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Surely Not Again !,

User
Posted 20 Aug 2023 at 20:19

I had my first PSA Test 11 years ago - I have had a further 17 tests since then & am now 76 - oh dear ! My PSA has increased during this period & I have been on Finasteride & Tamsulosin for several years. My current, Finasteride 'corrected PSA' is either 51.4 or 54 - there is a discrepancy that I am currently waiting to resolve.

I have had two Transperineal Biopsies, the first in June 2020 & the second in November 2022. I was told that 39 'cores' were taken in the second biopsy - when I experienced Acute Urinary Retention within a few hours of discharge. No cancer was found in either biopsy. A fairly pragmatic consultant set a target PSA of 50 after my last biopsy - with the current monitoring / testing regime to be relaxed if this were achieved.

I am of the perhaps inadequately informed opinion that if cancer has not been found after 11 years of monitoring & 2 biopsies then it is either not there or is extremely well hidden. I am comfortable living with that risk. Statistically the life expectancy of a 76 year old male is of the order of 10 / 11 years. I am minded to step back from the whole thing, with at most an annual PSA providing I know at what level there would be another 'intervention' & what that intervention would be. Am I being short sighted ? The PSA Tests aren't a problem - it is the uncertainty of not knowing what they may lead to that is so exhausting.

I have a private appointment with a consultant on Thursday solely to discuss my concerns & future course of action.

All of the detail is included in my profile - well at least most of it is !

Thanks

User
Posted 20 Aug 2023 at 23:13

G, I worked with a guy who was on a similar position,his PSA sometimes got to 200. After the third biopsy, which was a guided template biopsy, they indicated that he did not have cancer.

Hope you get some answers.

Thanks Chris 

User
Posted 21 Aug 2023 at 00:20

If you have no more testing not even PSA, the first time you had definite symptoms of prostate cancer it would be advanced and incurable, but with hormone treatment it could be held at bay for five to ten years. You would have the side effects of HT usually not bad, but possibly heart problems, weight gain, osteoporosis. So you may never develop cancer, but if you did, you would still live your natural lifespan, even if the last few years were sub optimal.

If you have annual PSA tests, yes there may be some false alarm biopsies, but it will be caught early and RT will almost certainly knock it out (probably six months HT). So you will then live your natural life cancer free.

I would seriously consider next PSA test in three years. You will save yourself a lot of pointless investigation. If you have cancer in three years (unlikely on your current form), statistically it is likely to be 18 months old, that would probably give you a 50% chance of being curable with RT, or manageable with HT. If all clear you can wait another three years. 

Obviously there is some risk in this strategy, but the reward is not having endless pointless biopsies. I wouldn't dream of suggesting this strategy to someone under 70, but once your life expectancy is ten years the downside of getting it wrong is not too high.

Dave

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User
Posted 20 Aug 2023 at 23:13

G, I worked with a guy who was on a similar position,his PSA sometimes got to 200. After the third biopsy, which was a guided template biopsy, they indicated that he did not have cancer.

Hope you get some answers.

Thanks Chris 

User
Posted 21 Aug 2023 at 00:20

If you have no more testing not even PSA, the first time you had definite symptoms of prostate cancer it would be advanced and incurable, but with hormone treatment it could be held at bay for five to ten years. You would have the side effects of HT usually not bad, but possibly heart problems, weight gain, osteoporosis. So you may never develop cancer, but if you did, you would still live your natural lifespan, even if the last few years were sub optimal.

If you have annual PSA tests, yes there may be some false alarm biopsies, but it will be caught early and RT will almost certainly knock it out (probably six months HT). So you will then live your natural life cancer free.

I would seriously consider next PSA test in three years. You will save yourself a lot of pointless investigation. If you have cancer in three years (unlikely on your current form), statistically it is likely to be 18 months old, that would probably give you a 50% chance of being curable with RT, or manageable with HT. If all clear you can wait another three years. 

Obviously there is some risk in this strategy, but the reward is not having endless pointless biopsies. I wouldn't dream of suggesting this strategy to someone under 70, but once your life expectancy is ten years the downside of getting it wrong is not too high.

Dave

 
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