Question on prostate cancer recurring

[Tribetime]

8 yes ago I went through radiation for prostate cancer and my psa was .4 for most of that time until this summer it went to .86 but 15% was bound which concerned my family doctor. I went to urologist a new one my old one retired and he tested again at .95...he wants to do a eurolift or something to relieve pressure but not a biopsy....I'm way more concerned about cancer returning than anything else....should I get a 2nd opinion

[onecaliberal]

1. I wouldn't get any treatment without a second opinion.

[XanaDUer2]

2. Yes

I would. Good luck

[captain queeg]

3. No answer here but I'm watching this thread. Just got referred for radiation yesterday.

I haven’t even met the radiation team yet but I plan on following thru. 2 of my friend died of prostate cancer last year, both youger than me, 65. One just got his with an extremely aggressive type, the other ignored all signs and warnings and when it finally got so bad he went in and was diagnosed stage 4. He lasted a couple more years but it wasn’t till the very end he openly kicked himself in the ass for waiting so long.

So anyway I’m motivated to get on it. They just found it this summer and it’s small and non aggressive. Doc thinks radiation will kill it. I hope whoever you see has positive news for you. Best of luck.

[Tribetime]

5. Yes my radiation went well

Like 5 days a week for 6 was or so I forget...Worked full time in a labor type job no problems

[JohnSJ]

8. You might want to consider a Decipher genetic test on the positive biopsy sample to help determine

the aggressiveness, and also ask for a second read of the slides from John Hopkins.

Did you have an MRI done?

[Tribetime]

10. No the only thing he did was check my bladder

[JohnSJ]

12. Tribetime I was addressing this answer to captain queeg who indicated he hasn't had any treatment

yet

There are still diagnostics he may want to consider before initiating treatment

In your case you already had treatment, so it is a different ball game

[captain queeg]

15. Yeas MRI first then the biopsy

[JohnSJ]

17. Good. You might want to consider a second read on the positive biopsy slides from John Hopkins.

Insurance should cover it, and your urologist should have no problem facilitating that.

[captain queeg]

19. I'm out west. Biopsy was taken at a local hospital, Legacy I think.

[JohnSJ]

22. That isn't a problem. The request can be made by your urologist or the hospital pathology departmen

to send the slides to John Hopkins for a second read, and the results will be sent back to your urologist, along with the returned slides

These type of requests are done all the time. The reason why it is prudent is because John Hopkins is a leader in interpreting Gleason scores. The second read can be an upgrade, downgrade, or no change. I believe they change about 300 dollars if insurance doesn’t cover it

[captain queeg]

18. You know that number they give it to rate it, can't remember what it's called off hand?

I’m at a 7 which seems kind of high to me for the early stage, smalll affected area, and no symptoms yet. No pee problems and besides all the tests I’ve had a lot of different fingers up my ass the last few months. They al said it felt normal, no enlargement, nothing they could feel externally.

[JohnSJ]

20. Gleason score. It is intermediate. There are two numbers that make up the Gleason score

If you have a 7, it is either 3+4, or 4+3

If it is 3+4, it is favorable intermediate. A 4+3 would be unfavorable intermediate.

The first number represents the dominant pattern in the core, and the second number represents the lesser pattern

In your situation you might want to consider a genetic test on the sample. Some of those tests are Decipher, Prolaris, and Oncotype. Decipher is the test a lot of the comprehensive centers are using

What you are doing is gathering data points to help make an informed decision. You have time to explore your options

Depending on the pattern and volume of the 7, you might even consider Active Surveillance


There are focal therapy options also that you may qualify for also

TULSA Pro(ultrasound), HIFU(ultrasound), FLA(laser) etc

[captain queeg]

21. Yes that it. Thanks

[JohnSJ]

4. Yes. You should go to a comprehensive center and request a PSMA to help determine if it is really

a recurrence, and still contained

Also the PSAs need to be done at the same place. Different labs can give variations do to methodology differences

I am assuming the PSA monitoring has been done using the Ultrasensitive PSA assay

The urolift is for BPH. Does he believe that is why your PSA is elevated? I am not sure that makes sense since you had radiation therapy to treat the PCa

Definitely get a second opinion from a comprehensive center, and request a PSMA which is a CT scan with a special marker

[Tribetime]

7. Thank you so much

[JohnSJ]

9. Urolift is for an enlarged prostate. Was an MRI done to see if the prostate was enlarged? There

are drugs that you might want to consider first if it is BPH before the urolift procedure

[Tribetime]

11. Yeah it doesn't bother me I don't wake up at night I can make it through work it's not a big deal wi

I believe they had an mri done or an ultrasound I forget 2 years ago when I peed pure blood but it was the only time it's happened

[JohnSJ]

13. Urolift may not make sense. A second opinion is definitely called for

[al_liberal]

6. Hell yes

Since you had radiation they won’t say you’re recurrent until your PSA gets to 2.0 but you can get around that if you have a short doubling time. My RO said he expects PSA to remain at or below 0.50.

Now you can get a new type of scan, PSMA, that is sensitive enough to find cancer at low PSA values.

[JohnSJ]

14. Exactly. Also, the new urologist recommending urolift really needs a second opinion. The PSMA

is definitely warranted

[Rebl2]

16. Second opinion

[TNNurse]

23. Not sure of your age.

I worked with prostate patients in my early nursing career. There has been progress. But they used to say that most men would get prostate cancer eventually.

I am a big fan of second opinions.

[Tribetime]

24. I first got it at 54. 62 now