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Newly Diagnosed

Prostate Canc er Patient Guide

Prostate Cancer Patient Guide is compiled with the contributions of top-tier doctors and researchers in prostate cancer, and is a must-have resource. EXCELLENT PUBLICATION!

What do I do if my PSA is rising? Here are some recommended diagnostic steps

Some great thoughts below from a respected fellow member of the MNPCC.ORG, Rob Hardcopf.  These are suggestions for your diagnostic process to use prior to treatment decisions are made.

1: The PSA reading is just a number, by its self it doesn’t mean much. Some non-aggressive cancers can express larger amounts of PSA. While some aggressive cancers can express lesser amounts of PSA.  Don’t get hung up on what the number is. What you want to know is how much it’s changed and how fast it’s changing, (PSA Doubling time).

    The PSA number can be affected by a number of things like, Sex right before, riding a bike, and there are some others. So, when getting a blood draw for the PSA know what those things are and refrain from them for a day or two before. Also, it can change from day to day, due to activity of the prostate gland, so get it at the same time, each time you have it taken, normally in the morning. (This may or may not be true, but to eliminate any doubt I have done at the same time of day).  

     A higher-than-normal reading can be caused by a few things. 1: BPH (enlarged Prostate), Prostatitis (infection or injury) or Cancer. The goal is to find out which of those it is. 

2: Know your family history. If you have a brother, father and then Uncles that had Prostate Cancer it raises our level of concern. Any, and our chances of getting cancer goes up by about 60%. 

3: Getting a DRE might be the next step in checking for Cancer. Up until the PSA test it was the only way a Doctor could tell if something was going on in the Prostate. Not all prostate issues show up as urinary problems. This will only show something if it’s getting to the later stages. 

Here’s the video that explains the steps pretty well.  https://youtu.be/ZUSkWb5QP8A

The following steps will help determine if a biopsy is needed, which I feel should be the last step in the chain. 

4: PSA Density (prostate volume divided the PSA number) 10%-15% or below is normal. So, for a guy with a 100cc volume any reading less than 10 would be normal. I would think an ultrasound or MRI can tell the Prostate Volume; a DRE can’t do it. 

5: Get some blood tests done like the OPKO 4Kscore, or SelectMDX, EXODX. If one or both of these indicate a concern then you can proceed further. 

6: MRI

Next would be to get an MRI of the Prostate. Some doctors will skip right to this after a higher-than-normal PSA reading. There are a number of options when it comes to MRI’s. I feel the best is the mpMRI, but discuss the options with your Doctor. Some doctors aren’t up on this, so if not, then find another Urologist who is. 

The AUA (American Urological Association) has updated their guidelines to recommending the MRI prior to doing any Biopsy. You can look this up on the internet to find the paper. 

Here’s a link to it: https://www.urotoday.com/recent-abstracts/urologic-oncology/prostate-cancer/115993-update-of-the-aua-policy-statement-on-the-use-of-multiparametric-magnetic-resonance-imaging-in-the-diagnosis-staging-and-management-of-prostate-cancer.html

7: Lastly would be a targeted Biopsy, they go in and sample only the areas of concern using the MRI to guide them, but maybe also the other areas of the Prostate that maybe the MRI didn’t show. Here again there are options as to what type of Biopsy you can get. The link below talks about them. Discuss them with your Doctor to decide what’s best, and why. 

 Here’s a video of the different types of Biopsy. They show the basic 4 different types. 

https://www.youtube.com/watch?v=qVIEQa_vM7o

This has been kind of the list to proceed by. 

If a Doctor recommends against one of these tests most time, they don’t have the ability to do them at their hospital or clinic. Ask them if they do. A lot of times the Insurance company dictates what will be paid for. I’ve paid for somethings out of pocket if I felt there was a great enough need, and I could afford it. Ask those questions also. 

Just remember these are my thoughts, and I’m not a medical expert. They are worth what you paid for them. Take them only as a guide to use to ask questions of your doctor. With that make your own decisions, but be part of the process.  

Rob Hardcopf, March 2022

 

Shown below is a link to the USTOO web site section on "Newly Diagnosed" Prostate Cancer patients (diagnosis, staging, risk assessment, what to expect, questions for your doctor, finding support, etc.)