loissolomon@myself.com

I'm writing on behalf of my husband since he is in an absolute panic
state at this point. Some background - Steve is almost 50 and had
gone in for a physical exam with his regular doctor. At the time, the
doctor noted two things on the exam - an enlarged prostate and blood
in the stool. Steve was able to make a quick appointment with a
Gastroenterologist and a follow-up colonoscopy revealed two polyps
which after being removed and tested and were found to have high-grade
dysplasia. Doctor feels he removed them successfully and scheduled a
follow-up appointment in three months just to make sure. Doctor does
say it was lucky he got this tested when he did since it would have
definitely turned into Colin cancer. In between appointments, he also
went to a Urologist to follow up on the enlarged prostate. He has
been having symptoms such as nighttime frequency, weak flow, some
erectile disfunction, etc. Urologist sent him for a PSA test (his
first) and it came back as 12.4 ng. When Steve returned to the
Urologist he found out these results. In addition the Urologist did a
DRE and tested urinary function. DRE showed a slightly enlarged
prostate but Uro found nothing unusual such as lumps or hardening. He
did show some significant Urinary symptoms on the tests. My husband
called me at work in an almost panic state and told me about his PSA
and that this was bad and that it probably meant he had advanced
cancer! Unfortunately, the Urologist did nothing to qualm his fears
other than telling him it was always possible it might be an infection
but apparently mentioned nothing about the enlarged prostate possibly
causing some rise in PSA. All the doctor told him was that the PSA
level concerned him and it was significant.

I started to immediately do research since I am the type of person who
wants to see as many positive stories as possible about people who had
high PSA's and either had negative biopsy results or were found to
have early-stage treatable cancer and also to learn as much as
possible, especially if it turns out to be cancer. Every time Steve
looks at the information, he focuses on the negative. Anyway, three
days ago he had a 6 core biopsy. Doctor saw nothing unusual on the
Ultrasound. Steve found the test painful and had bleeding afterwards
that was stopped by applying ice packs. Unfortunately, we still have
to wait another 7 days until we can go back to see the doctor for the
biopsy results. Steve is all "gloom and doom" still expecting the
worst. He keeps saying he has all the symptoms of advanced cancer
since he has the urinary problems. I still believe these symptoms are
probably BPH related. He also keeps telling me about every ache and
pain he has, suspecting it has spread to the bones. I keep reminding
him that he has had back pains since we met but he still does not seem
to believe me. Doctor put him on Flomax and that has helped the
urinary symptoms substantially.

One thing that concerns me is that the PSA density for Steve is .30
and I know that .15 is the threshold. Would this mean that even
though he has BPH, that certainly does not explain the high PSA
reading? Is it possible for a slightly enlarged prostate to cause
such a high PSA?

One thing we have both decided, is if the results show cancer we will
find a doctor at John Hopkins since we live only an hour away from
there. We also both are aware that even if the results are negative,
that he will need to keep getting tested to see if the cancer was
missed on the biopsy.

I am looking for ways to calm my husband's fears but know this will be
difficult because he is such a pessimist. I am the opposite of him
and consider myself an optimist but his negative attitude is beginning
to make me more nervous about the results.

Steve had another appointment with his regular doctor and even the
doctor said he was "going off the deep end" about this. Luckily I
convinced him to at least talk to someone about this and he was able
to contact a counselor through his Employee Assistance Program. He
did say he likes her a lot and she wants him to call as soon as he
gets the results - good or bad.

Anyway, I thought it would be good to vent a little and hope to get
some responses that I can share with Steve to make him feel more
positive about most likely not having late-stage cancer.

Lois

dave p

Hi Lois,

I will answer what I can.

For advanced PCa - Steve's psa would most likely be signicantly higher -
well above 12. My Doctor stated that for a bone scan to show any cancer your
psa would have to be in most cases above 20 - 40 and then would only show a
tiny amount. For bone pain he stated it would be in the 100 - 1000.

Your living by Johns Hopkins is a big positive as they are known to be one
of the best in the nation.

I had a relative that just recently had the same prostate
cir***stances/symptoms as Steve. His psa rise (15) was mostly due to BPH. On
biopsy they did find some cancer, he had an RP and is now going on two years
with an undetectable psa.

Staying positive and thinking about positive outcomes is a must throughout
this process for the both of you. Its difficult and you have to work at it
daily - but it really does have a positive impact on attitude and behavior.

I hope you have your own support system - I acted the same way Steve did
when I found out that I might have (had) PCa and it really did have a
negative effect on my wife. She had a strong support system that kept her
healthy.

My prayers are with you.

Dave P

derry argue

Lois,

Your husband is a lucky man to have you as a wife!

I have had two biopsies and have a PSA of 9. I, too, found the first biopsy
unpleasant and asked for an anaesthetic the second time around. I would
strongly recommend your husband goes this route next time as I did not know
a thing about it until I woke up.

BTW, the PSA is an indication only. I was worried, of course, but have now
been declared free of cancer for the second time and hope to have the
operation (PVP) in the next few weeks. There can apparently be many reasons
for a high PSA but it is wise to have the biopsy to check.

I suspect some of your husband's symptoms may be due to the side effects of
Flomax which I am also on. The medication does what it says but posters
here have described various side effects including mood altering. One thing
that has come out in our discussions is that not everyone experiences the
same things with BPH.

Good luck and I hope everything turns out OK.

Derry

judamd@aol.com (dave

Lois, tell hubby he probably does not have advanced cancer. Advanced
cancer usually has PSA readings in the hundreds, even thousands. I
have an acquaintance with a PSA of 23 and nothing on the biopsy or
bone scans. I'm not sure how high the PSA's go only with prostate
enlargement so it is possible he does have some cancer but the fact
that nothing was noted on the ultrasound is certainly good news. My
urologist saw right away I had a tumor on ultrasound which turned out
to be cancer even though my DRE was negative.

Now, what is the worse case? He might have prostate cancer and if he
does he should be made aware that of all the cancers one can get,
prostate cancer is one of the friendliest. With many other cancers,
the patient can expect to be dead in six months with or without
treatment. However, with prostate cancer, even with no treatment at
all, most men live many, many years and treatment (either surgery or
radiation)has a very high cure (not delay but actual cure) rate. A
non-smoking man my age (60) with excellent cardiovascular numbers as I
have has a 10% chance of death from a heart attack within 10 years,
much higher than the few percent chance of dying from prostate cancer
after treatment yet everyone focuses on the cancer giving no thought
to the more likely heart attack. Always remember that even though
many men are diagnosed with prostate cancer something like only 1 in
10 of those diagnosed ever die of it and that doesn't include the many
who have it and never know they have it. I think your husband has
probably been pretty healthy all of his life and now to be suddenly
clobbered by colon polyps and then a high PSA is more than he can bear
causing him to think the end is in sight. His biopsy may not show
anything but if it does, there are plenty of good options open to him
for treatment and he can expect a full recovery.

Keep us posted on what develops, here's hoping it's all good news.
Dave Perry

bnd777

Providing all the proper tests are done and an op done to remove the
prostrate if nessecary as its been caught early it should be fine
I know someone who had same thing 15 yrs ago and he is great they did a
Prostatectomy and got the lot

leonard evens

Your husband is certainly a worrier. I have gone through phases where
I did the same sort of thing. In my case, I realized that I was trying
to prepare myself for the worst case. The more I thought about it, the
harder it got. The problem is that you can't prepare yourself in
advance for such things, and moreover there is no point in trying. Most
likely, it won't occur, and if you obsess about it, you are just going
to make yourself unhappy. It is better to assume the best and only
attend to the worst if it actually happens.

As far as the details of his situation are concerned, I agree with the
others. He almost certainly doesn't have advanced prostate cancer. All
his symptoms have much more likely explanations. It is even more likely
than not that he doesn't have prostate cancer at all. If he does, it
is likely to be at a treatable stage. In addition, at his age, the
treatment is less likely to have serious side effects.

gadesta@totcon.com (chris

Your husband if very, very lucky to have you to keep a level head. But you
will have a difficult time to convince him to calm down and not worry until
there is something to worry about.

I have been where he has been and more. This month marks my 6-year
anniversary of being cancer free after having colon cancer.

Then too, I have currently got a PSA of 18.75, but it is due to a large
prostate. I know this because I have had two biopsies in the previouse years.
Both showed negative.

My uro has suggested that I have a TURP or a TUNA, but I'm not ready in spite
of the visits at night to the bathroom. I had been taking Proscar for 5
years. It did reduce the PSA, but it had side effects that I didn't care for,
so I stopped taking it.

I am scheduled for a cystoscopy next week. Depending to the results, I am
strongly considering contacting the doctor in St. Augustine, Florida to
schedule a PVP.

Whatever you both choose as your solution, do it with full confidence in the
doctor(s), hospital, etc. You might not succeed in infusing a positive
approach in your husband, but try to keep yours. Good luck to your both.

Regards,
Chris

firechief

At least one member of the family is remaining level-headed.

Fellows have been writing in here and in sci.med.prostate.cancer
about their mid- to high-hundreds PSA results. While 12.4 is
considered above normal, it is not a death certificate. And there
are many other things, other activities, which could produce an
above average test result. Did the urologist tell your husband
to avoid *** before the test?

I cut-and-paste these two sentences so you can see the
relationship between erectile disfunction and Flomax. I was
unable to tell if he he's had the problem for a long time or
just since taking Flomax.

Tamsulosin hydrochlorideTamsulosin hydrochloride
Tamsulosin hydrochloride (Flomax)
Tamsulosin hydrochloride
(tam-SOO-loh-sin)
Pregnancy Category: B Flomax (Rx)

Classification: Alpha-1 adrenergic blocking agent

Action/Kinetics: Blockade of alpha-1 receptors (probably alpha1A) in
prostate
results in relaxation of smooth muscles in bladder neck and prostate; thus,
urine flow rate is improved and there is a decrease in symptoms of BPH. Food
interferes with the rate of absorption. t1/2, elimination: 5-7 hr.
Significantly
bound to plasma proteins. Extensively metabolized in liver; excreted through
urine and feces.

Uses: Treatment of signs and symptoms of BPH. Rule out prostatic carcinoma
before using tamsulosin.

Contraindications: Use to treat hypertension, with other alpha-adrenergic
blocking agents, or in women or children.

Special Concerns: Use with caution with concurrent administration of
warfarin.

Side Effects: Body as a whole: Headache, infection, asthenia, back pain,
chest
pain. CV: Postural hypotension, syncope. GI: Diarrhea, nausea, tooth
disorder.
CNS: Dizziness, vertigo, somnolence, insomnia, decreased libido.
Respiratory:
Rhinitis, pharyngitis, increased cough, sinusitis. GU: Abnormal ejaculation.
Miscellaneous: Amblyopia.

Overdose Management: Symptoms: Hypotension. Treatment: Keep client in supine
position to restore BP and normalize HR. If this is inadequate, consider IV
fluids. Vasopressors may also be used; monitor renal function.

Drug Interactions: Cimetidine causes significant (something lost in
download)
in clearance of tamsulosin.

How Supplied: Capsules: 0.4 mg

Dosage
Capsules Benign prostatic hypertrophy.
Adult males: 0.4 mg daily given about 30 min after same meal each day. If,
after
2 to 4 weeks, clients have not responded, dose can be increased to 0.8 mg
daily.

don

I suffered with bph for several years. Prior to having a TURP at age 68
in 98, my psa went from 4 to 17. It has never been less than 4. I had
several biopsies during this period, all negative. After having the
TURP, my psa dropped back to 4 and has been there since. My urologist
says this is fairly common in people with enlarged prostates. This
could very likely be the reason for your husband's high psa. Let's hope
it is.

Don

steve kramer

Sorry, Lois, but at this time, I'd say the best that can be said is that his
results so far are inconclusive. He may have cancer. He may have BHP. He
may have unusually high PSA.

However, he does not have ADVANCED prostate cancer. Of that you can be
almost certain. Which means if it has not penetrated the prostate, he has a
chance at a cure.

--
Steve Kramer
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000
PSA .1 .1 .1 .3 .4 .8
EBRT 05-07/2002 @ 47
PSA .3 .2 .2 .2
Erection 05/12/2003 @ 48