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Seeking advice on course to take - PSA 7.7

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User
Posted 14 Feb 2024 at 14:41

Hello and thanks for reading:

I am in Mexico City and could not place a forum like this here. Specific forums on Internet I have found are excellent means to find more objective help.

I'm hoping I can get some advice and pointers from those more experienced with this.

A few days ago I had blood tests done. They allways include PSA. Now it is 7.71 ng/mL

In previous cases it was bellow 4.

I also had an ultrasound done. It does not seem to show very alarming indicators. Prostate is 58g

(Previously it was measured at 68 and 63cc.)

Managing to have an urologist in the public health system here actually see me is probably a two or more months wait. If they determine it, having an operation with them could take several more months.

Private practice urologists however are generally in the business of getting everyone who visits them to have an operation. The expense is rather high for me, so I need to make a better decision, rather than one determined by nervousness.

My main question is this: Considering the above indicators, which are limited, what would be the best and least invasive or easiest testing method I should seek in order to determine if having an operation is really the course of action to take?

It would seem a biopsy would be the thing to do and clearest way to determine if an operation is in order.

However, any pointers, ideas or sugestions are very welcome.

Thanks again for reading.

I hope you have an excellent day today.

 

User
Posted 14 Feb 2024 at 14:41

Hello and thanks for reading:

I am in Mexico City and could not place a forum like this here. Specific forums on Internet I have found are excellent means to find more objective help.

I'm hoping I can get some advice and pointers from those more experienced with this.

A few days ago I had blood tests done. They allways include PSA. Now it is 7.71 ng/mL

In previous cases it was bellow 4.

I also had an ultrasound done. It does not seem to show very alarming indicators. Prostate is 58g

(Previously it was measured at 68 and 63cc.)

Managing to have an urologist in the public health system here actually see me is probably a two or more months wait. If they determine it, having an operation with them could take several more months.

Private practice urologists however are generally in the business of getting everyone who visits them to have an operation. The expense is rather high for me, so I need to make a better decision, rather than one determined by nervousness.

My main question is this: Considering the above indicators, which are limited, what would be the best and least invasive or easiest testing method I should seek in order to determine if having an operation is really the course of action to take?

It would seem a biopsy would be the thing to do and clearest way to determine if an operation is in order.

However, any pointers, ideas or sugestions are very welcome.

Thanks again for reading.

I hope you have an excellent day today.

 

User
Posted 14 Feb 2024 at 21:17

 Hi Montana, well you need a doctor to be sure of things rather than relying on advice from us amateurs on the internet. As your prostate is twice the size of the average prostate a high PSA may just about be classified as within limits. For a normal size prostate a PSA above 4 needs investigation for a double sized prostate you could argue PSA over 8 needs investigating. In reality I think your PSA is high enough to warrant further investigation. The other issue is the rapid increase, as a general rule prostate cancer results in increasing PSA so that is another red flag. An increase in PSA can be caused by infection and we have seen higher PSAs than yours with no sign of cancer. So it definitely needs investigating, but it may not be a problem.

A digital rectal exam (DRE) or finger up the bum, is the most cost effective next test. If doctor says it is hard and lumpy that is a strong sign of cancer. Smooth or soft would be good outcomes. If it will take months to see a public health doctor book the appointment now, get a PSA test the week before you see him. With another PSA result a few months after your most recent to determine if this rise is consistent and a DRE there would be enough evidence to justify if an MRI scan or biopsy is needed.

I don't think you need to go private. Prostate cancer is slow growing and a few months gap between PSA tests might make diagnosis easier.

Good luck.

Dave

User
Posted 15 Feb 2024 at 13:10

Hello all,

Many thanks for your kind and very usefull and specific responses in several seses.

It is now clear to me for now the best course of action will be:

- Make an appointment in the state health service to start.

- Get a bipsy done and make sure a tact evaluation is also done. (That's Mx$15K so manageable.)

- MRI could also be done, but the biopsy seems the best first step. (That's Mx$4K.)

- Consider the situation from there.

If one has evacuated well and squats in the shower, soaping one finger, it is not difficult, though not very comfortable either to feel the prostate. I on occasion have don this and it has been rather hard for as long as it has turned up enlarged. But it has not changed or grown much. The only change was the PSA this time.

Your comments have been very informative and very usefull: I can have a clearer pictre, more objective and even worry less, while at the same time have a clear course of action.

For years I have used forums to get help in order to fix my subsequent motorcycles and other such things, but had not used myself one for health matters untill now.

Your help has been excellent for me and I will further along note here how things go.

This is really an excellent form of self-help / mutual-aid.

Doctors here in private practice can really be $driven$ to make $sugestions$ in a very $specific$ way and not even realize it, although definitely not all of them. (I've had students working in private hospitals describe some of their shocking private conversations to this effect.) State service can be fowl or brilliant, but it allways takes time. Your pointers have helped a lot to deal with all this.

Thanks again for your kind help.

 

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User
Posted 14 Feb 2024 at 21:12
If the cost of having private consultations are too high then I would suggest getting on the lists of the public health system. A wait of 2-3 months for a consultation and then maybe a year before surgery or radiotherapy is unlikely to cause you a problem.

Prostate cancer is slow growing and it's not like other cancers that have to be treated as soon as possible.

I live in Europe and waited 2 months for my consultation and then I had a biopsy etc so surgery didn't happen until 9 months after the consultation - so don't worry too much about the time it takes.

Your choices will be surgery or radiotherapy - both have high success rates.

Good luck

User
Posted 14 Feb 2024 at 21:17

 Hi Montana, well you need a doctor to be sure of things rather than relying on advice from us amateurs on the internet. As your prostate is twice the size of the average prostate a high PSA may just about be classified as within limits. For a normal size prostate a PSA above 4 needs investigation for a double sized prostate you could argue PSA over 8 needs investigating. In reality I think your PSA is high enough to warrant further investigation. The other issue is the rapid increase, as a general rule prostate cancer results in increasing PSA so that is another red flag. An increase in PSA can be caused by infection and we have seen higher PSAs than yours with no sign of cancer. So it definitely needs investigating, but it may not be a problem.

A digital rectal exam (DRE) or finger up the bum, is the most cost effective next test. If doctor says it is hard and lumpy that is a strong sign of cancer. Smooth or soft would be good outcomes. If it will take months to see a public health doctor book the appointment now, get a PSA test the week before you see him. With another PSA result a few months after your most recent to determine if this rise is consistent and a DRE there would be enough evidence to justify if an MRI scan or biopsy is needed.

I don't think you need to go private. Prostate cancer is slow growing and a few months gap between PSA tests might make diagnosis easier.

Good luck.

Dave

User
Posted 14 Feb 2024 at 21:21

Hi,

I've read an average normal prostate is around 20g or 25cc.  From that yours seems fairly large.  That could make your psa higher. 

A finger check by a doctor is often the first check.  Then a blood test. In the UK an MRI followed by a biopsy are next.  They used to do the biopsy before the MRI as the MRI is expensive. 

As you say a biopsy seems the cheapest and quickest way to get an indication.  Although you can't always trust a biopsy unless it finds a reasonable amount of cancer or it finds high grade cancer.  It could miss some or it could just find a small section of low grade to give false optimism.

There are a few kinds of biopsy. A 12 pin TRUS or 24 pin perineurial with local or general anaesthetic.  The more pins the more accurate although an MRI first enables targeting with fewer pins.

Once you start looking it can easily become an obsession.  You can only take one step at a time and a finger (digital rectum examination), followed by a biopsy appear the cheapest routes.

I just saw Steve's comment and if you're lucky it can be slow growing or benign. Until you know the location, size and Gleason you don't know although a psa of 7 is often a lower sounding risk.

User
Posted 15 Feb 2024 at 13:10

Hello all,

Many thanks for your kind and very usefull and specific responses in several seses.

It is now clear to me for now the best course of action will be:

- Make an appointment in the state health service to start.

- Get a bipsy done and make sure a tact evaluation is also done. (That's Mx$15K so manageable.)

- MRI could also be done, but the biopsy seems the best first step. (That's Mx$4K.)

- Consider the situation from there.

If one has evacuated well and squats in the shower, soaping one finger, it is not difficult, though not very comfortable either to feel the prostate. I on occasion have don this and it has been rather hard for as long as it has turned up enlarged. But it has not changed or grown much. The only change was the PSA this time.

Your comments have been very informative and very usefull: I can have a clearer pictre, more objective and even worry less, while at the same time have a clear course of action.

For years I have used forums to get help in order to fix my subsequent motorcycles and other such things, but had not used myself one for health matters untill now.

Your help has been excellent for me and I will further along note here how things go.

This is really an excellent form of self-help / mutual-aid.

Doctors here in private practice can really be $driven$ to make $sugestions$ in a very $specific$ way and not even realize it, although definitely not all of them. (I've had students working in private hospitals describe some of their shocking private conversations to this effect.) State service can be fowl or brilliant, but it allways takes time. Your pointers have helped a lot to deal with all this.

Thanks again for your kind help.

 

User
Posted 15 Feb 2024 at 13:45

Originally Posted by: Online Community Member

Your choices will be surgery or radiotherapy - both have high success rates.

Good luck

 

Excuse me, but what are you basing that on?  There could also be active surveillance.  It could also be BPH or prostatitis or the raised PSA may be the result of an infection.

 
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