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Diagnosed with prostate cancer. What does PSA level more then 20 mean?

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Practicing since : 1991
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my question is about prostate cancer. My father was diagnosed about three weeks ago, but we are confused about the answer the urology gave us. I researched online and asked him some question, i asked about the stage, and he couldn't give me a specific answer, he said XXXXXXX we believe it might be T2 stage and that they found cancer on each biopsy ( he said all the 6 parts they took had cancer cells, but that they could not see anything on the CT SCAN)...i asked him how aggressive are the cancer cells? ( he did not give me a clear answer)....and he did not give me the XXXXXXX number either. He said they might do a bone scan, but even that is taking to long in my opinion....when a patient is diagnosed with cancer (since the cancer cells divide at a high speed) isn't the urologist supposed to rush things??? and his PSA levels are 40 he said. i did my research and it seemed like the PSA goes up to 20, is that correct?? what would you suggest we do?? from your experience and what we've heard from his urologist, what would you think the stage is?? on my way out i asked on more question, if he believe it's high risk??? i swear it seemed like he didn't know what to say to me. He talked about brachytherapy as one of the options, and from the research i did...if he is at high risk (surgery would be the first thing they would do). I apologize if i'm mistaking with the research i have done. I just need some clarifications because we are very confused. Thank you........information: PSA 40, nothing seen on CT SCAN, found cancer cells on 6 parts of the prostate with biopsy.
p.s do you think his cancer has spread from the prostate? ( when i ask this question i know that it is impossible to answer without a bone scan i guess? but im asking for your assumption given the numbers??? and if CT scan doesn't show any tumor, how do we explain the 6 parts cancer cells??
You can be as unofficial as you want, this information is personal use only; i will not be sharing it with anyone.
Posted Wed, 7 Nov 2012 in Cancer
Answered by Dr. G.Srinivasan 53 minutes later

Welcome to XXXXXXX
I understand your worry.
The issues you need to understand are.
1. Prostate cancer is slow growing and rushing is not needed.
2. Regarding cancer, lots of things are unknown and hence no one can be blamed.
3. PSA more than 20, warrants BONE SCAN, as spread to bone is a possibility above this XXXXXXX
4. Gleasons grade is a MUST and treatment optionn might change based on that. Slide review may be requested or the slides may be taken to a higher center for review.
5. CT is mainly done to look for spread to the lymph nodes of the abdomen and not to see the prostate as such as we know the diagnosis already.
6. Aggression of the tumor is found out by Gleasons grade, PSA doubling time ( serial PSA is a must) or by special tests using the cancer cells - available in select centers.
7. PSA of this level - there is always a high chance of outside spread and it is at lease STAGE T2.
There is always controversy in deciding treatment for CAP, whether brachytherapy or surgery, as each has its merits and demerits.
In essence, pls get BONE SCAN and SLIDE REVIEW to proceed.

Hope this helps, kindly get back for doubts if any.......

Wishing your dad best health,

Above answer was peer-reviewed by
Follow-up: Diagnosed with prostate cancer. What does PSA level more then 20 mean? 15 hours later
i researched SLIDE REVIEW, and was unable to really find what it is??? what is a SLIDE REVIEW??? and is it smart for my father to sick a second opinion from another Urologist?? possibly even a second PSA TEST and biopsy? He has his doubts about the diagnosis, as the private urologist did not even give him a single sheet of paper with his 2 visits now; hence, his confusion about most of everything. I asked the doctor for a monogram on my out on the second visit, but he did not give me one.
I apologize for asking this as it might come as a bit offensive, but is it possible to be wrongfully diagnosed with prostate cancer??? by the way my father has no symptoms what so ever, and he was just telling me on his second visit the doctor mentioned his PSA went down to the 30's, what does that mean? (given he no curative measures have been taken yet). THANK YOU VERY MUCH FOR CLARIFYING EVERYTHING, HE WILL GET IS BONE SCAN DONE NEXT FOR SURE!oh im sorry i forgot (continued with the previous questions)... does his urologist determine his XXXXXXX number after the bone scan?? since he did not give it to us when i asked on the second visit.
Answered by Dr. G.Srinivasan 7 hours later

Welcome back.
Slide review - is one where the biopsy tissue is processed and compressed in a small glass slide and viewed under a microscope.
The slides of your fathers tissue will be available with the pathlogist who gave the biopsy report.
By reviewing this, BY ANOTHER PATHOLOGIST IN ANOTHER LAB, second biopsy can be avoided, unless absolutely necessary.
The gleason's is based on the slide and not the bone scan. Bone scan gives only spread to the bone and nothing else.
Opinion with another doc is better, as things look strange to me due to lack of reports( esp in this transparent world)
PSA, if at all - needs to repeated after 6 weeks only, after a biopsy, to prevent false high value due to biopsy trauma to the prostate.

Hope this helps...
Kindly get back for doubts if any...


Above answer was peer-reviewed by
Follow-up: Diagnosed with prostate cancer. What does PSA level more then 20 mean? 46 hours later
Thank you so much Doctor,
My Dad is getting a bone-scan tomorrow. I failed to mention something: his urologist had referred him to see someone within the same building saying that XXXXXXX this doctor has a neutral opinion", yesterday i get a call from someone saying that the specific doctor was going on vacation. So then they schedule my father with a different doctor for thursday. Today i do some research on the names of the doctors and find out that the first one who is going on vacation is an oncologist, but this other one the secretary scheduled him with is a hematologist. My question is..what would be the advantage of seeing a hematologist at this stage?? given that a they specialize in the study of blood??
My other question is, would you suggest that my father sees a second urologist for a second opinion? ( i got this from doing a research online, it say to ask your urologist if he is comfortable with you seeing another urologist?) is it standard process for patience to see a second urologist?? or might this come as offensive to a urologist???...After his bone scan tomorrow, can we ask for a copy?? or do they give the result directly to his urologist??
is it normal that my father hasn't gotten a single piece of paper from the doctors office to this day?? I am sorry if i come off as completely misinformed, the truth is, my father doesn't speak much of english and i had to get most of the answers online and from you, and that also shows the lack of information being handed to us from his urologist office. And to be completely XXXXXXX in the back of my head i'm doubting the whole diagnosis. He is seeing his urologist friday, and i am going to ask for the slide review, but is there anything else i could ask for from his urologist office in the form of paper??? Thank you for your patience and time.
Answered by Dr. G.Srinivasan 1 hour later

Welcome back.
In today world, second opinion is very common, especially if the diagnosis is cancer and it is not taken the wrong way.
Pl. go ahead with that (with a urologist) and this time pl. get a written or typed report of the check up and lab tests.
Pl. request for a copy of the bone scan.
Oncologist would be of help - but not a hematologist for this type of cancer.

Pl. keep me informed of his progress---


Above answer was peer-reviewed by
Follow-up: Diagnosed with prostate cancer. What does PSA level more then 20 mean? 46 hours later
Thank you!!!
Today they told him that the preliminary result of his bone scan looks good.
i found out his XXXXXXX # is 7, they could not find anything with the ultrasound.
so far the only concerning thing is his PSA being high, and ofcourse his biopsy result.
The doctor told him that he was going to refer him to a radiation oncologist.
In you opinion, which therapy should he go for???
brachyteraphy (high dosage)? combination of brachyteraphy and external beam radiation? do you think it would be best for him to take pills to decrease his testosterone? surgery? in general, which one would yield the best result at the end? ( considering also the rate of reoccurrence of cancer)
after doing extensive research i see that his XXXXXXX # is intermediate, had it not been for his PSA he would be T1, and given that there is no budding tumor on ultrasound and bone scan, we are hoping for just the right amount of therapy that could yield the best result ( without having to ignore the severity of the situation) Thank you
Answered by Dr. G.Srinivasan 1 hour later

Welcome back.
Practice varies across the globe.
In India, testes removal - thereby cutting the testosterone levels in the main modality of practice (this is not curative- only palliative).
The controversy here is irrespective of the mode of treatment, the long term survival does not change and only the quality of life differs.
In the U.S, either radiotherapy or radical prostatectomy is practiced with the intent of cure.
In case radiotherapy is decided, the radiation oncologist would be the best person to decide.
In this situation, one of the above will be decided once the cancer specialists XXXXXXX and decide the right line of approach based on various issues.

Hope this helps.
Above answer was peer-reviewed by
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