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PSA 6.5

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User
Posted 06 Mar 2018 at 22:37

Hi there 

I'm 51

Yesterday I got the results of my PSA test which is 6.5 

The GP then did a DRE and then said he was referring me to the Hospital for a scan and possible biopsy

The GP didn't comment on his DRE findings 

I've got hip pain and have had some unexplained weight loss which is unprecedented but not dramatic

I'm getting pretty scared just waiting for the appointment letter

Can anyone on here reassure me?

Cheers

 

User
Posted 07 Mar 2018 at 00:07

There are so many possible explanations other than cancer - no point getting in a tizz at this point. The GP would have been letting you down if he hadn't referred you for further checks. Weight loss is not commonly associated with prostate cancer and it would be extremely rare to have mets in your hip with a PSA of 6.5 so hopefully all will be well and you just have a bit of infection or an enlarged but benign prostate.

What made you have the PSA test? Was it routine or have you been having some symptoms that caused you to book an appointment with a doctor?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 07 Mar 2018 at 21:58

Originally Posted by: Online Community Member

 

What made you have the PSA test? Was it routine or have you been having some symptoms that caused you to book an appointment with a doctor?

Thank you for your reassurance.

 

I have been going to my GP with my concerns ever since I started to feel as though something was going wrong with me last autumn.

I had a colonoscopy in January that ruled out colon cancer

I have been having urinary problems for years now but they have got worse in the past year also I have an older brother who was diagnosed with Prostate Cancer 9 years ago.

I was offered a PSA test by a GP after discussing my concerns with them.

 

 On a lighter note:

A funny thing happened to me yesterday - I was at the opticians having a eye test.

At one point during the test the optician produced an instrument to look closely into my eyes to examine them for signs of disease.

As she positioned herself in front of me she directed my attention to the wall behind her upon which was projected a big black letter C.

She said "look at the big C"

I couldn't help but be amused and thought to myself - is this God's way of telling me something!

Edited by member 08 Mar 2018 at 10:59  | Reason: Not specified

User
Posted 09 Mar 2018 at 13:54

What a shame your GP didn’t discuss his findings (feelings!) with you following your rectal examination.

I recently had a multi-parametric MRI scan at 3T resolution (the best), and a subsequent template biopsy confirming cancer.

Two friends with PCa both said: Don’t let them palm you off with a TRUS biopsy (through the bowel and not accurate) which I was offered there and then on the day I met the consultant after the MRI.

I declined and was told the NHS waiting list for template was six months. “I’ll wait”.

In the event it was three weeks!

If you have to have a scan and subsequent biopsy I suggest you ask for the same investigations that I had, and if not available at your local hospital, travel to somewhere that does offer them.

Best of luck for a positive outcome (negative result!).

User
Posted 09 Mar 2018 at 16:20

Well I am sorry Bollinge but I don't think that is very good advice at all. You may have decided that you would prefer a template biopsy to a TRUS but that doesn't mean that it is better for everyone! And advice to travel elsewhere if the local hospital doesn't have mpMRI is rather OTT at this stage.

Lazarus, see what you are offered first - a TRUS biopsy before MRI scan is a bit like sticking pins in a cake and hoping to spear a cherry but if you are in an area where the scan is done first and the TRUS biopsy afterwards it is much more controlled as they can see where they want to take samples from. Many men (and doctors) would only consider a template biopsy if the scan and TRUS were both clear but PSA was still rising.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 09 Mar 2018 at 22:33

The TRUS scan is much less involved for both the medical team and the patient. For the local 'Trust' it is much quicker and less expensive and mostly what men are offered (at least originally) within the NHS. The Transperineal template biopsy is less likely to result in an infection than the TRUS which passes through the rectum. Also, because the needles are inserted through a grid (template), there is a better chance of finding tumours that are quite small. Much could depend on what the prior scan showed if done first. I have had both of these types of scan and given the need again and choice, on balance would opt for the template due to greater accuracy and less risk of infection. Some men occasionally have two negative TRUS biopsies and then when it is still believed there is cancer have a template one.

Barry
User
Posted 11 Mar 2018 at 01:20

I would have thought that you would have been advised if you were to have a biopsy at this initial meeting but I am pretty certain it wouldn't be a transperineal one. The latter requires that you attend a pre op appointment where you are assessed for suitability for this and for anesthesia. It's possible that blood and urine samples could be taken and a DRE done as may be decided by the consultant or the hospital protocol.

Barry
User
Posted 11 Mar 2018 at 07:02
I did not read my appointment letter properly until the night before my appointment, when I did it said the meeting would be with Mr X or one of his team and the possibility of a biopsy. I saw a registrar and the biopsy technician, signed a form and 20 minutes later was done,not in my top ten list of nice experiences but bearable and I had no post biopsy problems. A bit of blood in the urine and semen, back to work the next day. Hope all goes well.

Thanks Chris

User
Posted 11 Mar 2018 at 07:42

In Coventry and Warwickshire they have a “one stop shop” clinic after an MRI scan, inasmuch that the day you see the consultant to discuss your MRI results they rope you in for a TRUS biopsy there and then.

Having been advised by two friends separately to avoid such a procedure, I politely declined, and lo and behold, had a template biopsy three weeks later, despite there being “a six month wait” for one.

I am quite happy with the choice I made (but not with the result!). It’s all a matter of cost for the over-subscribed and under-funded NHS. TRUS is considerably cheaper than template, but template/transperineal is the gold standard. Another bonus is that template is under a general anaesthetic, so you don’t feel a thing. I had 42 cores sampled. Another guy on here said he was in agony after eight punctures during a TRUS and could stand no more.

The service and care at the hospital has been absolutely first class.

Edited by member 11 Mar 2018 at 08:27  | Reason: Not specified

User
Posted 17 Mar 2018 at 09:47

The gold standard for diagnosis is a multi-parametric MRI scan at 3 Tesla resolution followed by a transperineal biopsy targeted by the MRI imaging results.

That is exactly what I had, so thank you NHS. My friend had the same done privately and he paid about five grand as he was worried about NHS waiting lists. I had to only wait around eight or nine weeks from raised PSA to diagnosis.

User
Posted 24 Mar 2018 at 09:29

Yes, I had the same scan. The radiographers were two black guys from Eritrea, so I said “put some reggae on the headphones while I’m in the tunnel”. Did they buggery! All I heard was hideous grunge or house or garage mechanical “music”😂😂😂

They told me there was a “long” waiting list for the target biopsy after I (on the separate advice of two friends from different parts of the world) politely declined the rectal one on the day of the post MRI consultation. And in fact I had two letters from the hospital, one from the senior consultant, imploring me to go for a TRUS, one of which arrived the same time as a letter inviting me to go for pre-med tests prior to a general anaesthetic.

It’s purely down to money as a TRUS is so much cheaper. And the risk of infection of multiple piercings of the bowel is secondary to that. There is always a risk with a general anaesthetic, of course. In the event, I think I waited about three weeks.

Click on my profile for my latest good news - I’m not cured - yet!

Cheers,

John

User
Posted 24 Mar 2018 at 10:40

It is not purely down to money - it is not helpful to keep stating this like a fact as others starting the process may not realise that this is just the personal opinion of another newbie.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 24 Mar 2018 at 13:40

Lazarus - not dead yet to rise from, check out the posts here from the correspondent called “Rafael”. He had a Retzius-sparing prostatectomy a month ago by the same surgeon.

Of course you may not need any of that malarkey pending your MRI result, fingers crossed.

User
Posted 11 Apr 2018 at 14:49

Your consultant would have known the results of your MRI scan within a matter of days, and it seems a shame that you are left in the lurch worrying about the results.

If I were you, I would phone up the Urology department and ask a doctor or nurse to tell you the results of your MRI scan, sooner than leaving you in limbo for another two weeeks.

One would hope that the follow-up on the 26th is non-urgent, so maybe good news, but in the organised chaos that is the NHS today, who can say?

Fingers crossed🤞

User
Posted 13 Apr 2018 at 13:53

So, forget any hint of “good news”, except that you now have dates for a target biopsy and follow-up.

Transperineal biopsies are normally under general anaesthetic, unless your body cannot cope with one. Your MRI must have shown up what they euphemistically call an “abnormality” in your prostate, which may or not turn out to be benign.

Best of luck,

Cheers, John

User
Posted 13 Apr 2018 at 15:58
Hi, I had a transperineal biopsy under local anaesthetic, wasn't too painful Dr topped it up as and when needed, procedure took about 20 mins. My appointment was at 9am and I was home putting the kettle on at 10:30am.

I had some blood in urine for a couple of days and blood in semen for about a week after resuming sex, no big deal really. Don't let people stress you out.

Best wishes for a good outcome.

I have been told that I have BPH but time will tell.

Steve.

Edited by member 13 Apr 2018 at 16:14  | Reason: Not specified

User
Posted 14 Apr 2018 at 05:19

Matron,

I have a particular maxim in life, which is: “If I don’t know, I don’t say”. I have only ever commented on subjects of which I have specific knowledge, and the one time where I may have “got it wrong” was when a guy wrote that his PSA was 300 or something when he meant 0.03. I deleted that post, but in the event when he admitted his mistake I was absolutely correct in my initial comments.

You seem to regard this forum as your own personal fiefdom. You have been most helpful to sufferers on thousands of occasions, and are clearly extremely knowledgeable. Yet you have prejudices like telling me to “go to America” for treatment, against any criticism of the useless TRUS biopsy, about “rogue” surgeons opening their own private clinics, and against anyone with a sense of humour.

Leave me alone to deal with my cancer in my own way. Doing very nicely, actually!

User
Posted 14 Apr 2018 at 16:48

Billings, your problem is too many interventions in too many cases, leading to a tad too much assertiveness for one relatively inexperienced in this forum. I advise holding back and sticking to areas of where your personal knowledge will be helpful to the occasional reader. Over-exposure reduces the impact of your views, don't you think?

AC

User
Posted 23 Apr 2018 at 16:14

Louise, I deserve reporting for renaming Bollinge! But he's abstained since then so point must have been taken. Must learn not to trust the inbuilt spellchecker in Android!!

AC

User
Posted 26 Apr 2018 at 16:49

Lazarus, Good news (drop in PSA) is always welcome. I hope you get some more from the biopsy! At least then you will have firm knowledge rather than fears to take you forward.

Good luck!

AC

User
Posted 26 Apr 2018 at 18:57

It's unlikely Lazarus

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User
Posted 07 Mar 2018 at 00:07

There are so many possible explanations other than cancer - no point getting in a tizz at this point. The GP would have been letting you down if he hadn't referred you for further checks. Weight loss is not commonly associated with prostate cancer and it would be extremely rare to have mets in your hip with a PSA of 6.5 so hopefully all will be well and you just have a bit of infection or an enlarged but benign prostate.

What made you have the PSA test? Was it routine or have you been having some symptoms that caused you to book an appointment with a doctor?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 07 Mar 2018 at 21:58

Originally Posted by: Online Community Member

 

What made you have the PSA test? Was it routine or have you been having some symptoms that caused you to book an appointment with a doctor?

Thank you for your reassurance.

 

I have been going to my GP with my concerns ever since I started to feel as though something was going wrong with me last autumn.

I had a colonoscopy in January that ruled out colon cancer

I have been having urinary problems for years now but they have got worse in the past year also I have an older brother who was diagnosed with Prostate Cancer 9 years ago.

I was offered a PSA test by a GP after discussing my concerns with them.

 

 On a lighter note:

A funny thing happened to me yesterday - I was at the opticians having a eye test.

At one point during the test the optician produced an instrument to look closely into my eyes to examine them for signs of disease.

As she positioned herself in front of me she directed my attention to the wall behind her upon which was projected a big black letter C.

She said "look at the big C"

I couldn't help but be amused and thought to myself - is this God's way of telling me something!

Edited by member 08 Mar 2018 at 10:59  | Reason: Not specified

User
Posted 09 Mar 2018 at 13:54

What a shame your GP didn’t discuss his findings (feelings!) with you following your rectal examination.

I recently had a multi-parametric MRI scan at 3T resolution (the best), and a subsequent template biopsy confirming cancer.

Two friends with PCa both said: Don’t let them palm you off with a TRUS biopsy (through the bowel and not accurate) which I was offered there and then on the day I met the consultant after the MRI.

I declined and was told the NHS waiting list for template was six months. “I’ll wait”.

In the event it was three weeks!

If you have to have a scan and subsequent biopsy I suggest you ask for the same investigations that I had, and if not available at your local hospital, travel to somewhere that does offer them.

Best of luck for a positive outcome (negative result!).

User
Posted 09 Mar 2018 at 16:20

Well I am sorry Bollinge but I don't think that is very good advice at all. You may have decided that you would prefer a template biopsy to a TRUS but that doesn't mean that it is better for everyone! And advice to travel elsewhere if the local hospital doesn't have mpMRI is rather OTT at this stage.

Lazarus, see what you are offered first - a TRUS biopsy before MRI scan is a bit like sticking pins in a cake and hoping to spear a cherry but if you are in an area where the scan is done first and the TRUS biopsy afterwards it is much more controlled as they can see where they want to take samples from. Many men (and doctors) would only consider a template biopsy if the scan and TRUS were both clear but PSA was still rising.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 09 Mar 2018 at 22:33

The TRUS scan is much less involved for both the medical team and the patient. For the local 'Trust' it is much quicker and less expensive and mostly what men are offered (at least originally) within the NHS. The Transperineal template biopsy is less likely to result in an infection than the TRUS which passes through the rectum. Also, because the needles are inserted through a grid (template), there is a better chance of finding tumours that are quite small. Much could depend on what the prior scan showed if done first. I have had both of these types of scan and given the need again and choice, on balance would opt for the template due to greater accuracy and less risk of infection. Some men occasionally have two negative TRUS biopsies and then when it is still believed there is cancer have a template one.

Barry
User
Posted 10 Mar 2018 at 20:01

Originally Posted by: Online Community Member

What a shame your GP didn’t discuss his findings (feelings!) with you following your rectal examination.

Yes, I regret not asking him now.

After doing the DRE he just washed his hands and said he was going to refer to the Hospital for a scan and a biopsy.

I've had my appointment letter come through today.

Will the first Hospital appointment just be an initial consultation?

Will I have to go back for the actual scan and or biopsy?

PS thank you for your advice

User
Posted 10 Mar 2018 at 20:14

Originally Posted by: Online Community Member

 

Lazarus, see what you are offered first - a TRUS biopsy before MRI scan is a bit like sticking pins in a cake and hoping to spear a cherry but if you are in an area where the scan is done first and the TRUS biopsy afterwards it is much more controlled as they can see where they want to take samples from. Many men (and doctors) would only consider a template biopsy if the scan and TRUS were both clear but PSA was still rising.

 

Thank you for your advice.

What you have told me will help me I'm sure

Will I be given time to think about it before making my decision?

Will I even be given a choice?

My wife is going with me to the appointment which is great for moral support but I'm really wishing I had someone with me who has been through the process themselves 

User
Posted 10 Mar 2018 at 20:21

Originally Posted by: Online Community Member

The TRUS scan is much less involved for both the medical team and the patient. For the local 'Trust' it is much quicker and less expensive and mostly what men are offered (at least originally) within the NHS. The Transperineal template biopsy is less likely to result in an infection than the TRUS which passes through the rectum. Also, because the needles are inserted through a grid (template), there is a better chance of finding tumours that are quite small. Much could depend on what the prior scan showed if done first. I have had both of these types of scan and given the need again and choice, on balance would opt for the template due to greater accuracy and less risk of infection. Some men occasionally have two negative TRUS biopsies and then when it is still believed there is cancer have a template one.

 

Thanks for the info 

Sounds to me like the template biopsy is the better one in terms of greater accuracy and less complications.

Wonder if I'll be given a choice 

User
Posted 10 Mar 2018 at 21:31

I just want to thank the three people on here who have answered my posts.
I feel I know a bit more about it now thanks to what you have told me.
Ever since I've been having symptoms I have been pretty worried and scared that I might have cancer.
Now that I could be about to find out whether I have it I feel terrified and also quite depressed.
I just want to wish everyone on here the best of luck with it all.
I'll let you know how I get on with my first appointment at the Hospital later in the week.
I'm guessing the first appointment will just be talking with a doctor but to be honest I really don't know what to expect.
I'm grateful I will have my wife with me on that day and I have told my brothers one of which was diagnosed with prostate cancer 9 years ago.

User
Posted 11 Mar 2018 at 01:20

I would have thought that you would have been advised if you were to have a biopsy at this initial meeting but I am pretty certain it wouldn't be a transperineal one. The latter requires that you attend a pre op appointment where you are assessed for suitability for this and for anesthesia. It's possible that blood and urine samples could be taken and a DRE done as may be decided by the consultant or the hospital protocol.

Barry
User
Posted 11 Mar 2018 at 07:02
I did not read my appointment letter properly until the night before my appointment, when I did it said the meeting would be with Mr X or one of his team and the possibility of a biopsy. I saw a registrar and the biopsy technician, signed a form and 20 minutes later was done,not in my top ten list of nice experiences but bearable and I had no post biopsy problems. A bit of blood in the urine and semen, back to work the next day. Hope all goes well.

Thanks Chris

User
Posted 11 Mar 2018 at 07:42

In Coventry and Warwickshire they have a “one stop shop” clinic after an MRI scan, inasmuch that the day you see the consultant to discuss your MRI results they rope you in for a TRUS biopsy there and then.

Having been advised by two friends separately to avoid such a procedure, I politely declined, and lo and behold, had a template biopsy three weeks later, despite there being “a six month wait” for one.

I am quite happy with the choice I made (but not with the result!). It’s all a matter of cost for the over-subscribed and under-funded NHS. TRUS is considerably cheaper than template, but template/transperineal is the gold standard. Another bonus is that template is under a general anaesthetic, so you don’t feel a thing. I had 42 cores sampled. Another guy on here said he was in agony after eight punctures during a TRUS and could stand no more.

The service and care at the hospital has been absolutely first class.

Edited by member 11 Mar 2018 at 08:27  | Reason: Not specified

User
Posted 11 Mar 2018 at 10:02

Originally Posted by: Online Community Member

I would have thought that you would have been advised if you were to have a biopsy at this initial meeting but I am pretty certain it wouldn't be a transperineal one. The latter requires that you attend a pre op appointment where you are assessed for suitability for this and for anesthesia. It's possible that blood and urine samples could be taken and a DRE done as may be decided by the consultant or the hospital protocol.

 

Thank you Barry

I have just read the appointment letter and there is no mention of any procedures 

Edited by member 11 Mar 2018 at 10:03  | Reason: Not specified

User
Posted 11 Mar 2018 at 10:07

Originally Posted by: Online Community Member
I did not read my appointment letter properly until the night before my appointment, when I did it said the meeting would be with Mr X or one of his team and the possibility of a biopsy. I saw a registrar and the biopsy technician, signed a form and 20 minutes later was done,not in my top ten list of nice experiences but bearable and I had no post biopsy problems. A bit of blood in the urine and semen, back to work the next day. Hope all goes well.

Thanks Chris

 

Thanks Chris

I'm glad I'm not the only one who scan reads letters - it was my wife who pointed out to me that the Hospital was a different one to our usual one - so I might have turned up at the wrong Hospital!

I have just read the letter again and there is no mention of any procedures scans or biopsies.

User
Posted 11 Mar 2018 at 10:18

Originally Posted by: Online Community Member

In Coventry and Warwickshire they have a “one stop shop” clinic after an MRI scan, inasmuch that the day you see the consultant to discuss your MRI results they rope you in for a TRUS biopsy there and then.

Having been advised by two friends separately to avoid such a procedure, I politely declined, and lo and behold, had a template biopsy three weeks later, despite there being “a six month wait” for one.

I am quite happy with the choice I made (but not with the result!). It’s all a matter of cost for the over-subscribed and under-funded NHS. TRUS is considerably cheaper than template, but template/transperineal is the gold standard. Another bonus is that template is under a general anaesthetic, so you don’t feel a thing. I had 42 cores sampled. Another guy on here said he was in agony after eight punctures during a TRUS and could stand no more.

The service and care at the hospital has been absolutely first class.

 

Thank you Bolloinge 

I do appreciate your advice 

The appointment letter makes no mention of scans or biopsies so I am guessing it will be just a consultation, (if the truth be known probably mainly so the Hospital can meet it's two week urgent referral deadline!)

I will report back after I have had my first appointment on Thursday.

You raise a very important point regarding the under resourced NHS and the quality of care available to it's patients.

I'm sorry about your diagnosis and I am grateful for you taking the time and using your knowledge and experience to advise me on here.

Thanks again.

User
Posted 11 Mar 2018 at 10:23

No Bollinge, you should desist from putting your opinion as if it is fact! It is not acceptable, as new posters have no idea that you are also new. In your opinion, template biopsy is the gold standard. But the one stop shop clinic that your American friends advised you against, we were celebrating in the news last week as the way forward. It is not just a matter of cost - it is also about unnecessary general anaesthesia. And it is certainly unhelpful to tell another poster that something is going to be agony when you haven’t even experienced it yourself.

Lazarus, the vast majority report that the biopsy was nowhere near as painful as imagined, and felt somewhat like being flicked with an elastic band.

Edited by member 11 Mar 2018 at 10:25  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 11 Mar 2018 at 10:57

They are not my American friends, Matron, neither of whom have PCa, the advice came from friends in England who both have it and have had to endure a TRUS biopsy and then a subsequent template biopsy for improved accuracy.

I knew I had made the right decision when I met a guy on the recovery ward who had just had a template like me. He had had a TRUS last August which was not accurate enough so he had to wait nearly six months for a template before being sent off to Cambridge for specialist treatment of his very aggressive cancer.

The small risk from general anaesthesia has to be balanced against the risk of perforating the bowel in multiple locations and chance of infection thereafter.

Edited by member 11 Mar 2018 at 12:03  | Reason: Not specified

User
Posted 11 Mar 2018 at 16:59

Even 10 years ago, the standard biopsy was transperineal, as in my case, in Coventry and Warwickshire, and as Lyn said was like being flicked repeatedly with an elastic band. No big deal. And this post IS based on experience.

AC

User
Posted 12 Mar 2018 at 01:35

Originally Posted by: Online Community Member

Even 10 years ago, the standard biopsy was transperineal, as in my case, in Coventry and Warwickshire, and as Lyn said was like being flicked repeatedly with an elastic band. No big deal. And this post IS based on experience.

AC

 

Did you mean TRUS AC?  If your experience of the biopsy was of being flicked by a band you would not have known as you are normally put 'under' or on rare occassions given an epidural with the transperineal biopsy

Barry
 
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