PSA test

[JimmyJ]

1 minute ago, bubba said:

I suppose that depends on how old you are, what sort of treatments can be considered and whether you consider those to be less desirable to an early, unnecessary and painful death due to metastatic prostate cancer. When PCa is detected early, there are emerging treatments such as focal laser ablation that will spare you from a radical prostatectomy and the potentially associated issues as well as saving your life. 

 

Your posts are intelligent and informative.

 

"When PCa is detected early, there are emerging treatments such as focal laser ablation that will spare you from a radical prostatectomy and the potentially associated issues as well as saving your life."

 

I'll read up on that today.

[elektrified]

1 hour ago, JimmyJ said:

I couldn't find any news confirming that the US medical profession are now again recommending PSA testing, as someone stated early in this thread.

 

I did find this:

 

"Why I Won't Get a PSA Test for Prostate Cancer"

 

https://blogs.scientificamerican.com/cross-check/why-i-wont-get-a-psa-test-for-prostate-cancer/

 

I also will not get a PSA test.

And haven't for the past 11 years.

 

 

Odd post. It could save your life.

[JimmyJ]

3 hours ago, elektrified said:

Odd post. It could save your life.

 

The second link I posted is about that very question - How can one say "That test saved my life?". Is that reasonable and accurate?

 

It's author brings up some interesting points.

[JimmyJ]

4 hours ago, bubba said:

I suppose that depends on how old you are, what sort of treatments can be considered and whether you consider those to be less desirable to an early, unnecessary and painful death due to metastatic prostate cancer. When PCa is detected early, there are emerging treatments such as focal laser ablation that will spare you from a radical prostatectomy and the potentially associated issues as well as saving your life. 

 

For me, the focal laser ablation would be something I would want to see results and statistics about what % of the time using it results in incontinence and impotence (and any other dangers), its effectiveness, etc.

 

 

The most recent article in the US I could find is from Feb. 25, 2018 and says it is not yet approved in the US by the FDA.

http://www.ascopost.com/issues/february-25-2018/ucla-scientists-receive-nih-research-grant-to-advance-adoption-of-focal-laser-therapy-for-prostate-cancer/

 

But I also found this - https://laserprostate.com/about-laser-prostate/faqs/ - so I assume it was approved during the last 9 months?

 

I couldn't find any studies about effectiveness and issues.

 

 

"When PCa is detected early, there are emerging treatments such as focal laser ablation..."

 

What other emerging treatments would you suggest I read up on?

 

 

 

 

[JimmyJ]

Here is the update to the U.S. Preventive Services Task Force comments on PSA testing:

 

"Based on a review of the evidence, the Task Force determined that the potential benefits and harms of prostate-specific antigen (PSA)–based screening are closely balanced in men ages 55 to 69 years, and that the decision about whether to be screened should be an individual one.

 

For men age 70 years and older, the potential benefits do not outweigh the harms, and these men should not be screened for prostate cancer"

 

https://www.uspreventiveservicestaskforce.org/Announcements/News/Item/public-comment-on-draft-recommendation-statement-screening-for-prostate-cancer

 

https://www.npr.org/sections/health-shots/2017/04/11/522912221/federal-task-force-softens-opposition-to-routine-prostate-cancer-screening

 

 

[JimmyJ]

2010 op-ed by the man who discovered PSA:

 

"...the test is hardly more effective than a coin toss."

 

https://www.nytimes.com/2010/03/10/opinion/10Ablin.html

[xylophone]

11 hours ago, bubba said:

I think you should be happy, Garry. For 56 years old, a 0.59 is definitely at the low end or normal. I don't think any urologist would suggest that you do a PSA bi-annually. Some would suggest that you don't do any at all. Others would suggest an annual PSA to watch PSA velocity. PSA almost always increases with age and inevitable growth of the gland, so what they would look for over time is how fast PSA is increasing and doubling time. That said, there is a small percentage of men with normal or low normal PSA who actually have high grade adenomas, so PSA is not always definitive. 

 

Good post bubba and you make some very valid points.

 

My doctor in NZ reckoned a once yearly PSA test combined with a DRE (for those who are unaware, a digital rectal exam – – not my favourite exam I must admit) was good, whereas others in the medical profession vary on their opinion on these things, however one thing seems to be constant, and that is as one gets past a certain age, certainly some checks are good to have.

 

The PSA test, although not the "be all and end all" of tests, can highlight an increase from the previous test, which can be a warning signal. Having said that, it doesn't always work out better that way, because a very good friend of mine who had religiously followed the annual PSA and DRE tests since he passed 50 years old, suddenly at the age of about 64 was diagnosed with prostate cancer as the PSA reading relative to the year before had skyrocketed.

 

He underwent chemotherapy and radiotherapy and just about every other therapy, before succumbing to it about 18 months after the original diagnosis – – poor bugger.

 

I do tend to agree with the physicians who suggest that over the age of 70 it might not be that useful, because from what I understand, many of us at that age may well have some sort of cancer in the prostate, but it is so slow-growing that we will probably die with it, rather than die of it. 

[bkk6060]

I suggest get several tests and make some adjustments in lifestyle related issues if it is high.

I have had several tests over the past 4 years as my Father had P cancer.

But, I have noticed things like being dehydrated, sitting on your nuts for long periods of time (such as long motorbike or bike rides) booze, and sex can affect the test.

With me, it was almost a 4 point difference (lower) after taking a Doctors advise. 

[lipflipper]

A PSA test, both the normal and the Free PSA test if this is your first one should be treated with a grain of salt. A high number is just that initially and therefore should be used as a baseline. Another blood test should be done in six months and compare the numbers. Also for your information there are certain things that if done prior to having the PSA test will effect the results giving you a higher number. I.E. Ejaculating within forty eight hours prior, or riding a bicycle for long periods. If the Urologist is worth his degree he will recommend further tests and not suggest a biospy right away. If he suggests that run away and seek a second opinion a.s.a.p.

Sent from my CMR-AL19 using Thailand Forum - Thaivisa mobile app

[elektrified]

I will take the route of "better safe than sorry". I've had 2 MRI's; one with abdominal scanner and one with endorectal coil. One was interpreted by the Professor of Radiology with many years experience in prostate MRI. Both indicated a suspect area. I've had 2 biopsies over the years (both negative), but the last one had extensive investigation in the suspect area and did find "inflammation". I completed a 30 day course of Levofloxacin and feel better than I have in years. For 4 years I took the PSA every 3 months and I will take it again in January - now every 6 months.

 

But it is your body, so up to you.

 

One of my best friends didn't take the PSA and only took Finasteride. Eventually he knew something was terribly wrong and after testing he learned he had cancer in half of his prostate but not outside the capsule - yet. He went through a horrible time with the treatment; hormone injections with side effects that made him want to die, and countless radiotherapy sessions that scorched his rectum and required cauterization. Half way through the treatment he suffered a massive heart attack which the cardiologist said was a direct result of the injections to stop the testosterone production.

 

Why anyone would not take the PSA is beyond me.

[JimmyJ]

On 11/20/2018 at 7:59 PM, elektrified said:

I will take the route of "better safe than sorry". I've had 2 MRI's; one with abdominal scanner and one with endorectal coil. One was interpreted by the Professor of Radiology with many years experience in prostate MRI. Both indicated a suspect area. I've had 2 biopsies over the years (both negative), but the last one had extensive investigation in the suspect area and did find "inflammation". I completed a 30 day course of Levofloxacin and feel better than I have in years. For 4 years I took the PSA every 3 months and I will take it again in January - now every 6 months.

 

But it is your body, so up to you.

 

One of my best friends didn't take the PSA and only took Finasteride. Eventually he knew something was terribly wrong and after testing he learned he had cancer in half of his prostate but not outside the capsule - yet. He went through a horrible time with the treatment; hormone injections with side effects that made him want to die, and countless radiotherapy sessions that scorched his rectum and required cauterization. Half way through the treatment he suffered a massive heart attack which the cardiologist said was a direct result of the injections to stop the testosterone production.

 

Why anyone would not take the PSA is beyond me.

 

"Why anyone would not take the PSA is beyond me."

 

I assume you did not read the 2 Scientific American articles I linked to, nor the op-ed by the man who discovered PSA, as they give reasons, although you may disagree with the reasons.

 

Why you would say it is beyond you and yet not investigate the reasoning is beyond me.

If you did read those 3 articles and it is still beyond you, it's surprising to me as the reasons are clearly stated.

 

I don't have a problem with you disagreeing with my decision, just surprised if you've read those articles and still don't understand why one may not want to take that test.

 

Here are some other similar themed articles by the same writer, John Horgan:

 

"Why I Won't Get a Colonoscopy": https://blogs.scientificamerican.com/cross-check/2012/03/12/why-i-wont-get-a-colonoscopy/

[Me neither - and never have]

 

https://blogs.scientificamerican.com/cross-check/consumers-must-stop-insisting-on-mammograms-and-other-ineffective-cancer-tests/

 

"Cancer Establishment Admits We’re Getting Overtested and Overtreated": https://blogs.scientificamerican.com/cross-check/2013/08/05/cancer-establishment-admits-were-getting-overtested-and-overtreated/

 

"ABC Reporter, National Football League Promote Mammograms While Experts Question Benefits": https://blogs.scientificamerican.com/cross-check/2013/11/13/abc-reporter-national-football-league-promote-mammograms-while-experts-question-benefits/

 

"Celebrities Should Inform Women about Risks as Well as Benefits of Mammograms": https://blogs.scientificamerican.com/cross-check/2013/12/12/celebrities-should-inform-women-about-risks-as-well-as-benefits-of-mammograms/

 

"How Can We Curb the Medical-Testing Epidemic?": https://blogs.scientificamerican.com/cross-check/2011/11/07/how-can-we-curb-the-medical-testing-epidemic/

 

 

 

 

 

 

 

[bubba]

There is a range of opinions regarding PSA.  But just one question for those who never plan to do PSA or any other diagnostic test for PCa, consider this: In virtually all cases, by the time you develop any symptoms of PCa, extracpasular tumour growth and metastasis has occured, usually to bones and lymph nodes and sometimes also to the liver, lung and brain. Prognosis for five year survival is less than 30% for distant metastases. My father-in-law discovered he had prostate cancer when he began to have weakness and numbness in his right arm, and this was due to a tumour on his spine due to metastatic prostate cancer. Chemo may have delayed things, but he only made it six years as additional bone tumours occured as well as two tumours in his lung. 

 

Prostate cancer is the second leading cause of cancer deaths for men. So are you willing to take a crap shoot on never developing prostate cancer, which when detected early is often treatable with full remission?

 

A very high PSA or rapid and sustained rise in PSA is usually due to PCa. That said, as many have noted, PSA is not definitive for PCa – rather, it is indicative. I agree with all the opinions that PSA is not definitive for PCa. Many urologists now would never biopsy you for a high PSA (and low free PSA) alone. There are further differential diagnostic tests that can follow, including genetic marker testing which can better confirm PCa and also grade the aggressiveness of the cancer. As mentioned in the thread, there is also multiparametric MRI which has high predictive value and can distinguish between inflammation and a lesion. Note that the quality of the MRI imaging is essential and requires skilled technicians to do the imagining, a modern, high resolution instrument and a specialised radiologist. Good MRI imaging and diagnostic interpretation can see lesions down to 1mm in size. If all this leads to the recommendation for a biopsy, an in bore, MRI guided biopsy can be performed to precisely target the lesion. Specialist radiologists who perform these sometimes only take two bored, rather than the shotgun approach of 12 - 16 bores using ultrasound guidance.

 

Unfortunately, I was unable to locate any MRI facility in Thailand that uses the latest high resolution instruments with experienced and specialised techs, so I had one done in the USA while on a business trip, out of pocket, for US$1,800. My PSA had been as high as 11 and was hovering around 7, and the urologist here finally recommended a biopsy. The decision following that MRI with interpretation from a specialist radiologist: it is chronic inflammation and no, I did not need a biopsy. But it could have been an adenoma and I never would have known either way without those PSAs prompting further investigation.

 

Following a two hour phone consultation, with explanation of what was in the images, the radiologist advised that chronic inflammation can eventually result in PCa and I should have quarterly PSAs with an annual MRI to monitor the situation. If the quarterly PSAs turn rapidly high and stay there, I am to have another MRI.

 

When PCa is detected early, with no extracapsular growth and even local metastasis, ten year survival rates are close to 100% following initial treatment and ongoing monitoring with potential further treatment. Hopefully it doesn't happen, but if PCa does develop, I am willing to fight it with either RP or focal therapy and survive to a ripe old age, rather than succumb in the next five years to a painful and unpleasant early death.

[xylophone]

34 minutes ago, bubba said:

There is a range of opinions regarding PSA.  But just one question for those who never plan to do PSA or any other diagnostic test for PCa, consider this: In virtually all cases, by the time you develop any symptoms of PCa, extracpasular tumour growth and metastasis has occured, usually to bones and lymph nodes and sometimes also to the liver, lung and brain. Prognosis for five year survival is less than 30% for distant metastases. My father-in-law discovered he had prostate cancer when he began to have weakness and numbness in his right arm, and this was due to a tumour on his spine due to metastatic prostate cancer. Chemo may have delayed things, but he only made it six years as additional bone tumours occured as well as two tumours in his lung. 

 

Prostate cancer is the second leading cause of cancer deaths for men. So are you willing to take a crap shoot on never developing prostate cancer, which when detected early is often treatable with full remission?

 

A very high PSA or rapid and sustained rise in PSA is usually due to PCa. That said, as many have noted, PSA is not definitive for PCa – rather, it is indicative. I agree with all the opinions that PSA is not definitive for PCa. Many urologists now would never biopsy you for a high PSA (and low free PSA) alone. There are further differential diagnostic tests that can follow, including genetic marker testing which can better confirm PCa and also grade the aggressiveness of the cancer. As mentioned in the thread, there is also multiparametric MRI which has high predictive value and can distinguish between inflammation and a lesion. Note that the quality of the MRI imaging is essential and requires skilled technicians to do the imagining, a modern, high resolution instrument and a specialised radiologist. Good MRI imaging and diagnostic interpretation can see lesions down to 1mm in size. If all this leads to the recommendation for a biopsy, an in bore, MRI guided biopsy can be performed to precisely target the lesion. Specialist radiologists who perform these sometimes only take two bored, rather than the shotgun approach of 12 - 16 bores using ultrasound guidance.

 

Unfortunately, I was unable to locate any MRI facility in Thailand that uses the latest high resolution instruments with experienced and specialised techs, so I had one done in the USA while on a business trip, out of pocket, for US$1,800. My PSA had been as high as 11 and was hovering around 7, and the urologist here finally recommended a biopsy. The decision following that MRI with interpretation from a specialist radiologist: it is chronic inflammation and no, I did not need a biopsy. But it could have been an adenoma and I never would have known either way without those PSAs prompting further investigation.

 

Following a two hour phone consultation, with explanation of what was in the images, the radiologist advised that chronic inflammation can eventually result in PCa and I should have quarterly PSAs with an annual MRI to monitor the situation. If the quarterly PSAs turn rapidly high and stay there, I am to have another MRI.

 

When PCa is detected early, with no extracapsular growth and even local metastasis, ten year survival rates are close to 100% following initial treatment and ongoing monitoring with potential further treatment. Hopefully it doesn't happen, but if PCa does develop, I am willing to fight it with either RP or focal therapy and survive to a ripe old age, rather than succumb in the next five years to a painful and unpleasant early death.

Great post bubba and wholeheartedly agree with all you have said.

[Dante99]

1 hour ago, bubba said:

 

 

Unfortunately, I was unable to locate any MRI facility in Thailand that uses the latest high resolution instruments with experienced and specialised techs, so I had one done in the USA while on a business trip,

Since then have you located a place in Thailand for the MRI?  What about Singapore?

[bubba]

1 hour ago, Dante99 said:

Since then have you located a place in Thailand for the MRI?  What about Singapore?

I personally spoke with the major hospitals in Thailand, including Bumrungrad and Bangkok Hospital. Bumrungrad is still using an old 1.5T MRI instrument with an endorectal coil which is simply not a modern and reliable instrument for the necessary prostate imaging. Bangkok Hospital's techs did not seem that versant in MP MRI prostate imaging and according to my consulting radiologist, while they did have 3T, it was not an instrument that yielded the highest resolution images that he wanted to see. This was all as of around 14 months ago and things may have changed since then. 

 

I didn't check Singapore, since I knew I had a trip coming up to the USA and there are many MRI facilities with modern instrumentation that specialise in prostate imaging, so that is where I went. I am planning to do my next annual MRI there again. 

[JimmyJ]

"When PCa is detected early, with no extracapsular growth and even local metastasis, ten year survival rates are close to 100% following initial treatment and ongoing monitoring with potential further treatment."

 

What type of initial treatment and potential further treatment would be used?

 

 

Was focal laser ablation approved in the USA by the FDA within the last 9 months?

 

I'd be interested in reading any studies of its effectiveness/problems if you know of any, although if I'm correct that it was only approved this year the sample size will be pretty small.

 

 

I wasn't aware of focal laser ablation until you mentioned it.

Are there other new or emerging technologies which are hopefully not as potentially damaging as the traditional ones?

 

 

"RP for Prostate Cancer May Not Offer Survival Advantage"

 

"Men with localized prostate cancer (PCa) treated with radical prostatectomy (RP) survive no longer than those undergoing observation, according to study results from PIVOT (Prostate Cancer Intervention versus Observation Trial) published in the New England Journal of Medicine."

 

https://www.renalandurologynews.com/prostate-cancer/localized-prostate-cancer-prostatectomy-may-not-reduce-deaths/article/674711/

 

 

 

 

"...rather than succumb in the next five years to a painful and unpleasant early death."

I plan on skipping the long painful and unpleasant part.

 

 

[bubba]

JimmyJ - a course of treatment recommended by the urologist would of course depend on many factors including the Gleason score grading of the lesion(s), how many lesions, whether the tumour has become extracapsular and the degree, if any, or metastasis. In my father-in-law's case, which was not diagnosed until distant metastases had already occurred, the decision was made because of his age and the metastases to only treat with hormonal therapy. Some tumours are very responsive to that, others become refractory and begin to grow again. In his case, the therapy probably only extended his life for a year or so. 

 

Just curious – with all your questions regarding treatment options, while deciding against any screening by way of PSA tests, are you interested in treatment options because you suspect you may have PCa?

[JimmyJ]

2 minutes ago, bubba said:

JimmyJ - a course of treatment recommended by the urologist would of course depend on many factors including the Gleason score grading of the lesion(s), how many lesions, whether the tumour has become extracapsular and the degree, if any, or metastasis. In my father-in-law's case, which was not diagnosed until distant metastases had already occurred, the decision was made because of his age and the metastases to only treat with hormonal therapy. Some tumours are very responsive to that, others become refractory and begin to grow again. In his case, the therapy probably only extended his life for a year or so. 

 

Just curious – with all your questions regarding treatment options, while deciding against any screening by way of PSA tests, are you interested in treatment options because you suspect you may have PCa?

 

I have no signs of it.

I suppose anyone who hasn't taken the PSA test for years could have PCa since you mention there are almost never signs of it until it is too late.

(And some or many who take the test also could have it without the test indicating it based on what I've read).

 

 

I'm interested in treatment options because as I've mentioned previously I feel it would be pointless and counterproductive to take the test if I'm not willing to accept any of the treatments.

 

I last looked into it 11 years ago, and you are well informed on the current state of treatments, so wondering what is new.

 

 

 

 

[elektrified]

5 hours ago, xylophone said:

Great post bubba and wholeheartedly agree with all you have said.

Me too.

[bubba]

11 hours ago, JimmyJ said:

 

I have no signs of it.

I suppose anyone who hasn't taken the PSA test for years could have PCa since you mention there are almost never signs of it until it is too late.

(And some or many who take the test also could have it without the test indicating it based on what I've read).

 

 

I'm interested in treatment options because as I've mentioned previously I feel it would be pointless and counterproductive to take the test if I'm not willing to accept any of the treatments.

 

I last looked into it 11 years ago, and you are well informed on the current state of treatments, so wondering what is new.

 

 

 

 

I think the point is that there are many different treatment options, and those all depend on the diagnosis and nature of the PCa. In some cases, urologists are now recommending active surveillance with no treatment at all for small, low-grade lesions. 

 

If you do not engage in any kind of PSA screening with follow-up diagnostics, then it is sort of pointless to spend a lot of time researching the many currently available treatments since you will not be diagnosed. As time goes on, more treatment options will no doubt become available. Statistics show that one man in 40 will die of PCa, more than that for men in a high risk group, so just taking your chances with the odds is certainly one approach. 

[tideout]

Some people have doctors or research hospitals. We've got bubba. ????????????

[elektrified]

1 hour ago, bubba said:

I think the point is that there are many different treatment options, and those all depend on the diagnosis and nature of the PCa. In some cases, urologists are now recommending active surveillance with no treatment at all for small, low-grade lesions. 

 

If you do not engage in any kind of PSA screening with follow-up diagnostics, then it is sort of pointless to spend a lot of time researching the many currently available treatments since you will not be diagnosed. As time goes on, more treatment options will no doubt become available. Statistics show that one man in 40 will die of PCa, more than that for men in a high risk group, so just taking your chances with the odds is certainly one approach. 

I may fall into this category. My PSA has been rising for years as high as 13.4. MRI shows a lesion 1 cm X 0.5 cm and 2 biopsies (2nd one was 26 cores) have been negative for PCa. CMU did call and request authorization for additional investigation of the cores from the suspect area and detected "chronic inflammation". The doctor said it is possible there may be a lesion so small and so non-aggressive that in 5 years it hasn't grown or affected surrounding tissue. Or it could be chronic prostatitis. I complete a 30-day course of Levofloxacin and will check PSA again in January.

[bubba]

1 minute ago, elektrified said:

I may fall into this category. My PSA has been rising for years as high as 13.4. MRI shows a lesion 1 cm X 0.5 cm and 2 biopsies (2nd one was 26 cores) have been negative for PCa. CMU did call and request authorization for additional investigation of the cores from the suspect area and detected "chronic inflammation". The doctor said it is possible there may be a lesion so small and so non-aggressive that in 5 years it hasn't grown or affected surrounding tissue. Or it could be chronic prostatitis. I complete a 30-day course of Levofloxacin and will check PSA again in January.

A few things you might want to consider:

 

1. Doing an ultrasound guided biopsy is almost like throwing darts. There could be a small lesion, but none of the cores hit it, and especially with a small lesion such as yours. The gold standard now is in-bore MRI biopsy, where the radiologist visualises the lesion real time and has something to aim at. As I mentioned earlier, some radiologists can get what they want with just two cores. I really feel for you having done 26 cores. Did they actually hit the lesion with any of the cores and provide you with a Gleason score?

 

2. How experienced was the radiologist and how good were the images? Did he/she provide you with a PIRADS score for your lesion? You might want to consider getting a second opinion from a specialist radiologist. It is easy to do, obtaining your images on a DVD, uploading it to something like Dropbox and then the radiologist at the other end downloads them. That's what I did and it saved me from a biopsy, plus I learned a lot in the two hour consultation call. I consulted with Dr. Joe Busch in the USA for this, who is generally considered to be a recognised expert in the area. His fee was US$200 and well worth it. Dr. Busch is very frank and will inform you if he thinks the imaging is of inadequate quality or if he disagrees with your radiologist's assessment. If you are interested in this approach, PM me and I can provide you with more details and contact info.

 

3. Dr. Busch also considers prostate density in considering high PSAs. Did you get an estimate of prostate volume from your MRI? Have a look at this recent journal article regarding PSA density:

 

Prostate-specific antigen (PSA) density in the diagnostic algorithm of prostate cancer.

 

 

[bubba]

24 minutes ago, tideout said:

Some people have doctors or research hospitals. We've got bubba. ????????????

 

Thanks, Tideout. Having been on the active surveillance route for more than five years, undergone two MRIs, consulted with several different urologists and radiologists and spent a lot of hours researching the subject, I hope I can share some information that is useful. 

[tideout]

16 hours ago, bubba said:

 

Thanks, Tideout. Having been on the active surveillance route for more than five years, undergone two MRIs, consulted with several different urologists and radiologists and spent a lot of hours researching the subject, I hope I can share some information that is useful. 

Your posts always helpful, respectful and the content is thought out.....and you look like everyone's dad from the 50's. Take care!

[elektrified]

On 11/23/2018 at 9:25 AM, bubba said:

A few things you might want to consider:

 

1. Doing an ultrasound guided biopsy is almost like throwing darts. There could be a small lesion, but none of the cores hit it, and especially with a small lesion such as yours. The gold standard now is in-bore MRI biopsy, where the radiologist visualises the lesion real time and has something to aim at. As I mentioned earlier, some radiologists can get what they want with just two cores. I really feel for you having done 26 cores. Did they actually hit the lesion with any of the cores and provide you with a Gleason score?

 

2. How experienced was the radiologist and how good were the images? Did he/she provide you with a PIRADS score for your lesion? You might want to consider getting a second opinion from a specialist radiologist. It is easy to do, obtaining your images on a DVD, uploading it to something like Dropbox and then the radiologist at the other end downloads them. That's what I did and it saved me from a biopsy, plus I learned a lot in the two hour consultation call. I consulted with Dr. Joe Busch in the USA for this, who is generally considered to be a recognised expert in the area. His fee was US$200 and well worth it. Dr. Busch is very frank and will inform you if he thinks the imaging is of inadequate quality or if he disagrees with your radiologist's assessment. If you are interested in this approach, PM me and I can provide you with more details and contact info.

 

3. Dr. Busch also considers prostate density in considering high PSAs. Did you get an estimate of prostate volume from your MRI? Have a look at this recent journal article regarding PSA density:

 

Prostate-specific antigen (PSA) density in the diagnostic algorithm of prostate cancer.

 

 

Yes, the 12 core biopsy 5 years ago was easy, but the 26 core biopsy was painful for 72 hours afterwards! And the inflammation and bleeding lasted 2 weeks.

 

Extensive investigation was done on the samples from the suspect area. The radiologist seems to have provided a location in numbers (like a GPS location - sort of..) for the surgeon to target? 6 cores were taken there. No Gleason score was given.

 

The 2nd MRI (endorectal coil) was interpreted by the Asisstant Professor of Radiology at CMU with 25 years experience in abdominal imaging and the preferred radiologist of all urological surgeons in CMU. She gave a PIRADS-4 - as did the radiologist at Siriraj who read the first MRI (abdominal scanner) 4 months earlier. The team who did the imaging on MRI #2 were the same team that have performed prostate imaging for both Suan Dok and Sriphat for years, according to the doctors. So I have faith in the images. The volume IS indicated on the radiology report from MRI #2.

 

Funny thing about the MRI guided biopsy. I asked many times, even popping my head into the control booth where a Professor was working with some students on MRI's and asked about it. He sensed my concern and invited me in to sit down and have a discussion (I love that about CMU). He said "not available in Northern Thailand - only Bangkok", same thing everyone else told me. Then, after my 2nd biopsy my doctor told me that "in some cases" it can be performed only at Suan Dok. But it requires a number of people to approve it and then set-up for it. I'm used to contradictory information in Thailand by now.

 

Thank you very much for your advice and offer. I will PM you for the contact details.

 

[bubba]

Elekrified: Did your radiologist happen to mention where in Bangkok an in-bore MRI biopsy is available?

 

Also - 

 

Every biopsy should have a Gleason score. I am surprised the pathologist in your case did not provide one.

 

Both radiologists gave you a PIRADS 4 for the lesion they observed. PIRADS 4 is defined as highly suspicious with clinically significant cancer likely. So it seems that either the radiologist's interpretation or the biopsy was misdiagnosed, or perhaps you underwent two very unpleasant and unnecessary biopsies. Similar to your case, the hospital radiologist in the USA who interpreted my MRI gave me a PIRADS 4. The second opinion I obtained from Dr. Busch, who specialises only in prostate imagining, very frankly told me that the hospital radiologist was wrong, didn't know what he was doing with prostate MRIs, told me I didn't need a biopsy and he would not perform one for me even if I asked him to. You may want to consider investing in another opinion.

 

What was your prostate volume? Did you calculate prostate density?

 

Update after I posted this: saw your PM and replied.

[rumak]

On 11/23/2018 at 10:32 AM, tideout said:

  On 11/23/2018 at 9:28 AM, bubba said:

 

Thanks, Tideout. Having been on the active surveillance route for more than five years, undergone two MRIs, consulted with several different urologists and radiologists and spent a lot of hours researching the subject, I hope I can share some information that is usefu

I recently disagreed with bubba on another topic ( verification of income for extensions of visa) . But i must say that he seems very knowledgable about this subject (PSA and prostate cancer).  Congrats to him for being a source for others.   As for me,  i'm probably in the group that thinks....lived long enough, not going to do biopsies, etc.   But, if that time comes..... who knows ?  

[thaibeachlovers]

On ‎3‎/‎25‎/‎2018 at 1:12 AM, NancyL said:

You can't emphasize this enough.  No anesthetic.  Hubby had a high PSA reading a few years ago and a urologist at one of the top private hospitals in Chiang Mai wanted to do a biopsy without anesthetic.  Can't name names for the same reason you mentioned.  Needless to say, he did some internet research and went down to Bumrungrad hospital.  Now that Bangkok Hospital-Chiang Mai is opened, he doesn't have to put up with this nonsense and can get good treatment closer to home.  

 

His biopsy was clean, but once again his PSA readings are high.  Note how I said readingS.  Can't stress enough the importance of getting at least two readings before doing anything drastic like a biopsy.  In his case, he waited two months just to see how much the number to would increase and it pretty much stayed the same.  The urologist at Bangkok Hospital - Chiang Mai recommended a MRI and it showed enlargement in the same area where enlargement was noted five years ago at Bumrungrad.  

 

We've decided against a biopsy and instead will go with PSA readings every 3 months.  After a certain age, many men have prostate cancer, but they die of other causes.   After age 70, the medical community has mixed opinions about treating for prostate cancer.  Personally, I'm glad we have the money available for Hubby to be tested every 3 months and to have an ultrasound or MRI if the number goes higher to see if the "enlargement" is getting bigger.  

 

There are certain dangers in doing a biopsy.  Like rectal perforation.  Like spreading what had been an "encapsulated" cancer elsewhere in the body.  And, the clean-out procedure to get ready for the biopsy isn't pleasant and the next day or two afterwards is down-time also, especially in Thailand's heat.  

 

All this being said, in my activity of assisting older expats with medical problems in Lanna Care Net, I've helped some men who had prostate cancer that they decided not to treat.  It's not a good or quick death.  The cancer spreads to the bones of the hip, pelvis and spine, is painful and robs the man of the ability to walk or even turn himself over in bed.  Any dreams of "dying at home" are shattered because your family doesn't have the equipment or strength to take care of you.  Thus, the importance of having PSA tests and other tests like ultrasounds and MRI to see what's going on if you're like my husband and have decided not to have biopsies any more.  

It's some time since I posted on this thread, but for interest's sake-

I had a biopsy done without anaesthetic and it was barely a pinch, several times. Certainly nothing to stress about. The most discomfort was having the tube inserted, and a local wouldn't do anything about that.

The only side effect was blood in my stools for a few days.

NOT a big deal.

Having had the surgical option I really regret it. Ruined my life completely.

I'd rather have had the laser to open the urethra through the prostate, and offed myself if and when the cancer spread, but that's just me. Unfortunately, the laser wasn't on offer then, and I wasn't able to talk to other men been through the procedure.

I was fortunate though in that I read about radiation after when the lymph glands have been removed causing elephantiasis, so I refused it, and still cancer free ( far as I know ) 13 years later. The side effects of the surgery are horrible though.

 

For sure if I hadn't had the surgery I'd be dead now, but I've said it before, and sometimes living is worse than death.

 

 

[bkk6060]

I met a guy a few days ago and this topic came up.

He told me his PSA is 220

I asked him 2.20?

He said no 220!!

He is going in next week for a biopsy...

Never heard of it this high.