My husband, Bob, was sent to a urologist after his internist felt something on his DRE (Digital Rectal Examination) in 2008. The urologist called it a "linear nodule" on the LEFT side, and it was not visible on ultrasound when he did the first biopsy in 2009. [Normally a biopsy ordered because of a positive DRE on one side of the gland would be labelled T2a (See Staging) but the urologist said the nodule didn't feel like a typical cancer nodule - which begs the question as to why a biopsy was ordered.]
Here's more info on that biopsy and the next two:
Bob's DRE in 2009 at 60: Linear nodule, L side
PSA: still 0.4-0.5 ng/ml....unchanged since 2006
2009: One positive needle in 12, Right lateral apex, Gleason Score 6 in 5%
2010: No positive needles so no Gleason Score; Right mid, HGPIN (High Grade Prostatic Intraepithelial Neoplasia); Right lateral mid, atypical cells
2011: Two positive needles in 12, Right lateral apex, Gleason Score 6 in 2% of sample and Right mid, Gleason Score 6 in 2% of sample Prostate size: normal at 25g
We're going the watchful waiting route, but the last biopsy results aren't exactly comforting. [This result does not move Bob out of the category of men where he would qualifiy for Active Surveillance.] Still, with such a small percentage of the cores positive, surgery seems out of the question since it's something Bob has been strongly opposed to from the beginning. Perhaps instead of the regular biopsy next year, he'll have a color doppler done.
For the past five years Bob has had some minor ED and urinary issues, but nothing problematic for either of us. Since being diagnosed, he has started eating more healthfully at home, but less so when he travels and I'm not around to bug him about it. About a year ago he started taking Vitamin D, and I plan on trying again, to get him to drink pomegranate juice daily. He exercises only two or three times per week; we'll have to try to increase that.
His dad died of colon cancer at age 72, and Bob had a few polyps removed two years ago. I suppose his dad had PCa, too, and never knew it, but we've been told that the colon is an unlikely place for PCa to metastasize. [I think it is unlikely that Bob's father died of prostate cancer on the basis of this evidence, but most men of 70 or older have prostate cancer cells - but not a fatal form of the disease.]
The initial diagnosis was scary for both of us, but we're hoping he's got a slowly progressing kind of prostate cancer , and that less invasive, affordable procedures will be available should he require one in the next five years.
Oct 2011 PSA = 0.6 We saw Dr. Fred Lee (Rochester Urology PC in MI) for a second opinion. He felt the same elongated nodule on DRE as other docs. Color Doppler US showed nothing suspicious in areas that were G3+3 (only 2-5%)in 3 of 36 cores on 2009 and 2011 biopsies. There was some increased color at periphery of prostate near the hypoechoic lesion (nodule), but he felt it was most likely a benign nodule since there was no cancer found in that area on Bob's three previous biopsies.
He believed Bob's PC is the indolent variety, and recommended biopsies only if Bob's PSA jumps or if he develops other symptoms. That was good news for us. Bob hasn't spoken with his urologist about his plan to stop the annual biopsies, and will discuss it with his internist in April. Although all the lit says that treatment is recommended under age 65, we're hoping our gut feeling, and Dr. Lee's opinion, that Bob's is a very slow-growing cancer prove to be correct. With my frequent reminders, Bob is still watching his diet, exercising, and knows he still has cancer.
PSA in April 2012 was 0.7. Bob had one done in fall 2012 but he did not record the result so it must have been the same or lower. He is due for another.....
Bob just had his blood drawn should have PSA results soon. Otherwise he's feeling fine.
Aug 2013 PSA was 0.8
July 2014 PSA was 0.6
Still assuming PC is the indolent kind so no more biopsies. Still continuing the veg-heavy diet. Probably exercising less which is not helping the pre-diabetes. (HbA1C remains at 6.0)
In December 2015 PSA was 0.8. In November 2016 it's 2.3. Will have a repeat done in a few weeks.
Have been reading about doubling time and wonder if, even with such a low PSA, the almost 3-fold increase is significant. Hate to start the biopsies again only to find the same--PCa exists but only a small % of cells in a small fraction of cores are positive. Would a pre-biopsy MRI help any? Or maybe a color Doppler biopsy? Still no symptoms, thankfully.
The repeat PSA done on 11/11 was 0.9 so Bob's continuing with active surveillance--no biopsy. He did say the 10/19 DRE seemed rougher than normal and his labs were drawn right after that. I'd also read that biking may cause an elevated PSA, so before the repeat Bob did not do his normal upright bicycling at the gym--only bike used was the recumbent. Next PSA will be done in 6 mos.
Correction: The PSA drawn on 10/19/16 (not November), after Bob's DRE, was 2.3. The repeat drawn on 11/11/16 was 0.9
Bob's e-mail address is: firstname.lastname@example.org