Prostrate Cancer

[al007]

I posted on: I have a cancer a personal perspective this morning the following

Posted Today, 13:57

God bless may you not suffer too much

I am 70 yrs old and overweight currently living in KhonKaen

I am here on this forum because yesterday my PSA was 13.1 norm up to 4, three years ago it was 3.2 and six years ago 2.0, and it is suggesting quite strongly prostrate cancer, I need to liaise with people who have been through this and be advised where to go for checking and treatment, I am at present on antibiotics to clear any infections and will then in two weeks be retested for psa readings

Ultra sound yesterday was unable to view prostrate well

I have no medical insurance but can pay reasonable medical bills

I could return to the Uk but really have no where to stay, and have so much love and care here from a very loving wife, we also have people to help in our house

I feel that I was imposing on someone else's difficult situation and was being insensitive, and have thus started a new topic, I also apologise to the original poster

I have already received some helpful feed back for which I thank people

I have also read higher readings do not necessarily mean cancer, and infections could elevate the level, also just because one has a low PSA count does not mean one does not have cancer

So all a little worrying to say the least, my head goes round and round, it is often to easy to draw the wrong conclusion

It is all a bit scary and very unsettling, I am doing a lot of research

At present the task is to ascertain do or don't I have it, then at what stage is it

I can not at present find anywhere what my life expectancy might be

I can not find anywhere what are the stages in the closing weeks and how much pain is there, I hate pain

I will investigate next week PET scans and costs

I need to find out where I can have an up the ass ultrasound, I see there is one

I was twice given an ultrasound on Friday but it was unable to view the prostrate properly

I may well be able to pay for treatment in Thailand although it will hurt my finances substantially, so I have to check I get good treatment but not on the basis cost does not matter it does, I will be depleting the pot that my thai wife will eventually get, that concerns me

England as an option very difficult, no where to stay and no one to look after me, but having paid all my contributions and being retired I am eligible for free treatment

I propose to post regularly so others might be able to benefit from what I find out

[puck2]

Your PSA is steadily going up as it seems. This can be an indicator for prostate cancer, but must not. Not knowing makes someone nervous, your main problem at now. Therefore IMO, solve this problem at first, have a biopsy (12 needles). It's worthwhile to have a pain for a short while (1 day - if at all). The result of a biopsy will show you if you are infected by cancer or not.

The doctor will explain that you cannot rely on this result by 100%, if the biopsy is free of cancer. But if it contains cancer the result is reliable by 100%. If the the doctors cannot find any cancer within the biopsy they will recommend a new one within a special time. A biopsy is the best method these days, CT scans or ultra sounds are not.

If the biopsy result is positive (having P.-cancer) you'll get information about the stage of the cancer. That means to talk about having a surgery or not. Prostate cancer is like an unexploded bomb of the WorldWar II. The problem is, will it explode during your lifetime or will the bomb/cancer remain in in the earth/your body before exploding/before building metastases. Exploding means building metastases, the actual danger of cancer.

[manfredtillmann]

dear al007

a lot more males die WITH prostrate cancer than FROM it. it is not always a death sentence and often can be 'managed' with medication. my father lived with it for almost 20 years and died from something entirely different at age 86. i have had an enlarged p. for many years now, at times giving me hell and at other times not noticed at all. i do take medication with good results.

what ever you do, inform yourself very clearly about the side effects of your treatment or operation prior, should it come to it. life after is not that pleasant.

all the best, mate.

[Sheryl]

It is understandable that you would be very worried now but try not to get ahead of yourself/the facts on hand as that may mean unnecessary worrying.

At present you do not even know if you have prostate cancer. More tests are needed for that which I gather are being planned.

If it is cancer, you do not yet know what stage and how aggressive. Prostate cancer is often fully curable. In other cases, it is growing so slowly that given the patient's age treatment is not indicated as they would most likely die of another cause long before the cancer became an issue.

Until these things are known there is nothing at all that can be said about life expectancy and certainly no reason to be thinking about "final weeks", pain etc.

I suggest you take it step by step. Only if cancer is confirmed and then after it has been staged, can questions about life expectancy be raised or answered. As to "final weeks" and pain, that presupposes a terminal diagnosis which has not been made and might well not be (you may not even have cancer, or it might be fully curable). So try to close the door on those issues - you may be putting yourself through them unnecessarily. Can always go back to hem if worst case scenario proves true (odds favor against that, BTW). Why go through them now when they may be completely inapplicable?

As to where to go, I don't know where you are being treated not but the management so far described (antibiotics to clear up possible infection and then repeat PSA, and ultrasound) sound appropriate to me though I am confused when you indicate the ultrasound done was not done with a rectal probe? How was it done?

Where do you live? (relevant in terms of where best to go). And where are you being treated currently?

Lastly what did the doctor find on rectal examination in terms of size and regularity of the prostate? The direct rectal exam (DRE) is actually more reliable than PSA. PSA can be elevated nto only from infection but also in benign enlargement of the prostate. PSA results have to be interpreted in conjunction with other findings like DRE and ultrasound.

Diagnosis of cancer cannot be made except by biopsy but biopsy will be indicated only if the combination of DRE, PSA and ultrasound results are suggestive of cancer. In some borderline cases they will do additional tests as well to help decide on whether to do a biopsy.

[al007]

It is understandable that you would be very worried now but try not to get ahead of yourself/the facts on hand as that may mean unnecessary worrying.

At present you do not even know if you have prostate cancer. More tests are needed for that which I gather are being planned.

If it is cancer, you do not yet know what stage and how aggressive. Prostate cancer is often fully curable. In other cases, it is growing so slowly that given the patient's age treatment is not indicated as they would most likely die of another cause long before the cancer became an issue.

Until these things are known there is nothing at all that can be said about life expectancy and certainly no reason to be thinking about "final weeks", pain etc.

I suggest you take it step by step. Only if cancer is confirmed and then after it has been staged, can questions about life expectancy be raised or answered. As to "final weeks" and pain, that presupposes a terminal diagnosis which has not been made and might well not be (you may not even have cancer, or it might be fully curable). So try to close the door on those issues - you may be putting yourself through them unnecessarily. Can always go back to hem if worst case scenario proves true (odds favor against that, BTW). Why go through them now when they may be completely inapplicable?

As to where to go, I don't know where you are being treated not but the management so far described (antibiotics to clear up possible infection and then repeat PSA, and ultrasound) sound appropriate to me though I am confused when you indicate the ultrasound done was not done with a rectal probe? How was it done?

Where do you live? (relevant in terms of where best to go). And where are you being treated currently?

Lastly what did the doctor find on rectal examination in terms of size and regularity of the prostate? The direct rectal exam (DRE) is actually more reliable than PSA. PSA can be elevated nto only from infection but also in benign enlargement of the prostate. PSA results have to be interpreted in conjunction with other findings like DRE and ultrasound.

Diagnosis of cancer cannot be made except by biopsy but biopsy will be indicated only if the combination of DRE, PSA and ultrasound results are suggestive of cancer. In some borderline cases they will do additional tests as well to help decide on whether to do a biopsy.

Thank you, yes slowly slowly I agree but prefer to be prepared and better educated than I was ten days ago, helps me ask the consultant the right questions and also get the answers I need

I travelled the world for nearly ten years in retirement on my own motor Yacht 60 ft with only a wife who knew little, I always planned for the worst and tried to imagine the worst and it always stood me in good stead, and i went through some very major problems but always survived, because I had planned well

I live KhonKaen

The ultrasound was done as part of regular check up, not done with rectal probe, at that time I did not have the knowledge of even the existence of rectal probe, it was a smaller hospital that does not have all the attachments for its ultrasound

I have found many answers and much help on TV thanks to many positive posts

I am better informed and will discuss with specialist when meeting after next PSA test

[al007]

dear al007

a lot more males die WITH prostrate cancer than FROM it. it is not always a death sentence and often can be 'managed' with medication. my father lived with it for almost 20 years and died from something entirely different at age 86. i have had an enlarged p. for many years now, at times giving me hell and at other times not noticed at all. i do take medication with good results.

what ever you do, inform yourself very clearly about the side effects of your treatment or operation prior, should it come to it. life after is not that pleasant.

all the best, mate.

Thank you I appreciate your comments

I am learning fast many things about Prostrate Cancer, and have a very open mind

I am learning about some of the side effects of the various treatments, I am very aware that more die with PC than as a result of it, I hope i will be in that category

I need to inform myself as much as possible, because in the end I will only consult with a couple of consultants, and will want those meetings to be filled first with many questions I will have, ten days ago I would not have had the information I have today

[nev]

I have just add a prostate operation at srinakharin hospital in khonkaen, very reasonable costs and the doctor is one of the best around due to him being a Professor at the university, as the hospital is part of the university.

They found in part of my prostate taken out that I had a high count over 10, I have had a few tests since and has gone back to normal.

If you go Srinakharin hospital you might have to wait a bit but I have found they look after you very well, sometimes I see the doctor and only costs 50baht, when you visit you are given a number and they will tell you how long before you see the doctor it might be 2 hours, so me and my wife will go away and come back later.

[Sheryl]

I second the above. Srinakharind is best quality medical care in that region.

[al007]

I have just add a prostate operation at srinakharin hospital in khonkaen, very reasonable costs and the doctor is one of the best around due to him being a Professor at the university, as the hospital is part of the university.

They found in part of my prostate taken out that I had a high count over 10, I have had a few tests since and has gone back to normal.

If you go Srinakharin hospital you might have to wait a bit but I have found they look after you very well, sometimes I see the doctor and only costs 50baht, when you visit you are given a number and they will tell you how long before you see the doctor it might be 2 hours, so me and my wife will go away and come back later.

Your message very much appreciated I have PM to you, I will definitely explore this in depth

Someone replying in my location with recent experience is so very valuable to me

Thanks

[al007]

I continue my research, I wish to be able to intelligently discuss with consultant in the event it is necessary, I found this article which is the most comprehensive I have seen so far

http://umm.edu/health/medical/reports/articles/prostate-cancer

[al007]

Posted 2015-08-20 11:36:24

al007, on 20 Aug 2015 - 10:41, said:

I expect to die in Thailand, It may also happen quicker than I wish , and if you had my prognosis you should be on your way home

I have given all this much thought, in Thailand I have no insurance, I could go to the Uk and get free medical, and free hospice but have no family left there

In this world we have many choices and if you are amongst those who do not wish to die here maybe (very understandable) you should return home sooner rather than later, maybe you want to have your cake and eat it, unrealistic, YOU HAVE CHOICES

I have been out of the Uk for over 20 yrs and the love and care in the hospitals here is very difficult to find elsewhere, my understanding however is pain medication maybe in short supply, so might need plan to to close things on ones own choice, with asking the wife to shoot me like the lame horse

I also have a plan to maybe even die at home, I know the love I get here both from my wife and the nursing community is second to none

There is no shortage of pain medication. But there is reluctance to provide large amounts of narcotic for outpatient use, even in terminal cases, and such meds as are prescribed will only be oral which is a problem for people near death as often unable to swallow. Home hospice care such as in the west, complete with iv morphine at home etc, is not available here.

As a result one has to choose between dying at home (indeed an option provided family members and treating physician are on board and advance directive made out) or dying pain free but in a hospital.

• Like This

I picked Sheryl,s reply from another related topic replying to one of my posts

There is such a wealth of good information available here, I am someone who likes to plan for both the good and the bad, and again I continue to learn, the advice here is good and changes my views, to set up arrangements with hospital for last days of care, stay at home as long as possible, and when pain becomes too much move, to where it has been agreed pain will be suppressed

These things would need to be planned, some hospitals might have a policy not to take terminal patients who are on their way out, do not want to be in back of pick up with wife driving around trying to find hospitals especially as she can not reverse !!!

We need to keep smiling

• Quote

[Sheryl]

I do not think any hospital wil refuse to admit a patient because he is near detah.

But -- and this is very important -- only some hospitals have specialists in pain management/palliative care, and only some of those are really good.

Also, even in a hospital with a god palliative care specialist, unless you are officially under that person's care (admitted as their patient), you may not have the benefit of this.

So the issue if in a terminal condition is to locate a physician specializing in pain management/palliative care that you are comfortable with and plan on being admitted under their care when the time comes, to whatever hospital they are affiliated with.

It is also very important to have an advance directive signed and on file with hte hospital and for all treating doctors to be aware of this, if you wish to avoid life support measures that might prolong suffering. Most hospitals have their own specific form for this purpose. So locate doctor -->hospital --> sign the form.

[al007]

More excellent advice, so where in the KhonKaen area might one find the physician and hospital specialising pain management and palliative care, I would have thought it could be a smaller hospital without the needs for all the expensive equipment bigger and teaching hospitals require.

Will quietly continue my research

[al007]

Prostrate Cancer

My findings in the last ten days since discovering PSA level 13.1, normal below 4.0

We all deal with things in different ways, I am dyslectic and reading alone for me is difficult, if I write it helps my comprehension and prepares me for meetings with consultants, so I can participate and question rather than just listen

It is interesting to note Prostrate cancer, is not as prevalent in Asia as in USA, Europe and Africa, so maybe the consultants might not be as well versed as elsewhere, and gaining knowledge myself can only be beneficial.

I am being retested next weekend and have a meeting with a consultant then to discuss the next stage, of investigation, I am rushing nothing as prostrate cancer is one of the slower growing cancers, I also have a very open mind as to how to progress

I share below some of my findings relevant to my own predicament, on a topic on which until recently I was uninformed on, as is the case with many male friends so they tell me

What Is Prostate Cancer?

The prostate is a gland in the male reproductive system. It makes most of the semen that carries sperm. The walnut-sized gland is located beneath the bladder and surrounds the upper part of the urethra, the tube that carries urine from the bladder.

Prostate cancer is a major health concern for American men. The disease is rare before age 50, and experts believe that most elderly men have traces of it.

The American Cancer Society predicts that 220,800 new cases of prostate cancer would be diagnosed in 2015. An estimated 27,640 men will die of it. African-American men are more likely to get prostate cancer and have the highest death rate. Other than skin cancer, prostate cancer is the most common cancer in American men. In other parts of the world -- notably Asia, Africa, and Latin America -- prostate cancer is rare.

Prostate cancer is usually a very slow growing cancer, often causing no symptoms until it is in an advanced stage. Most men with prostate cancer die of other causes, and many never know that they have the disease. But once prostate cancer begins to grow quickly or spreads

outside the prostate, it is dangerous.

Prostate cancer in its early stages (when it’s only found in the prostate gland) can be treated with very good chances for survival. Fortunately, about 85% of American men with prostate cancer are diagnosed in an early stage of the disease.

Cancer that has spread beyond the prostate (such as to the bones, lymph nodes, and lungs) is not curable, but it may be controlled for many years. Because of the many advances in available treatments, most men whose prostate cancer becomes widespread can expect to live five years or more. Some men with advanced prostate cancer live a normal life and die of another cause, such as heart disease.

What Causes Prostate Cancer?

Prostate cancer affects mainly older men. About 80% of cases are in men over 65, and less than 1% of cases are in men under 50. Men with a family history of prostate cancer are more likely to get it.

Doctors don’t know what causes prostate cancer, but diet contributes to the risk. Men who eat lots of fat from red meat are most likely to have prostate cancer. Eating meat may be risky for other reasons: Meat cooked at high temperatures produces cancer-causing substances that affect the prostate.

The disease is much more common in countries where meat and dairy products are common than in countries where the diet consists of rice, soybean products, and vegetables.

Hormones also play a role. Eating fats raises the amount of testosterone in the body, and testosterone speeds the growth of prostate cancer.

A few job hazards have been found. Welders, battery manufacturers, rubber workers, and workers frequently exposed to the metal cadmium seem to be more likely to get prostate cancer.

Not exercising also makes prostate cancer more likely.Doctors don’t know what causes prostate cancer, but diet contributes to the risk. Men who eat lots of fat from red meat are most likely to have prostate cancer. Eating meat may be risky for other reasons: Meat cooked at high temperatures produces cancer-causing substances that affect the prostate.

The disease is much more common in countries where meat and dairy products are common than in countries where the diet consists of rice, soybean products, and vegetables.

Hormones also play a role. Eating fats raises the amount of testosterone in the body, and testosterone speeds the growth of prostate cancer.

A few job hazards have been found. Welders, battery manufacturers, rubber workers, and workers frequently exposed to the metal cadmium seem to be more likely to get prostate cancer.

Not exercising also makes prostate cancer more likely.

High PSA Level? Check it Again

The PSA blood test is commonly used to check for signs of prostate cancer or other prostate problems. When a PSA level comes back high, the next step is often a biopsy. But a new study suggests another course of action: Another PSA test done more than a month later.

That's because PSA levels can fluctuate up and down -- so a man with a high PSA level may not actually have any prostate problems at all. In fact, after studying nearly 1,000 men, researchers found that about half of those whose PSA levels were initially high had a normal result in a subsequent test.

But unfortunately, says the study's lead researcher, James Eastham, MD, FACS, of Memorial Sloan-Kettering Cancer Center, the initial finding of an elevated PSA is enough to warrant one of three typical responses from doctors.

The first scenario, and a common one, is that the patient is referred for a biopsy, which may be unnecessary and painful.

The second is that the PSA is immediately repeated, within a week or so. But that will only take into account any possible lab error, since it's not enough time to get a handle on natural fluctuations.When my retest was scheduled I was not well enough informed to suggest it being deferred a little longer, but then i can have another done later

And the third scenario is that the patient is assumed to have inflammation or infection in the prostate, and put on antibiotics or anti-inflammatory drugs.”

Instead, Eastham suggests taking no action until another test is done four to six weeks later -- a time period that he says allows for a natural decrease in fluctuating PSA levels.

"The bottom line is that the recommendation for a biopsy should not be based on a single elevated test result, and a second test shouldn't be given too soon after the first," he says.

In fact, even after a second test produced elevated PSA levels, biopsy detected prostate cancer in only one of four of study participants, according to Eastham's findings, published in the May 28 issue of TheJournal of the American Medical Association.

"But the study is unable to determine how many men with an elevated PSA level who later returned to normal still could have had prostate cancer -- subsequent 'normal' tests may actually have been false negatives," says Richard M. Hoffman, MD, MPH, of the University of New Mexico School of Medicine.

Controversial Test

The PSA blood test, first introduced in the U.S. in 1986, is still a controversial test for prostate cancer.

Even though a PSA test is likely to detect prostate cancer at an earlier stage, there is no evidence that the test saves lives. This is because prostate cancer is generally slow-growing and typically strikes men at an older age, when they are more likely to die from other causes. Thus, treating prostate cancer in some men, the argument goes, may cause more harm than benefit.

"Men don't realize the downside to a PSA test," Evelyn C. Y. Chan, MD, of the University of Texas-Houston Medical School, tells WebMD. "There are false positives associated with this test, and there are false negatives. And it has never been established that the PSA test is going to reduce deaths caused by prostate cancer."

A high PSA level indicates some abnormality in the prostate -- possibly cancer, but also any type of prostate infection or prostate enlargement, which occurs in most men after age 50. Even ejaculation within two days of having a PSA test may result in artificially high levels suggesting a "false positive."

"The suggestion for men considering the test is that they ask their doctor whether or not a PSA is the right test for them -- and then ask their doctors why," Chan tells WebMD. "Don't feel that this is a test that everyone agrees upon and recommends."

The American Urological Association, the American Cancer Society, and the American College of Physicians recommend that doctors discuss PSA and other screening tests each year with men older than age 50, high-risk men, black men, or those with a family history of prostate cancer, should talk to their doctor at age 40.

Meanwhile, the U.S. Preventive Services Task Force and the National Cancer Institute are opposed to routine PSA screening, believing the risks of follow-up tests and the side effects of treatment may outweigh the possible benefits for many men.

"I believe the PSA test saves lives," Eastham tells WebMD. "But there are many factors that influence PSA levels, so the test needs to be used with confirming evidence before undue worry or undue procedures.”

Making the Most of Your Doctor's Appointment

Doctors often have only a short period of time with each patient they see for routine examinations. (Of course, there is also time out of the exam room that is spent reviewing the chart and records.) The experience can be both confusing and frustrating when communication on one or both sides is lacking, particularly if you're presented with new information to process or new instructions to follow.

While a visit to the doctor's office can be intimidating, you can lessen the stress and worry associated with doctor's appointments by taking steps to be sure that you're provided with all the information you need at the appointment. There are also ways you can improve the quality of your care by helping your doctor develop the best understanding possible of your symptoms, condition, and wishes regarding treatment.

Before the appointment, write down a list of things you need to tell the doctor. Note any concerns or questions you may have. Also write down the names and dosages of any prescription, over-the-counter medications, or supplements you are taking.

It is very important to take this list with you to the appointment - don't count on remembering every single item.

Before you leave the office, go over the list to be sure you've covered everything.

This simple step benefits both you and your doctor by keeping the discussion focused and ensuring that all your concerns are addressed.

Don't hesitate to use the words "I don't understand."

Doctors are human and may not always know when they haven't explained something well or in terms you can understand. Never feel embarrassed or shy about asking for clarification about something your doctor says.

When in doubt, repeat back what your doctor has told you and ask if you've got it right. especially if in a foreign language You can also ask if he or she recommends any specific reading materials about your condition.

If your doctor asks questions that sound embarrassing or overly personal, remember that the information you provide enables the doctor to better establish a diagnosis or to determine which treatment is most appropriate for you.

Never fib in response to questions about alcohol or drug use, sexual history, or other lifestyle matters. Be honest about the extent to which you are taking your prescriptions or following a treatment plan.

Withholding the truth can affect the quality of your care and can even lead to a wrong diagnosis or treatment.

Finally, the office medical assistants and nurses can be an additional resource of information. Do not hesitate to ask them questions about your concerns as well.

Advance preparation for your doctor's visit is a vital step toward becoming a partner in your own health care and an advocate for your health and well-being.

A good doctor will always encourage your desire to understand as much as possible about your condition and will welcome your active participation in your care.

Diagnosis & Tests

Several tests are used to diagnose prostate cancer.

Prostate Cancer Diagnosis: Common Tests

Two initial tests are commonly used to look for prostate cancer in the absence of symptoms. Learn what those tests are and how well they work.

Tests

Digital Rectal Examination for Prostate Problems

A digital rectal exam is an early, simple test to screen for prostate cancer. It can catch the disease early, when it's most treatable. Learn who should get one and what to expect.

Prostate-Specific Antigen Blood Test: Diagnosing Prostate Cancer

When the results of this blood test are high, it may indicate cancer. Find out how the test is done and what the results can mean.

Prostate Ultrasound and Biopsy to Diagnose Prostate Cancer

After an abnormal digital rectal exam or a high PSA your doctor may suggest a closer look. Find out what to expect from a prostate cancer biopsy or ultrasound and how to prepare for them.

Cystoscopy or Bladder Scope Test to Diagnose Prostate Cancer

Cystoscopy, also called a cystourethroscopy or a bladder scope, measures the health of the urethra and bladder. Used to diagnose disease or pain, find out how this test works and what to expect.

CAT Scans and Prostate Cancer Diagnosis

A CAT scan uses X-rays to produce a cross-section image of the body, so a doctor can check for swollen or enlarged lymph nodes. When is a CAT scan necessary? Find out.

MRIs to Diagnose Prostate Cancer

MRIs use a large magnet, radio waves, and a computer to examine the prostate and nearby lymph nodes, distinguishing between noncancerous and cancerous areas. Find out more.

Treatment for Prostate Cancer

There’s no one prostate cancer treatment that’s right for every man, but you've got plenty of options. Your doctor will consider many things when he recommends one for you, including:

The size of your tumor and how far it has spread, called the stage of your disease

How quickly the tumor is likely to grow

Your age and how healthy you are

Your personal preferences

What Options Are Available?

Watchful waiting or active surveillance. Your doctor might suggest waiting to see if your tumor will grow or spread before you treat it.

Most prostate cancer grows slowly, and some doctors think it’s better not to treat it unless it changes or causes symptoms. In watchful waiting, your doctor will closely track how the disease makes you feel. With active surveillance, you’ll also get regular tests to check on the cancer.

Surgery.This usually involves removing all or part of the prostate. The kind of operation you get depends on the size of the tumor and where it is.

Radiation.This treatment uses high-energy waves or particles to kill cancer cells and shrink tumors. There are a few types doctors can use for cancer that’s only in the prostate, and others for when it spreads to other parts of the body.

Hormone therapy.Some of the hormones your body makes can fuel the growth of prostate cancer cells. This type of therapy lowers levels of those hormones or stops the cells from using them.

Chemotherapy.Drugs that you take by mouth or through an IV travel through the body, attacking and killing cancer cells and shrinking tumors. You might get chemo if the disease has spread outside your prostate and hormone therapy isn’t working for you.

Biologic therapy. This treatment works with your immune system to fight the disease. It’s used to treat advanced prostate cancer.

Bisphosphonate therapy. If the disease reaches your bones, these drugs can ease pain and prevent fractures.

Cryotherapy or cryosurgery. They treat cancer located only in the prostate. Doctors use probes that give off extreme cold to freeze the tumor’s cells.

High-intensity focused ultrasound. The opposite of cryotherapy, this treatment uses a probe that gives off high heat, which kills cancer.

Proton beam radiation therapy. A type of radiation, it uses very small particles to attack and kill cancer cells that haven’t spread.

Your doctor will usually start with one treatment at a time. But in some cases, you might get a few treatments at once. Talk to your doctor about the course that’s best for you.

Are There Side Effects?

The treatments for prostate cancer also can affect your body in other ways. Side effects can include:

Bowel problems

Lower sex drive

Erectile dysfunction

Loss of your ability to get a woman pregnant

Leaky bladder or loss of bladder control. You might also need to pee a lot more often.

Side effects are another factor to think about when you’re choosing a treatment. If they’re too tough to handle, you might want to change your approach. Talk to your doctor about what you can expect. He can also help you find ways to manage your side effects.

What Else Should You Consider?

Remember, you have options, and it’s important to choose the one that works best for you. When choosing a treatment, think about:

The risks. Talk to your doctor about the pros and cons of each type of therapy.

The side effects. Consider whether or not you’re willing to deal with how the treatment might make you feel.

Whether or not you need it. Not all men with prostate cancer need to be treated right away.

Your age and overall health. For older men or those with other serious health conditions, treatment may be less appealing than watchful waiting.

SOURCES:

Prostate Cancer Foundation.

Prostate Cancer Research Institute.

National Library of Medicine.

National Prostate Cancer Coalition.

National Cancer Institute.

American Cancer Society

[tartempion]

Jeez, my PSA Is above average since 2003, I am 69 and still not panicking.

Usually around 10, sometimes 17 and once last year 78!

What is certain is I have BPH ( enlarged prostate) and have urinating problems.

I also suffer from chronic prostatitis requiring antibiotic treatment once a year for 40 days to lower the PSA to the 10 value.

Taking care of that is more important than not sleeping from prostrate cancer fear.

There is also a ratio calculation PSA/free PSA with a cancer risk result, as long that result shows low risk I will not have a biopsy.

You need to follow up on your PSA level, not panicking.

[BngkkB]

Did the doc do a physical exam of the prostrate before the psa was taken? If so retake the psa test without the physical exam first.

[Sheryl]

Best also not to have any sexual activity for

a day or two before the repeat psa

[chubby]

be careful your not your own worst enemy, esp in thailand, with this type of CA, i believe treatment can shorten your life , assuming you even have CA

Diagnosis

• Screening by digital rectal examination and prostate-specific antigen

• Assessment of abnormalities by transrectal needle biopsy

• Grading by histology

• Staging by CT and bone scanning

Sometimes stony-hard induration or nodules are palpable during digital rectal examination (DRE), but the examination is often normal; induration and nodularity suggest cancer but must be differentiated from granulomatous prostatitis, prostate calculi, and other prostate disorders. Extension of induration to the seminal vesicles and lateral fixation of the gland suggest locally advanced prostate cancer. Prostate cancers detected by DRE tend to be large, and > 50% extend through the capsule.

Diagnosis of prostate cancer requires histologic confirmation, most commonly by transrectal ultrasound (TRUS)–guided needle biopsy, which can be done in an office with use of local anesthesia. Hypoechoic areas are more likely to represent cancer. Occasionally, prostate cancer is diagnosed incidentally in tissue removed during surgery for benign prostatic hyperplasia (BPH).

Screening

Most cancers today are found by screening with serum prostate-specific antigen (PSA) levels (and sometimes DRE). Screening is commonly done annually in men > 50 yr but is sometimes begun earlier for men at high risk (eg, those with a family history of prostate cancer and black men). Screening is not usually recommended for men with a life expectancy < 10 to 15 yr. Abnormal findings are further investigated with biopsy.

It is still not certain whether screening decreases morbidity or mortality or whether any gains resulting from screening outweigh the decreases in quality of life resulting from treatment of asymptomatic cancers. Screening is recommended by some professional organizations and discouraged by others. Most patients with newly diagnosed prostate cancers have a normal DRE, and serum PSA measurement is not ideal as a screening test. Although PSA is elevated in 25 to 92% of patients with prostate cancer (depending on tumor volume), it also is moderately elevated in 30 to 50% of patients with BPH (depending on prostate size and degree of obstruction), in some smokers, and for several weeks after prostatitis. A level of≥ 4 ng/mL has traditionally been considered an indication for biopsy in men > 50 yr (in younger patients, levels > 2.5 ng/mL probably warrant biopsy because BPH, the most common cause of PSA elevation, is rare in younger men). Although very high levels are significant (suggesting extracapsular extension of the tumor or metastases) and likelihood of cancer increases with increasing PSA levels, there is no cut-off below which there is no risk.

In asymptomatic patients, positive predictive value for cancer is 67% for PSA > 10 ng/mL and 25% for PSA 4 to 10 ng/mL; recent evidence indicates a 15% prevalence of cancer in men≥ 55 yr with PSA < 4 ng/mL and a 10% incidence with PSA between 0.6 and 1.0 ng/mL. However, cancer present in men with lower levels tends to be smaller (often < 1 mL) and of lower grade, although high-grade cancer (Gleason score 7 to 10) can be present at any level of PSA; perhaps 15% of cancers manifesting with PSA < 4 ng/mL are high grade. Although it appears that a cut-off of 4 ng/mL will miss some potentially serious cancers, the cost and morbidity resulting from the increased number of biopsies necessary to find them is unclear.

The decision whether to biopsy may be helped by other PSA-related factors, even in the absence of a family history of prostate cancer. For example, the rate of change in PSA (PSA velocity) should be < 0.75 ng/mL/yr (lower in younger patients). Biopsy is indicated for PSA velocities > 0.75 ng/mL/yr.

Assays that determine the free-to-total PSA ratio and complex PSA are more tumor-specific than standard total PSA measurements and may reduce the frequency of biopsies in patients without cancer. Prostate cancer is associated with less free PSA; no standard cut-off has been established, but generally, levels < 10 to 20% warrant biopsy. Other isoforms of PSA and new markers for prostate cancer are being studied. None of these other uses of PSA answers all of the concerns about possibly triggering too many biopsies. Many new tests (eg, urinary prostate cancer antigen 3 [PCA-3]) are under evaluation as aids to screening decisions.

Clinicians should discuss the risks and benefits of PSA testing with patients. Some patients prefer to eradicate cancer at all costs no matter how low the potential for progression and possible metastasis and may prefer annual PSA testing. Others may value quality of life highly and can accept some uncertainty; they may prefer less frequent (or no) PSA testing.

[al007]

Thank you Chubby, like other posts I am very appreciative of input, generally consensus of opinion is better than single opinion

I am not panicking, investigating and gathering information yes, I may need this to be able to make informed decisions at the appropriate time

I am not rushing any decisions, I will not, with out great thought, even allow a biopsy yet alone surgery, I am very aware more people die with Prostrate Cancer than from it, I can promise you my greatest preference is to do nothing, but I can not just bury my head in the sand, unfortunately ! ! I am not one of those sorts of person, sometimes I wish I were

I am 70 yrs old and neither expect or hope to live forever, and future years are all a bonus, but a bit longer would be wonderful I am a very happy man, thank you GOD, whoever or whatever you might be

[al007]

I Have had further tests and PSA was a little higher

I met two doctors on Sat At the Racheapreuk Hospital the second boing the Urologist consultant, who also works at both the KhonKaen hospital and Bangkok hospital, so at the moment I am getting the same advice as from the other hospitals also at a lower cost

I have done and continue to do research so when discussing the next step life was easier, the choice really were Ultrasound or MRI the consultant asked me what I wanted to do to which I replied it is not what I want but what will help you the most to investigate more, he sad MRI, the Ultrasound produces much less information

(It is interesting when discussing with the general doctor earlier he said he thought the MRI was not appropriate for Prostrate cancer, he also wanted me to have biopsy next)

I like the specialist around 45/50 old enough to have made mistakes but not too old

I am very much following the advice of the specialist, I told him quality of life is more important than length of life, I also said at the moment my opinion would be surgery only as a very last resort, or maybe not at all

He asked if I wanted drugs to reduce my PSA to which I replied I first wanted to wait for the MRI test

We talked about MRI, (Can be done at Bangkok hospital in KhonKaen but not KhonKean hospital) I had previously investigated costs both in KhonKaen and several hospitals in Bangkok, he asked if I was aware there was a free standing unit only doing MRI in KhonKaen, I sad no, he produced a fact sheet and the prices are the best by a long way so I am going there on Friday- I have no medical insurance

The specialist checked my prostrate with the finger test, when I asked him what he thought he just immediately said MRI test, I said no more and presumed the result was not good

I have another appointment with the consultant next Saturday, it may then be biopsy is recommended; at present I am reasonably relaxed on it all

I feel the overall treatment I am getting from the small Racheapreuk hospital is very good, and the price pleases me greatly