because the PSA results are almost random numbers. Anyone who tells you otherwise is misleading you. Two different doctors told me my PSA numbers weren't reliable, but just to be safe they both suggested a biopsy, both saying its very likely going to be a complete waste of time. Not because they knew anything, but because they are unsure about everything when it comes to PSA and prostate cancer, so they take the most conservative approach possible. I don't mind a colonoscopy every 10 years to make sure nothing's going on in there, but the prostate biopsy is a completely different and far more invasive procedure, so its a shame that they have to do so many of them because of an unreliable indicator like PSA being all they have to go on.
Prostate too large?
- Thread starter STmark1300
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OP
OP
STmark1300
Ron
"If you like having a dart gun shot up your ass 10 or 12 times, and pissing and ejaculating blood for a few days, I highly recommend the prostate biopsy."
I told my wife it felt like a 22. going off 12 times.
I told my wife it felt like a 22. going off 12 times.
OP
OP
STmark1300
Ron
My wife just found a steam treatment for large prostates. Yahoo. Surgery is on hold immediately.
OldWingit
Ed Wing
Back on subject. PSA tests may not be fool proof but when mine jumped from below 4 to 6 it saved my life nine years ago. I had very aggressive cancer and without it I would never have been alive to be the oldest ST1300 rider on this site at 84. Don't pay attention to your PSA at your own risk.
Ed
Ed
I don't think the message has been to ignore the PSA entirely, but rather to understand it's a notoriously unreliable test and ask lots of questions to avoid over-reacting to a small change in value. There are many sources online that give statistical descriptions of probabilities of unnecessary biopsies, over-treatment of benign cancers, etc. after reacting to a PSA value change. Reading a few of them to educate yourself on the reliability of the PSA screening is helpful to making an informed decision. There are also other alternatives to biopsies these days, which are also mentioned in the literature, so ask your doctor about them if and when he recommends a biopsy.
OP
OP
STmark1300
Ron
I am just sorting my way through this stuff. I am not telling anyone what they should do, nor would I judge that. Sounds like the Finasteride would have been a good way to go. I went to surgeon and he suggest surgery...surprise surprise. I do have cancer but it's only stage 1 out of 5. I want the least invasive solutions. Maybe it's the new steam treatment.
OldWingit
Ed Wing
My doctor described the biopsy test this way. You are floating around a large swimming pool in a raft and a dozen times you jab your ore into the water. You may or may not hit the problem spot. I my case they found it right away and it wasn't good at a nine Gleason.
Ed
Ed
my urologist explained it a lot differently than your swimming pool analogy, he claimed something like 80-90% coverage with one biopsy, 90-95% with two, and 95-98% with three, or something along those lines. In my case I seem to recall they used an ultrasound to help aim at various angles and cover as much of the prostate area as possible. Also, as they take more samples the chances increase that there's either nothing to find, or whatever they might have missed is very small.
I read an article that claimed because the PSA numbers are such an imperfect indicator, only 20% of the biopsies detect a dangerous cancer, so you fell into that category that makes the whole procedure worth it. Another 60% have no cancer at all, which appears to be my category, and 20% have cancer, but in a form that isn't really dangerous and doesn't benefit from further treatment. The majority of prostate cancers are the non-aggressive form that isn't all that life threatening unless you're young enough to have several decades of life remaining.
I read an article that claimed because the PSA numbers are such an imperfect indicator, only 20% of the biopsies detect a dangerous cancer, so you fell into that category that makes the whole procedure worth it. Another 60% have no cancer at all, which appears to be my category, and 20% have cancer, but in a form that isn't really dangerous and doesn't benefit from further treatment. The majority of prostate cancers are the non-aggressive form that isn't all that life threatening unless you're young enough to have several decades of life remaining.
OP
OP
STmark1300
Ron
That's what my docs said, mine is non-aggressive. If it was we would know by now. I checked into the steam therapy. Looks promising but my prostate is to large according to the FDA. Surgery certainly has it's risks. I appreciate all your input. I think at this point I am beyond other options.
Upon having a long over do check up I included the p.s.a blood test which came back with a low 4 reading and 5+ reading on a second later test. Very low numbers , but still concerning . Had a physical examination and was told the prostrate appeared to be normal in size and shape later verified by ultra sound to be ok. I was convinced to do a biopsy which confirmed cancer but determined to be low on the aggression scale. Postponed surgery for 6 months , had the prostrate removed and pathology later proved to be a extremely aggressive cancer , but contained only inside not on the margins of the prostrate. Follow up radiation to ensure all bases were covered. You can never trust the numbers, physical examines and pathology completely . My surgeon did a remarkable job , and Canada 's leading cancer hospital Princess Margaret provided the rest . Sorry for long thread .
Glad you had the biopsy and surgery.
Here's to your health.
Here's to your health.
I suppose you all know this already..... an enlarged prostate surrounds the urethra essentially making it too small, and causes you to go pee more often because you can't empty your bladder. The bladder always has something in the tank when it should be empty, and when more goes in you have to go. My urologist did a procedure where they put a small camera up your penis/urethra and take a good look around. He had done a manual prostate exam and stated it wasn't cancerous, and the camera was to confirm everything, I watched it on a hi-res monitor while he explained it to me...... I didn't see that anyone has mentioned that yet...... that option should be available to you I would think.
Hope you are joking about this Ray, but I suspect you are not. And you were awake for this???
On second thought, how the heck is a camera gonna see the prostate from inside that passageway?
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No joke. A little bit of numbing past on the end of the camera, in it goes. Slick, totally painless, takes all of 10 minutes. You're right, only see the urethra and bladder. The standard procedure is (was?) to scrape material off to enlarge the tube, then 3 weeks of itching and burning as recovery. New way is laser, much faster, no recovery time. But, doc will put you on Flowmax or Rapiflow meds first.
ReSTored
Site Supporter
Prior to retirement I spent my last 5 years working in a large public health laboratory and often heard discussions amongst clinicians re a specific diagnostic test's sensitivity and specificity. Every test has 4 possible results; true positive, false positive, true negative and false negative. Most routine and relatively non invasive tests, the PSA included, are just screening tests and not always terribly accurate. With the PSA test a false positive is a high PSA value(s) which leads your MD to recommend a confirmatory test or prostate biopsy. If you have a PSA that led to a needle biopsy that came back negative you're probably going to be pretty relieved, initially, and then likely very unhappy you had to go through the procedure. PSA tests are generally accepted to generate a lot of false positives. The alternative, of course, is to not do a PSA test or to decide to not do a confirmatory test if your PSA test numbers are such that your MD recommends a biopsy. After all, it really is your choice.
Our local plumber up at the cottage was one of those guys who only went to the MD when he absolutely had to and he thought the PSA test was a waste of time. When his pelvic pain got to a point where he could no longer stand it he went to his MD and through a series of tests got a diagnosis of advanced prostate cancer. Over a period of 10 years he had chemo, radiotherapy, a radical prostatectomy with many complications, a remission for a period of time and then cancer popped up in a number of other areas. Given his initially diagnosis he lived a very long time and died last May in a lot of pain.
The procedure Ray describes is a cystoscopy where a rigid scope with a small fiber optic cable for light and a CCD camera on the end of it is passed down (up??) the urethra. The scope has a number of channels and you can pass long thin instruments down it to do a transurethral resection of the prostate or TURP if necessary. With apologies to Ray's MD I'm pretty certain that a digital exam of the prostate and a cystoscopy does not exclude prostate cancer.
Given what I hear from people in general when there is discussion about medical issues, tests to be done and then results I think many don't have a good understand about the various types of tests that are out there and if a diagnostic test a screening test or a confirmatory test and just what is the relative accuracy of the test result itself. Sensitivity and specificity info is available on the web for every test out there. All patients want all tests to generate 100% accurate true positives and true negatives. Unfortunately, it just doesn't work that way.
Our local plumber up at the cottage was one of those guys who only went to the MD when he absolutely had to and he thought the PSA test was a waste of time. When his pelvic pain got to a point where he could no longer stand it he went to his MD and through a series of tests got a diagnosis of advanced prostate cancer. Over a period of 10 years he had chemo, radiotherapy, a radical prostatectomy with many complications, a remission for a period of time and then cancer popped up in a number of other areas. Given his initially diagnosis he lived a very long time and died last May in a lot of pain.
The procedure Ray describes is a cystoscopy where a rigid scope with a small fiber optic cable for light and a CCD camera on the end of it is passed down (up??) the urethra. The scope has a number of channels and you can pass long thin instruments down it to do a transurethral resection of the prostate or TURP if necessary. With apologies to Ray's MD I'm pretty certain that a digital exam of the prostate and a cystoscopy does not exclude prostate cancer.
Given what I hear from people in general when there is discussion about medical issues, tests to be done and then results I think many don't have a good understand about the various types of tests that are out there and if a diagnostic test a screening test or a confirmatory test and just what is the relative accuracy of the test result itself. Sensitivity and specificity info is available on the web for every test out there. All patients want all tests to generate 100% accurate true positives and true negatives. Unfortunately, it just doesn't work that way.
OP
OP
STmark1300
Ron
Well, I had sent a letter to a Dr. at the Mayo Clinic last Firiday. I told him some of my specifics and said if I am a candidate for the steam treatment, let me know. He called today and said no your prostate is not to large and I have done others that size. Answered prayer. So I will be making an appointment there. Down time is a few days as opposed to 6 weeks. What a relief. Also with out all the risk of complications.
nobody expects 100% accuracy, what's been discussed here is the relatively poor performance of the PSA test in general as an indicator of cancer, as a cautionary statement regarding how to proceed if your PSA numbers change. Here's an excerpt from the Univ. of Chicago website, it pretty much mirrors dozens of others.
Due to concerns about overdiagnosis and overtreatment, in 2012, the United States Preventive Services Task Force (USPSTF) discouraged PSA screening in healthy men of all ages, a “D” recommendation.
In May 2018, the USPSTF upgraded the recommendation to a “C,” denoting men between the ages of 55 to 69 at average risk of developing prostate cancer should discuss the benefits and harms of screening with their doctor, so they can make the best choice for themselves based on their values and individual circumstances. For men 70 and older, the USPSTF recommends against routinely screening for prostate cancer. Other groups, such as the American Cancer Society, state that overall health status, not age alone, is important when making decisions about screening.
Scott Eggener, MD, Professor of Surgery (Urologic Oncology), believes the PSA test remains valuable for potentially saving lives, but he and other urology experts at UChicago Medicine take a sensible approach. “Every man who has a life expectancy estimated to be greater than 10 years should at least have the conversation with their physician about the pros and cons of checking their PSA levels,” Eggener said. “Not every man needs a PSA, not every man with an elevated PSA needs a biopsy, and not every man with cancer necessarily needs immediate treatment.”
Now THAT is impressive!
