Prostate Cancer

[whattodo]

My husband is 49 (will turn 50 later this year). He is healthy and fit and has no high risk factors and no symptoms.

He had a PSA test done by his family physician a little over three years ago. Score 1. Had another one done late fall 2007, score 2.00

Saw a urologist last week who is recommending needle biopsy in the next month. DRE was completely normal.

Is the biopsy at this time pre-emptive? Nothing else (i.e. repeat PSA, antibiotics) has been suggested.

[kdunbar]

I must say I find your posting confusing, in that the PSA values do not appear to make sence. If PSA were 1 or 2 for Nov '07 no Urologist would suggest a biopsy. If on the other hand your husbands were above the normal range 0 - 3 for his age, a DRE may be inclusive. A TRUS may show something. Generally a Urologist does not suggest a biopsy lightly, however I would suggest if in any doubt seek a second opinion. Your husband is young and the earlier a prostate cancer is removed the better the chance of a cure. Good luck.
KD

[whattodo]

kdunbar- thanks so much for your response. This is precisely why we are confused.

His initial PSA ( done just over two years ago) was .93. Had another one done as part of a general physical last August which came up at 2.1... It is unknown to me why his personal physician started doing PSA tests so young, he is not in any high risk group.... Anyway, at the time of the last test, personal physician suggested a referral to a urologist based only on the increase from 1 to 2 in PSA. DRE was normal.

He saw urologist second week of Feb. (yes, he delayed a bit!). DRE again was normal. Urologist insisted on biopsy, based on the increase over the last few years. tentatively scheduled for end of March.( first available). We did our online research and wondered if the biopsy was a bit pre-emptive as no further PSA testing was prescribed, nor an antibiotic trial, etc. He actually went back to the urologist and requested a follow up PSA for tracking, but was refused. Went back again late last week and insisted and we are awaiting the results of that test today. Urologist has not responded to phone messages and we have only been able to speak with his nursing staff.

We've actually made an appointment for next week with a urologist at a local University Teaching institute and hope for a better depth of care and explanations there.

Thanks for your input, the online info available has been a godsend to us!

[kdunbar]

Your husband was not too young to have a PSA two years ago. He should have had his first at 40 another at 45 and annually after 50. PSA is not always straightforward, occasionally those with normal values may have prostate cancer. Although the test has been refined to show Total PSA and % Free PSA, the latter needs interpretation. However an increase as shown over a given time may indicate a problem, even though the DRE did not show anything, and a biopsy may be the best and only way to be sure. You are wise to seek a second opinion, the main thing is to ensure the Urologist you consult treats many patients, not one or two a week, but many hundreds each year. I would suggest you get Dr Patrick Walsh's Guide To Surviving Prostate Cancer. In my opinion this is the bible on the subject. Dr Walsh is responsible for bringing the diagnosis and treatment of prostate cancer out of the 'dark ages', and his book will help you to understand the complexities involved, nothing is clear cut. Remember biopsies are not done lightly by Urologists, but it is important that you and your husband have complete trust in the treating clinician, and fully understand what is happening and why. Be prepared to ask questions, and ensure you understand the answers.

Do not despair, many of us have been there and came out smiling on the other side.

Good luck,
KD