complexed psa when to repeat biopsy

I've gotten a lot of help from the group, now I'm asking for a few more
comments.
My PSA history is below. Back in March 2006 I had a biopsy, 14 cores, of
which two were directed.
Only finding was chronic prostatits in one core. (A bit late, I know, but
I've had the slides sent to Epstein at Johns Hopkins this week.)

The 2.8 PSA prompted the biopsy.
My last November reading was 3.9, just had a repeat PSA this week, waiting
for the results.
This time I asked for complexed PSA and free PSA, just wondering if the
group would recommend any other tests.
I have an appointment with a urologist for Feb 14th (valetines day).
If I luck out this time, I'm thinking of being followed by a urologist.

Just thought I'd see if there's anything else I should be looking it.
I've been on an antibiotic, so I'm hoping if the PSA comes down we'll hold
off on another biopsy, also thought I'd read something by Dr. Catalona
recommending holding off on a repeat biopsy
after a 12 core biopsy for at least a year.

Just looking for comments/recommendations, and probably a bit nervous --
again.

Thanks,
Ed
(PSA history is below).
11/08/2006 3.9
3/20/2006 2.8
1/11/2006 2.5
11/2005 1.9
9/2005 5.4
1/2004 1.6
2/2002 1.5
6/2001 1.2
10/2000 1.1
9/1999 1.0

Ed:

Have your docs noticed anything from DREs?

--charlie

Charlie,
Thanks. Nothing on DRE's. Not this November by my Internist, nor with URO
last year.
I should add, my age is 59 and my prostate size is about 30 (from
ultrasound).
Ed
"chasjac" <chjacobson@elmira.edu> wrote in message
news:1168608529.920887.110380@a75g2000cwd.googlegr oups.com...
> Ed:
>
> Have your docs noticed anything from DREs?
>
> --charlie
>

"Ed Kratz" <ekratz2@earthlink.net> wrote in message
news:0oLph.9990$w91.9144@newsread1.news.pas.earthl ink.net...

> I've gotten a lot of help from the group, now I'm asking for a few more
> comments.

Welcome back, Ed. I think it was a good idea getting the fPSA test and will
be curious to see what it says. However, prostate cancer is the least
likely diagnosis, as I understand it, with your type of progression. And,
since you have already been diagnosed with chronic prostatitis, I suspect
that is the only culprit.

That said, you will probably have a life of continuing worries that the next
biopsy will reveal cancer. I just don't know how to get around that.

On the other hand, if it is cancer, at 3.9 PSA or higher, any future
biopsies should be a lot more certain of finding it. But, I wouldn't mess
around with a 12-core biopsy unless there is concern about turning your
prostate and colon into swiss cheese.




--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA .1 .1 .1 .27 .37 .75
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32
Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05,
2/06, 6/06
PSA .07 .05 .06 .09 .08 .132 .145
Casodex added daily 07/06
PSA <0.04
Non Illegitimi Carborundum

Steve,
Thanks for the comments.
You're right about the continuing worries, but I tend to worry anyway. My
new technique is to try to ignore something until the next test. For
example, when I got the 3.9 result in early November, I decided -- based
upon the prior biopsy and what I've found in the group --- rushing to get a
second PSA before New Year's would only sour my holidays and wasn't
critical, so I opted for the repeat PSA in January.
Now I'm just waiting for the results.
I have been lurking in the group for some time.
As I had said earlier, the more I know -- or think I do -- the more
empowered I feel, and the more ready I am to ask good questions -- or asks
for tests like the free PSA and complexed PSA.
I also wish I had determined to be followed by a urolgist, rather than my
internist. He's great, but he's an internist.
I hope I like the urologist I see Feb 14th, unless my PSA is exceptionally
high, in which case I'll move on to other options.
Thanks again, and good luck to you.

Ed


"Steve Kramer" <skramer@cinci.rr.com> wrote in message
news:45a8cdff$0$5145$4c368faf@roadrunner.com...
>
>
> "Ed Kratz" <ekratz2@earthlink.net> wrote in message
> news:0oLph.9990$w91.9144@newsread1.news.pas.earthl ink.net...
>
>> I've gotten a lot of help from the group, now I'm asking for a few more
>> comments.
>
> Welcome back, Ed. I think it was a good idea getting the fPSA test and
> will be curious to see what it says. However, prostate cancer is the
> least likely diagnosis, as I understand it, with your type of progression.
> And, since you have already been diagnosed with chronic prostatitis, I
> suspect that is the only culprit.
>
> That said, you will probably have a life of continuing worries that the
> next biopsy will reveal cancer. I just don't know how to get around that.
>
> On the other hand, if it is cancer, at 3.9 PSA or higher, any future
> biopsies should be a lot more certain of finding it. But, I wouldn't mess
> around with a 12-core biopsy unless there is concern about turning your
> prostate and colon into swiss cheese.
>
>
>
>
> --
> PSA 16 10/17/2000 @ 46
> Biopsy 11/01/2000 G7 (3+4), T2c
> RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
> PSA .1 .1 .1 .27 .37 .75
> EBRT 05-07/2002 @ 47
> PSA .34 .22 .15 .21 .32
> Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05,
> 2/06, 6/06
> PSA .07 .05 .06 .09 .08 .132 .145
> Casodex added daily 07/06
> PSA <0.04
> Non Illegitimi Carborundum
>
>
>

Ed Kratz wrote:
> I've gotten a lot of help from the group, now I'm asking for a few more
> comments.
> My PSA history is below. Back in March 2006 I had a biopsy, 14 cores, of
> which two were directed.
> Only finding was chronic prostatits in one core. (A bit late, I know, but
> I've had the slides sent to Epstein at Johns Hopkins this week.)
>
> The 2.8 PSA prompted the biopsy.
> My last November reading was 3.9, just had a repeat PSA this week, waiting
> for the results.
> This time I asked for complexed PSA and free PSA, just wondering if the
> group would recommend any other tests.
> I have an appointment with a urologist for Feb 14th (valetines day).
> If I luck out this time, I'm thinking of being followed by a urologist.
>
> Just thought I'd see if there's anything else I should be looking it.
> I've been on an antibiotic, so I'm hoping if the PSA comes down we'll hold
> off on another biopsy, also thought I'd read something by Dr. Catalona
> recommending holding off on a repeat biopsy
> after a 12 core biopsy for at least a year.
>
> Just looking for comments/recommendations, and probably a bit nervous --
> again.
>
> Thanks,
> Ed
> (PSA history is below).
> 11/08/2006 3.9
> 3/20/2006 2.8
> 1/11/2006 2.5
> 11/2005 1.9
> 9/2005 5.4
> 1/2004 1.6
> 2/2002 1.5
> 6/2001 1.2
> 10/2000 1.1
> 9/1999 1.0

Hi Ed...The PSA=5.4 seems aberrant and may well be due to prostatitis;
however, the rest of the data appears very well-behaved. Prior to
09/05, the data is linear with a doubling time of about 5 years. After
09/05, the data is again linear, but now with a doubling time around 1
year. Prostatitis may well be involved, but there appears to be an
underlying, orderly PSA progression. About 20% of the time the largest
tumor is present in areas not sampled by TRUS biopsy. If the current
test result comes back elevated, perhaps a targeted biopsy using color
doppler ultrasound would be informative. CDUS has the advantage of
being able to visualize the entire prostate, not just the peripheral
zone. In any case you are wise to keep following-up as you are doing.
Wishing you a low PSA...ron

Ed:

I'll be following your story with great interest.

My husband had an 18 (actually 19 according to the pathology report --
I think one piece fell apart) core biopsy in 8/2006 after his PSA rose
from 1.8 (in November 2005) to 2.6 (in June 2006). The biopsy was
negative -- no HGPIN, atypia and "scarcely any inflammation" to quote
the report

As part of the June 2006 blood work, he had a free PSA test done. The
result was 11.5 which was alarmingly low. He goes for his first post
biopsy PSA and free PSA blood test this week and has a follow-up
appointment with the uro on 1/29.

He also had a PCA3Plus urine based test sent to Bostwick Labs. His
result was 27.2, which at the time Bostwick labeled as "positive".
However, Bostwick has changed their threshold for "positive" results to
> 35 (It was > 10 last summer) so his 27.2 result would now be "negative" per their website.

http://www.bostwicklaboratories.com/about/PCA3.pdf

I have been trying to lookup criteria and timing recommendations for a
repeat biopsy, if one needs to be done.

Good luck. I'll be watching for your report.

CW89134
__________________________________________________ __________________


Ed Kratz wrote:
> I've gotten a lot of help from the group, now I'm asking for a few more
> comments.
> My PSA history is below. Back in March 2006 I had a biopsy, 14 cores, of
> which two were directed.
> Only finding was chronic prostatits in one core. (A bit late, I know, but
> I've had the slides sent to Epstein at Johns Hopkins this week.)
>
> The 2.8 PSA prompted the biopsy.
> My last November reading was 3.9, just had a repeat PSA this week, waiting
> for the results.
> This time I asked for complexed PSA and free PSA, just wondering if the
> group would recommend any other tests.
> I have an appointment with a urologist for Feb 14th (valetines day).
> If I luck out this time, I'm thinking of being followed by a urologist.
>
> Just thought I'd see if there's anything else I should be looking it.
> I've been on an antibiotic, so I'm hoping if the PSA comes down we'll hold
> off on another biopsy, also thought I'd read something by Dr. Catalona
> recommending holding off on a repeat biopsy
> after a 12 core biopsy for at least a year.
>
> Just looking for comments/recommendations, and probably a bit nervous --
> again.
>
> Thanks,
> Ed
> (PSA history is below).
> 11/08/2006 3.9
> 3/20/2006 2.8
> 1/11/2006 2.5
> 11/2005 1.9
> 9/2005 5.4
> 1/2004 1.6
> 2/2002 1.5
> 6/2001 1.2
> 10/2000 1.1
> 9/1999 1.0

Ron,
Thanks for your comments. The biopsy I had wasn't a color doppler
ultrasound, but was a clinical trail of adding
a contrast agent to the ultrasound, and two of the spots were directed
biopsies. I've been trying to find a report of the trial but haven' t found
it yet.
One other item I should add is that I rode an exercise
bike the day before the biopsy (I know, dumb, but I sort
of forgot.) The day I had the 5.4 I rode the bike in the morning.
But regardless, I am concerned about the rising PSA, even to 2.8
I'm glad I have an appointment with a URO, even if it's Feburary. Even if
my PSA comes down, I think being followed by a urologist is a good idea.
Ed
"ron" <oitbso@yahoo.com> wrote in message
news:1168709986.098940.170930@m58g2000cwm.googlegr oups.com...
> Ed Kratz wrote:
>> I've gotten a lot of help from the group, now I'm asking for a few more
>> comments.
>> My PSA history is below. Back in March 2006 I had a biopsy, 14 cores, of
>> which two were directed.
>> Only finding was chronic prostatits in one core. (A bit late, I know, but
>> I've had the slides sent to Epstein at Johns Hopkins this week.)
>>
>> The 2.8 PSA prompted the biopsy.
>> My last November reading was 3.9, just had a repeat PSA this week,
>> waiting
>> for the results.
>> This time I asked for complexed PSA and free PSA, just wondering if the
>> group would recommend any other tests.
>> I have an appointment with a urologist for Feb 14th (valetines day).
>> If I luck out this time, I'm thinking of being followed by a urologist.
>>
>> Just thought I'd see if there's anything else I should be looking it.
>> I've been on an antibiotic, so I'm hoping if the PSA comes down we'll
>> hold
>> off on another biopsy, also thought I'd read something by Dr. Catalona
>> recommending holding off on a repeat biopsy
>> after a 12 core biopsy for at least a year.
>>
>> Just looking for comments/recommendations, and probably a bit nervous --
>> again.
>>
>> Thanks,
>> Ed
>> (PSA history is below).
>> 11/08/2006 3.9
>> 3/20/2006 2.8
>> 1/11/2006 2.5
>> 11/2005 1.9
>> 9/2005 5.4
>> 1/2004 1.6
>> 2/2002 1.5
>> 6/2001 1.2
>> 10/2000 1.1
>> 9/1999 1.0
>
> Hi Ed...The PSA=5.4 seems aberrant and may well be due to prostatitis;
> however, the rest of the data appears very well-behaved. Prior to
> 09/05, the data is linear with a doubling time of about 5 years. After
> 09/05, the data is again linear, but now with a doubling time around 1
> year. Prostatitis may well be involved, but there appears to be an
> underlying, orderly PSA progression. About 20% of the time the largest
> tumor is present in areas not sampled by TRUS biopsy. If the current
> test result comes back elevated, perhaps a targeted biopsy using color
> doppler ultrasound would be informative. CDUS has the advantage of
> being able to visualize the entire prostate, not just the peripheral
> zone. In any case you are wise to keep following-up as you are doing.
> Wishing you a low PSA...ron
>

Thanks for your comments. Good luck to you and your husband. I'll post
with the results of my tests when I get them.
I'd be cuious what happens with your husband. Let us know.

Ed

"CW89134" <cwarman89134@gmail.com> wrote in message
news:1168711715.134382.71900@s34g2000cwa.googlegro ups.com...
> Ed:
>
> I'll be following your story with great interest.
>
> My husband had an 18 (actually 19 according to the pathology report --
> I think one piece fell apart) core biopsy in 8/2006 after his PSA rose
> from 1.8 (in November 2005) to 2.6 (in June 2006). The biopsy was
> negative -- no HGPIN, atypia and "scarcely any inflammation" to quote
> the report
>
> As part of the June 2006 blood work, he had a free PSA test done. The
> result was 11.5 which was alarmingly low. He goes for his first post
> biopsy PSA and free PSA blood test this week and has a follow-up
> appointment with the uro on 1/29.
>
> He also had a PCA3Plus urine based test sent to Bostwick Labs. His
> result was 27.2, which at the time Bostwick labeled as "positive".
> However, Bostwick has changed their threshold for "positive" results to
>> 35 (It was > 10 last summer) so his 27.2 result would now be "negative"
>> per their website.
>
> http://www.bostwicklaboratories.com/about/PCA3.pdf
>
> I have been trying to lookup criteria and timing recommendations for a
> repeat biopsy, if one needs to be done.
>
> Good luck. I'll be watching for your report.
>
> CW89134
> __________________________________________________ __________________
>
>
> Ed Kratz wrote:
>> I've gotten a lot of help from the group, now I'm asking for a few more
>> comments.
>> My PSA history is below. Back in March 2006 I had a biopsy, 14 cores, of
>> which two were directed.
>> Only finding was chronic prostatits in one core. (A bit late, I know, but
>> I've had the slides sent to Epstein at Johns Hopkins this week.)
>>
>> The 2.8 PSA prompted the biopsy.
>> My last November reading was 3.9, just had a repeat PSA this week,
>> waiting
>> for the results.
>> This time I asked for complexed PSA and free PSA, just wondering if the
>> group would recommend any other tests.
>> I have an appointment with a urologist for Feb 14th (valetines day).
>> If I luck out this time, I'm thinking of being followed by a urologist.
>>
>> Just thought I'd see if there's anything else I should be looking it.
>> I've been on an antibiotic, so I'm hoping if the PSA comes down we'll
>> hold
>> off on another biopsy, also thought I'd read something by Dr. Catalona
>> recommending holding off on a repeat biopsy
>> after a 12 core biopsy for at least a year.
>>
>> Just looking for comments/recommendations, and probably a bit nervous --
>> again.
>>
>> Thanks,
>> Ed
>> (PSA history is below).
>> 11/08/2006 3.9
>> 3/20/2006 2.8
>> 1/11/2006 2.5
>> 11/2005 1.9
>> 9/2005 5.4
>> 1/2004 1.6
>> 2/2002 1.5
>> 6/2001 1.2
>> 10/2000 1.1
>> 9/1999 1.0
>