. It is usual where a UTI is suspected or treatment for one has not been effective, for the man to provide a specimen so a culture test to be done and for him to be treated with antibiotics as appropriate.

Barry
User
Posted 29 May 2023 at 18:21

Before the biopsy I had no symptoms and now I feel a burning sensation at the tip of the penis most of the time I may have gotten an infection during the biopsy

User
Posted 19 Jun 2023 at 20:13

psa jumped from 1 to 4.5 within a month free psa 0.99. Ratio 22.3. %. I really don't understand what is happening and what caused the jump, maybe prostatitis, in the last few weeks I felt a constant burning at the end of the penis

User
Posted 19 Jun 2023 at 21:21
If you are feeling pain in your penis then you likely have a UTI (bacterial infection) - this needs treating with antibiotics and is usually very difficult to resolve quickly. In the early stages Prostate Cancer does not cause pain (and in many cases any symptoms).

People who get UTIs will get them frequently - my wife has suffered for years as did my mother - as soon as one infection clears up, another one starts.

Keep with the active surveillance with regular PSA tests but I don't think you have much to be concerned about regarding PCa at this stage.

 
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