Believe me – I wish I was posting about Bed and Bath coupons or something more light hearted…
My boyfriend of 7 months (we are very serious) is 62 and had his PSA levels checked twice – first one 6 months ago was 9, recently was high 5s. Urologist is recommending a biopsy. BF is concerned about side effects and not sure if it’s worth it.
Anyone had the biopsy or elevated levels? Apparently at his age the level should be in the 4s. I know PSA levels are not all the accurate as an indicator. He has no prostate cancer symptoms.
He should get a second opinion. If the second urologist recommends a biopsy, he should do it. Prostate cancer doesn’t always have symptoms. In my dad’s case, the doctor felt a small lump on the manual exam, but my dad’s PSA never went above 2.3 and he had no symptoms of any kind. The biopsy revealed a very aggressive cancer (highest Gleason scores), so he had to have a prostatectomy and radiation. He survived four more years, but would have died within 6 months if he had not been treated.
Many men die with, rather than of, prostate cancer, but it is best to know if you have it.
The problem, of course, is that a large number of men have to be screened and treated to prevent each death caused by prostate cancer, mainly because it is difficult to tell the common slow-growing prostate cancer (that men commonly die with) from the uncommon deadly fast-growing prostate cancer (that men can die of).
Screening (by biopsy after PSA) and treatment do bring with them significant medical risks and unintended effects, so the trade-off is between a higher likelihood of the unintended unpleasant effects (e.g. incontinence) versus the lower likelihood of missing an uncommon deadly fast-growing prostate cancer.
DH has a strong family history of prostate (and other) cancers. He had two elevated PSAs, but his doctor first tried antibiotics (we can’t remember what – something strong and 4-wk course) . His PSA returned to normal and has stayed there ever since, and he has regular screenings. YMMV, but a second opinion wouldn’t put your boyfriend at immediate risk.
Also side-effects are often overstated. Don’t let fear of a side effect cloud good judgement about fending off cancer.
@ucbalumnus – thanks for the link. Yes, you’re right – just want to make sure this isn’t the kind he could die of. Been through the big cancer scare with my ex (Stage IV). Is it me? ha ha ha not funny
@greenbutton – thanks for your post. He was on antibiotics when his level was at 9 and it came down but I think the urologist things high 5s are still elevated enough to warrant the biopsy. I’m pushing for the second opinion.
HIgh 5s warrants a biopsy. I really do not think there is any reason to avoid a biopsy. It isn’t that big a deal. Get the accurate info. THEN the meaningful decision-making begins.
Make sure the biopsy is with a dr or practice who do lots and lots of them! My friend’s H had one and described it as the most painful experience of his life (from a combat veteran). My H had one at a major cancer center and described it as “pretty uncomfortable, but not too bad”.
As someone who was browbeaten into having two biopsies recently, count me as one who says that you should thinkk long and hard about this. The fact that the PSA dropped dramatically after a course of antibiotics indicates that the inflammation may be caused by chronic infection, not cancer.
A prostate biopsy can cause infection to be released into the gut. I’m pretty sure this is what happened to me. I ended up with a case of ulcerative colitis, and went septic, which for those who might be interested has about a 30 percent mortality rate. This was followed by two c-diff infections which I picked up in the hospital while being treated for the first infection. Also, there is a school of thought that disturbing a prostate cancer with a biopsy can cause it to spread and grow, where otherwise it would remain in a somewhat dormant state.
This is just a very major procedure that should be avoided if possible. And if you do have it, you should be put to sleep with twilight anesthesia. It’s insane to have a painful procedure like this done while awake.
@EarlVanDorn I just had a biopsy done a bit less than a week ago and I agree it’s no picnic (I was wide awake). How long after your biopsy did the ulcerative colitis and the sepsis set in? I don’t have a fever or anything but have been tired and feeling just a bit …well off. I was rather hoping I’d be back to feeling 100% by now but I just feel sluggish.
@lvvcsf I think the stomach infection caused the ulcerative colitis. I stayed in the bed with terrible stomach pain and diarrhea for 24 or more hours before going to the doctor, and that’s why I went septic. Should you suffer any serious abdominal pain or have serious diarrhea (as in I befouled my drawers a couple of times, okay), then get thee to a doctor without delay.
If my PSA level stays high I am supposed to get another biopsy, but if I do I am going to go to Birmingham and get an MRI assisted biopsy. They are the only one’s in the Southeast that do this. It’s better than punching a bunch of random holes in your prostate.
If your PSA level is high, but no cancer is found, why would PSA level staying high indicate another biopsy? That’s even if you believe that PSA is a useful screener for prostate cancer, which the USPSTF and the discoverer of PSA disagree with (the latter’s opinion is found in [The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster](http://www.amazon.com/Great-Prostate-Hoax-Medicine-Hijacked/dp/1137278749).
My H had 6 prostate biopsies over the years due to elevated PSA – and all were negative. The urologist took 12 core samples each time.
His prostate never felt abnormal on digital exam. Sometimes he was given antibiotics for prostatitis, and sometimes that brought the PSA number down, but at the next yearly exam, the number would be elevated again. And the urologist would press him to have another biopsy. And H was so scared of cancer that he would go along with the recommendation.
The biopsies were painful. He always lost a day of work. In his trade that meant a day’s wages lost.
After 6 negative biopsies my H and his urologist finally concluded that the PSA test was simply a poor indicator for him. Basically now he has decided to stop having PSA tests. He’s about to turn 70 and figures that if he gets prostate cancer now, he will probably die with it, not from it.
I don’t think there is a one-size-fits-all answer. Antibiotics may bring the PSA down to normal. If they do, then why have the biopsy? If they don’t, maybe your BF would have greater peace of mind if he had a biopsy.
But remember that the cancer could always be in a different place in the prostate than the core samples were taken from. And a negative result now is no guarantee that next year the aggressive form won’t be found, which can progress to a lethal level between one year’s all-clear exam and the next.
Thanks. I’m mostly just tired and probably still uneasy about the whole concept. I haven’t gotten my results yet. My PSA was relatively low for a biopsy (3.7) but my father had prostate cancer, his older brother died of prostate cancer and his younger brother had prostate cancer but a stroke killed him. If it’s negative I am hoping they’ll let it go up a bit before going through that again. I’m only 57 and would like to be one of those that something gets them before the cancer and hopefully many years hence.
I had the biopsy last May. I can still feel the shots at times.
I know you can get false negatives. My test was negative. The doctor measured my prostate and the size of my prostate matched my psa level.
Since it is a year later, I am supposed to have another PSA blood test. I haven’t heard from the doctor. I am in no rush. If the doctor doesn’t contact me, I am not going to call him.
Sepsis is very serious, and there won’t be any 'tired and feeling just a bit …well off." You will feel like you’re going to die. When I developed sepsis, I was fine at 7PM on a Friday evening (was up to walking three miles a day and had gone out to the dog park with H earlier in the evening) and by 11:30-midnight, it was clear I was very, very sick. When I called the 24-hour BCBS nurse on-call and explained my symptoms and told her I’d had abdominal surgery 7.5 weeks earlier, she told me I needed to get to the ER within two hours. There, they determined with a scan that I had an abscess (which was drained at 8AM that morning) from my abdominal surgery (never had any pain from the abscess). My heart rate was probably above 120 for at least 2-3 days until they got the infection identified (which bacteria) and got me on the appropriate antibiotic.
This is a timely thread. Found out yesterday that my father had a level of “5” a few months ago – they wanted to check him again in a few months -checked again new level 8. They did the biopsy and parents told us yesterday he has very aggressive prostate cancer. He is having a CAT scan this week to determine if it has spread – no other symptoms. We are in shock – he has always been extremely healthy and seems fine. We were happy for the pre-screening and wish they had pushed for the biopsy six months ago when levels were slightly elevated. Will be following this thread.
Well I discovered yesterday that my biopsy was positive. I frankly expected it based on my family history. It still took a bit of wind out of my sails. I think moving from expectation to reality was a bit more of a shock than I thought it would be. I’ll go today to get the exact numbers, what they mean and treatment options.