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Suffer frequent urination. PSA test showed 9.9. Enlarged prostrate. Ultrasound scan showed areas of calcifications. Prostate cancer?

Jul 2016
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Practicing since : 1971
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Dear Doctor,

I started getting higher urinary frequency 19 years ago, I was testing for cancer (basic tests) in 1994 and was found to be negative (I don't know whether a PSA test was done). 4 years ago in 2009, I started getting Urinary Urgency. I saw the doctor last year (2012) and he ordered my first PSA test, the result was 5.4 confirmed 3 months later by a different lab (5.2). I had two DREs, one by my GP and one by my urologist, both normal, the urologist did NOT recommend a biopsy. As a mattter of routine on XXXXXXX 20th 2013, I had a repeat PSA test, it came back with a shocking 9.9 result, confirmed 2 days ago (6/8/2013) 9.79, my free PSA is 1.57, that is 16% of my total PSA, my prostate is large 68cc and the Ultrasound scan showed 3 areas of calcifications which worried the urologist I saw yesterday. My PSA density is 14.4%. My two recent DREs by a surgeon and a urologist are both normal. What are my chances of having Prostate Cancer rather than BPH (I believe I have suffered from that for some years and one year ago, I started going to the toilet once per night), and what are my chances of the cancer being aggressive (Gleason 8 or above) and are the calcification spots on my prostate significant and a cause for concern? My urologist seemed to think so but my radiologist seemed to think that they might be a sign of an old infection such as Prostatitis. Grateful for your answer as soon as possible as I am understandably worried. I am naturally waiting to have my first biopsy but it is hard where I live in the Middle East because the Eid holiday begins tomorrow. XXXXX
Posted Fri, 23 Aug 2013 in Urinary and Bladder Problems
Answered by Dr. P. T. Patil 53 minutes later
It appears that you have done your Serum PSA in 2012 which were 5.2 and Serum PSA done on 20th XXXXXXX was reported to be 9.9.

Though your DREs done by surgeon and Urologist are not conclusive it is not considered to be a 100% reliable as one may not have a hard nodule on peripheral aspect of prostate but may be dipper in the prostate gland. Considering the raising trend in serum PSA, it is to be taken seriously to rule out Cancer of the prostate which can assured only by doing multi core ultrasound guided biopsy of the prostate.

As regards calcification in the prostate most of the time, it is due to chronic prostatitis and has little significance.

One can have prostate enlargement and cancer of the prostate as both lesions can co exist at the same time.

The aggressive nature of the cancer of the prostate can be determined by doing CT scan or MRI studies of the prostate and histopathology of the prostate biopsy.

Please go ahead and get aforesaid investigations (MRI, CT Scan) and prostate biopsy to be sure about cancer of the prostate as planned. There is no risk in waiting for one more week.

If you have any more questions, please feel free to ask me. I shall be happy to help you.

Dr. Patil.

Above answer was peer-reviewed by
Follow-up: Suffer frequent urination. PSA test showed 9.9. Enlarged prostrate. Ultrasound scan showed areas of calcifications. Prostate cancer? 16 hours later
I am slightly reassured about the lack of significance of the calcification spots.

My final question is given my PSA velocity which is nearly double in one year only, is it not extremely likely that I have cancer, and, moreover that it is an aggressive cancer! What else could be causing the PSA increase? An infection has been ruled out, my urine analysis was normal. I believe BPH on its own cannot cause such a large rise in PSA. Am I right to worry?

Answered by Dr. P. T. Patil 3 hours later

Raising PSA is mostly suggestive of cancer of the Prostate unless proved otherwise.
It should be confirmed by doing prostate biopsy.

Next stage is to detect the extent of the disease whether it is confined only to prostate gland or has spread beyond capsule of the prostate, which is detected by either CT scan or MRI.

Treatment of cancer prostate depends upon the nature of the disease (Aggressiveness of the disease).
Please do not worry; get all these tests done to confirm the diagnosis.

With modern advanced techniques like Laproscopic Radical Prostatectomy or Robotic surgery, the results of surgery for cancer of prostate are encouraging and gratifying. This comes with less morbidity and 0% mortality.
Thanks and Regards.
Above answer was peer-reviewed by
Follow-up: Suffer frequent urination. PSA test showed 9.9. Enlarged prostrate. Ultrasound scan showed areas of calcifications. Prostate cancer? 1 hour later
Sorry, there is one part of my burning question you did NOT answer.

Does my rise in PSA from 5.2 to 9.79 which represents an 88% increase suggest that I have a more aggressive cancer, XXXXXXX score 7 or higher? Would a low grade cancer (1 to 4) not return a more modest PSA rise?

Finally, is it mildly encouraging that my PSA has NOT increased between 20 XXXXXXX 2013 and 5 August 2013, a period of just over 6 weeks. My first PSA was 9.9 and my second was 9.79 which could be accounted for by the difference in labs. If the cancer was fast growing and aggressive, would it not:

a) have caused an increase in the PSA in 6 weeks.
b) be higher than 10?

Grateful for your answer which should be final this time.

Answered by Dr. P. T. Patil 42 minutes later
Prostate cancer is very slow going cancer and raising PSA figures does not help to determine the aggressiveness of cancer.

Gleason's score of the cancer prostate is decided only on histopathological examination and on the degree of its extension in surrounding tissue and organs.

From the present PSA figures, I can say that it is still confined to prostate. Once it invades surrounding strictures like bladder or peri- prostatic tissue or had it been spread to distant organs or bone the PSA would have shoot up to more than 150 or even higher than that.

Hope this will help to allay your anxiety.
Thanks and Regards.
Above answer was peer-reviewed by
Follow-up: Suffer frequent urination. PSA test showed 9.9. Enlarged prostrate. Ultrasound scan showed areas of calcifications. Prostate cancer? 43 minutes later
Thank you, that is most helpful. I was confused because discussions on the Internet suggesting that PSA doubling in one year suggested a more aggressive cancer. I shall now wait for my biopsy.

Answered by Dr. P. T. Patil 1 hour later
Thanks for writing again.

Please go ahead and get the necessary tests done. Keep me posted about the progress and follow up.

Thanks and Regards.
Above answer was peer-reviewed by
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