# OK Guys... let's talk PSA



## QuickSilver (Apr 19, 2015)

Hubby's doc just called and hubby's PSA has gone up from 5.1 last year to 5.4 last week.   He wants him to see a Urologist.  I have heard that PSA is not a particularly reliable indicator of prostate cancer and that it results in millions of unnecessary invasive procedures..  So I'm really at a loss as to what to do..  I'd hate for him to go through a prostate biopsy for nothing... YET..........  I'd hate for him to have prostate cancer and not catch it early.  Anyone else have anything to share on this topic..  ?


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## Josiah (Apr 19, 2015)

I've had an abnormally high PSA for years. My prostate has been biopsied a total of five times. Every time the result is negative. Now they no longer even check my PSA, just a digital examine twice a year and now they'll probably stop that because of my age. A prostate biopsy isn't really that much of an ordeal.


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## Falcon (Apr 19, 2015)

Was sent to a urologist because, during a routine phys exam,  my doc found an increase in PSA count.
The Urologist did a digital exam then took 3 or 4 biopsies. (He told me that this was going to sting a little.)
The results showed a 'moderate'  cancer. I asked, "What now?".  He said he'd remove the entire prostate and that would be the end of it.
Then I asked if there would be any "side effects".  He said that I would be incontinent and impotent. So I said feggeddabout!
He called it the wish and wait theory; hope for the best. Which I have been doing.  I haven't experienced EITHER  one of those side effects.
I may add that this all happened about circa 15 years ago. (Well, having turned 91 a few days ago, I have to confess that the impotentcy
has kicked in, but I still pee a strong stream.  Remember, *Every case is different.*  Don't go by MY case; make your OWN decisions.


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## Josiah (Apr 19, 2015)

To clarify a possible terminology confusion between my comment and Falcon's. I was biopsied on five separate occasions and in each of these procedures four or five samples from different parts of the gland are extracted.


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## QuickSilver (Apr 19, 2015)

Question about the biopsies... are they done in the doctor's office or do you go to same day surgery at the hospital for a cystoscopy under general anesthesia?


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## Josiah (Apr 19, 2015)

Mine were done in a VA hospital under no anesthesia. I could well imagine they could be done in a well equipped doctor's office.


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## Falcon (Apr 19, 2015)

Mine were in the Drs office which is well equipped.

The procedure is done via the anus with guidance by the Dr.  As I mentioned before; each "snip" stung a little but not al that bad.

Just make sure your doctor didn't get his MD degree from an osteopathic  school.  (It's  your a$$ we're talking about.)  Well, I mean your husbands'.

(Please don't mention cystoscope to me; scares the $**t outa me!   Hope I never hafta have one.)


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## Josiah (Apr 19, 2015)

Falcon said:


> Mine were in the Drs office which is well equipped.
> 
> The procedure is done via the anus with guidance by the Dr.  As I mentioned before; each "snip" stung a little but not al that bad.
> 
> ...



I've been cystoscoped probably half a dozen times (the VA really looks after your plumbing) and I'd rather be scoped than biopsied any day. They numb the end of your penis before inserting the cystoscope.


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## AZ Jim (Apr 19, 2015)

I'm no more inclined to talk about it as I am to "bend over".  My first observation of a new MD is the size of his fingers.


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## Pappy (Apr 19, 2015)

I've been scoped several times. Even had the microwave procedure done. What a waste of time and money. Didn't solve a thing. PSA okay but very large prostate. Two doses of Flomax daily help most of the time. Yes, Jim. The phrase bend over and spread your cheeks is not my favorite saying.


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## Falcon (Apr 19, 2015)

I hate to hear the snap of the rubber glove; cause I KNOW what's coming next.


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## tnthomas (Apr 19, 2015)

Josiah said:


> They numb the end of your penis before inserting the cystoscope.



They numb....they numb what???  Ooooh noooo!

So much for *that* procedure, I'll be asking for plan B....

Edit:  I have been catheterized exactly once in my life, somebody's gonna get hurt if they try that again.


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## Josiah (Apr 19, 2015)

If you guys are squeamish about this stuff. Consider some men because of medical problems with their urethra have to catheterized themselves every time they have to urinate. Now there's a heavy trip to handle.


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## Shirley (Apr 19, 2015)

I had to catheterize DH three times a day the last two years he lived. He never complained about discomfort. The doctor prescribed the right size catheter and we used a lubricant.


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## Josiah (Apr 19, 2015)

I'm sure there's a special place in Heaven for you Shirley.


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## tnthomas (Apr 19, 2015)

Josiah said:


> If you guys are squeamish about this stuff. Consider some men because of medical problems with their urethra have to catheterized themselves every time they have to urinate. Now there's a heavy trip to handle.



Absolutely, I see those ads on TV for catheters and marvel at the trials that some must endure...


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## Capt Lightning (Apr 22, 2015)

Dr Ablin, the man who discovered PSA, has gone to great lengths to explain that PSA was never meant to be a diagnostic test for postrate cancer.  He has expresseed his extreme displeasure that, having made his point, the pharmaceutical industry proceeded to make million$ from PSA testing and that thousands of men had received unnecessary treatment.

When I asked my GP about it, she said that it was too unreliable to use as a screening procedure and it was not performed unless there was very strong evidence of postrate problems.


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## QuickSilver (Apr 22, 2015)

Capt Lightning said:


> Dr Ablin, the man who discovered PSA, has gone to great lengths to explain that PSA was never meant to be a diagnostic test for postrate cancer.  He has expresseed his extreme displeasure that, having made his point, the pharmaceutical industry proceeded to make million$ from PSA testing and that thousands of men had received unnecessary treatment.
> 
> When I asked my GP about it, she said that it was too unreliable to use as a screening procedure and it was not performed unless there was very strong evidence of postrate problems.



This is what I had been led to believe.. however, when you have your doctor saying that you MUST see a Urologist for a PSA of 5.4... because the high normal is 4.0.. do you say no?   That's the problem.. SO...  hubby has an appointment with a urologist next Monday..  Next step I am certain is a biopsy...


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## Falcon (Apr 22, 2015)

As I understand it, the PSA count only tells the SIZE of the gland, which may be cancerous or NOT.


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## John C (Apr 22, 2015)

My doctor included PSA as one item in a routine blood test.  At the laboratory, I was told this test is not covered by Medicare.  I saw in the Medicare Manual where all men over 50 are entitled to PSA blood testing. The outcome was that I filed an appeal because of the wording in the Medicare Manual.  Before it was over, my Congressman was involved and talked with the insurance company about why this was not covered.  The end result was that my appeal was absolutely denied and that was the end of the matter.  So now when I go for my routine blood test, I tell the laboratory people to cross off the PSA test.


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## Pappy (Apr 22, 2015)

John C. Same here. How stupid is this?


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## Falcon (Apr 22, 2015)

John C.  IMO you really should include the PSA count in your blood test as it does tell you the SIZE of your prostate but doesn't mean you have cancer.....But it COULD !
What's a few $$ when it comes to your health. ?!


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## Lon (Apr 22, 2015)

25 years ago my PC was concerned about the rate of increase in my PSA not just the score, in addition, he felt what he called, a nail when performing a rectal digital exam an suggested I see a Urologist who also felt the nail. A biopsy revealed a highly agressive  cancer with a Gleason Score of 9.5. After obtaining a Second Opinion at Stanford University I talked over the available options with the Urologist at Stanford. I opted for a Radical Prostatectomy because radio active seed implantation or radiation could literally fry the prostate and make any future surgery if required, extremely difficult. I was aware that impotence and incontinence might result from having a Radical Prostatectomy. The Surgeon told me he could do a Nerve Sparing Procedure that might take care of the impotence, but no guarantees. My cancer was serious enough that I did not want to mess around with watch & wait and getting that gland out was the best option for me. I was 100% continent one month after surgery and still am.I had  successful ****** intercourse six months after surgery. I am a fan of PSA exams, because I am alive today because of one smart PC doctor picking up the rate of increase in my PSA scores, plus the rectal digital exam and finally the biopsy and lastly, a great surgeon  which nailed down the problem. Many men have died I think, because they were hung up on the impotency/incontinence thing and delayed or did nothing. My life is more important than either of those two potential problems.


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## Josiah (Apr 22, 2015)

Lon, I would have done just what you did. I'm glad it worked out so well for you.


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## Josiah (Apr 22, 2015)

One other question Lon. They were able to determine it was an aggressive form of cancer from the biopsy analyses?


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## QuickSilver (Apr 22, 2015)

Thank you all for your candid responses...   Needless to say, I am concerned... however we have already talked about it... If it's cancer, the gland goes..  No if ands or buts..   He will have the surgery.


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## Lon (Apr 22, 2015)

Josiah said:


> One other question Lon. They were able to determine it was an aggressive form of cancer from the biopsy analyses?



The tissue that is taken from the different parts of the Prostate Gland   is  examined by the Pathologist and given a Gleason Score to the affected tissues. As I recall, a Gleason score of say 5.4 would be less serious than say mine at 9.5. I think the Gleason Score only goes to 12 as I recall. I will have to Google to confirm.

http://en.wikipedia.org/wiki/Prostate_cancer_staging


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## Josiah (Apr 22, 2015)

QuickSilver said:


> Thank you all for your candid responses...   Needless to say, I am concerned... however we have already talked about it... If it's cancer, the gland goes..  No if ands or buts..   He will have the surgery.



QS, don't make up your mind so soon. Lon certainly made the right decision, but that was based on his knowing his cancer was aggressive. Many prostate cancers are very slow growing and a better decision might be to do nothing. Lon's case was 25 years ago. Doctors are much better able to determine the long range risks today than they were in 1990.


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## QuickSilver (Apr 22, 2015)

Josiah said:


> QS, don't make up your mind so soon. Lon certainly made the right decision, but that was based on his knowing his cancer was aggressive. Many prostate cancers are very slow growing and a better decision might be to do nothing. Lon's case was 25 years ago. Doctors are much better able to determine the long range risks today than they were in 1990.




Of course you are right..... it's just the word "cancer" brings a pretty strong reflex..


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## Lon (Apr 22, 2015)

It's my understanding that almost 100% of men that have been autopsied after age 90, show some degree of Prostate Cancer, but died of something unrelated.


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## d0ug (Apr 24, 2015)

There is some very interesting supplements that have backing of publish medical results. That is mushrooms here is a couple videos.

https://www.youtube.com/watch?v=8mmHJGRsOR0&feature=youtu.be

https://www.youtube.com/watch?v=Mjv8Zj1ABAc

Good luck


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## QuickSilver (Apr 27, 2015)

Hubby just saw his urologist.  His prostate feels benign on exam, however is does have that gradual rise in PSA.  He was given 3 options

1. Repeat PSA in 3 months

2.  A two week course of antibiotics and then repeat PSA in 2 months (rise in PSA could be from asymptomatic prostatitis)

3.  Go ahead and do a biopsy now. 

He was told there is a 1 in 3 chance of prostate cancer.. but there is no risk in waiting..  so he chose to do option #2..  and if the PSA is still elevated, than go ahead with the biopsy..  

Doctor told him to stay away from "Dr. Google".....  and not worry.


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## Josiah (Apr 27, 2015)

Sounds like a good decision. I don't agree with counseling against the internet. If I'm concerned with a health issue I join a FB group who members share my concern and I selectively read a weeks worth of posts and when I'm done I've obtained a good perspective on that condition and my relationship to it. I think you got some useful information from this thread and we're just a few old farts.


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## John C (Apr 27, 2015)

Apparently, the doctors at Medicare don't believe in PSA tests, because they turn them down.  They should revise the Medicare Manual which implies men over 50 should have the test.


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## QuickSilver (Apr 27, 2015)

Josiah said:


> Sounds like a good decision. I don't agree with counseling against the internet. If I'm concerned with a health issue I join a FB group who members share my concern and I selectively read a weeks worth of posts and when I'm done I've obtained a good perspective on that condition and my relationship to it. I think you got some useful information from this thread and we're just a few old farts.




I agree.... and I will still check the internet....  I really appreciate all the information you guys.. provide..


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