Mens PSA, Prostate health

[cdlamb]

I am almost 52, and have been monitoring my Prostate health with the PSA blood test for about 7 years.

My father has also had an enlarged prostate for almost 30 years, & it is hereditary.

They have never done anything to treat it, & he will be 82 this fall.

I understand there is a urine test that they can check prostate health as well, but it might only be available in the USA.
has anyone had the MPS2 urine test?

They are talking about taking 12 biopsy samples from me to check for cancer. Have an appointment with the urologist next week to discuss.
I am not sure if I want a biopsy taken unless they can see with MRI or ultrasound that something may be an area of concern.

I don't really want them poking blindly in there when it might be caused by something else.

They say inflammation can cause the PSA to rise, but blood tests don't show any inflammatory markers.
I have been fighting some hip pain and lower back pain for 3 years, (degenerative arthritis) & also have an MRI booked for next Sunday.
I sometimes get a sharp shooting pain in my lower back, & I still think I have a herniated disc causing sciatica.

They say the MRI that I am booked for doesn't use the right magnet strength to get an image of the prostate.

In Canada our healthcare is covered through taxes we contribute, but our healthcare can be a waiting game.
Is healthcare options south of the border better with health insurance?

Wish this was just another oil sample off to the lab.
They say the PSA is 2 x normal level for a man my age.

 

[02SE]

My GP told me that every man will eventually get Prostate cancer, if they live long enough.

I can usually see my GP quickly, in a day or two. Sometimes even the same day if it's important. I have an insurance plan that is expensive. It got much more expensive, and coverage got worse, after Obamacare took effect.

When I was the caregiver for my parents, the Oncologist sometimes wanted to know what was going on with my dad's cancer, that day. So we'd get the CT scan or MRI, the same day. They had a Medicare Advantage plan. Usually it was pretty good, except when the insurance wanted to deny coverage for something based on reading a file, instead of actually seeing the patient.

An example was an intensive physical therapy program which would have benefited my dad greatly. The Insurance decided they didn't want to pay for the intensive physical therapy, and instead sent him home with a couple times a week physical therapy in the home. It took him a lot longer to recover than I believe it would have in the intensive program.

Or their was the time that insurance denied my mom continuing to receive in-home healthcare. I called and complained, the Nurse called, we did a telehealth visit with the GP who confirmed she needed continued in-home care. The insurance in their wisdom said they needed a hand-written letter from my mom, requesting why she needed to have continuing in-home healthcare.

This was a 92 year old with dementia/alzheimers, who had just been through the death of her husband (my father), she was aware enough to know he was gone, and she was suffering from Pneumonia... which the insurance was aware of. Let that sink in...

I wrote (forged) the dam* letter to the Humana Grievance Department, explaining why I (my mom) suffering from dementia/alzheimers, AND Pneumonia needed continued in-home care. I had to try and compose it as though I were her...

I mailed it off through the USPS, (because that is the only option they would accept) and waited, while I planned my dad's final arrangements. And continued to do my best to take care of mom.

In their magnanimity they eventually sent a letter that she had been approved for continued care... Unfortunately their letter explaining their benevolence, arrived the day she was rushed to the hospital and died in the ER.

Then they had a the gall to send another letter asking if we were pleased with their responsiveness and care... I called and was less than kind. I sent another letter to the Humana Grievance department, this time composed as myself, asking if that was how they would treat their own elderly parents? And suggested they take a good long look in the mirror.

Humana, is NOT Humana-tarian.

 

[Sierra048]

Back in 2010 my primary care doctor was concerned about my elevated PSA number. I went through the rather uncomfortable biopsy procedure. They took twelve samples from me as well. All twelve came back showing cancer cells. I ended up getting my prostate removed a few weeks later. If there is something you'd liked to know in more detail please reach out to me.

 

[MParr]

Back in 2010 my primary care doctor was concerned about my elevated PSA number. I went through the rather uncomfortable biopsy procedure. They took twelve samples from me as well. All twelve came back showing cancer cells. I ended up getting my prostate removed a few weeks later. If there is something you'd liked to know in more detail please reach out to me.

2014 was the year that I had my prostate removed. My PSA numbers were slowly increasing. I them booked an appointment with a Urologist. He did another PSA and it came in above 4.0. I decided to go ahead with the biopsy. Cancer was confirmed. I had the option of removal or radioactive seed therapy. Surgery was my best option.
If it turns out to be cancer, go ahead and have it removed. Radiation therapy isn’t the best choice. There are horrible side effects and no guarantee of success with radiation therapy.

 

[97K15004WD]

HIFU is also an option - much lower side effects and it works. A friend had this done in Mexico years ago, before it was allowed in the US. He has been in excellent health ever since.

High Intensity Focused Ultrasound (HIFU) - Prostate Cancer Treatment | Mount Sinai - New York

High-Intensity Focused Ultrasound or HIFU is a non-invasive heating procedure for treating localized prostate cancer.

www.mountsinai.org

Back story: His PSA level starting rising (he was 52 Y.O.) and his GP wanted him checked. Biopsy revealed 3 "spots" of agressive cancer in the prostate.

His options were the "seeds" or complete removal (with side effects just about certain). He and his wife did extensive research and found out about the HIFU option (US doctors said nothing about it). They went to Mexico and had the procedure done (2004). He has been cancer free for the last 20 years with PSA levels in the normal range.

What is even more crazy to me is this treatment was available 20 years ago in Mexico, but "outlawed" in the US. It's only now getting approval and "coded" so insurance will pay for it. I don't understand why the delay was "necessary" in the US as the procedure was fully refined years ago.

History of HIFU (for Prostate 50:24)

Home

www.fusfoundation.org

 

[PWMDMD]

Most men who live long enough will die with prostate cancer, not because of it.

 

[Pelican]

I am almost 52, and have been monitoring my Prostate health with the PSA blood test for about 7 years.

My father has also had an enlarged prostate for almost 30 years, & it is hereditary.

They have never done anything to treat it, & he will be 82 this fall.

I understand there is a urine test that they can check prostate health as well, but it might only be available in the USA.
has anyone had the MPS2 urine test?

They are talking about taking 12 biopsy samples from me to check for cancer. Have an appointment with the urologist next week to discuss.
I am not sure if I want a biopsy taken unless they can see with MRI or ultrasound that something may be an area of concern.

I don't really want them poking blindly in there when it might be caused by something else.

They say inflammation can cause the PSA to rise, but blood tests don't show any inflammatory markers.
I have been fighting some hip pain and lower back pain for 3 years, (degenerative arthritis) & also have an MRI booked for next Sunday.
I sometimes get a sharp shooting pain in my lower back, & I still think I have a herniated disc causing sciatica.

They say the MRI that I am booked for doesn't use the right magnet strength to get an image of the prostate.

In Canada our healthcare is covered through taxes we contribute, but our healthcare can be a waiting game.
Is healthcare options south of the border better with health insurance?

Wish this was just another oil sample off to the lab.
They say the PSA is 2 x normal level for a man my age.

There are many reasons for an elevated PSA one of which is size of prostate, a bigger healthy one will show a higher PSA level than a smaller one all things being equal. My urologist said that I will know when it's time to have removed and when that time came (~12yrs ago) I had the procedure done in Montreal at Royal Victoria Hospital by Dr Mustafa El Hilali with a procedure that he pioneered. Though I'm in Ontario the procedure was covered by my Ontario Health Care (OHIP). It was a walk-in procedure, completely painless and this procedure has no recidivism on record and I've been symptom free for all those years. It's a holmium laser procedure, ask your urologist he may know someone who can perform it for though many hospitals have the machine not many have the Drs with the know-how to do it.

 

[PWMDMD]

HIFU is also an option - much lower side effects and it works. A friend had this done in Mexico years ago, before it was allowed in the US. He has been in excellent health ever since.

High Intensity Focused Ultrasound (HIFU) - Prostate Cancer Treatment | Mount Sinai - New York

High-Intensity Focused Ultrasound or HIFU is a non-invasive heating procedure for treating localized prostate cancer.

www.mountsinai.org

Back story: His PSA level starting rising (he was 52 Y.O.) and his GP wanted him checked. Biopsy revealed 3 "spots" of agressive cancer in the prostate.

His options were the "seeds" or complete removal (with side effects just about certain). He and his wife did extensive research and found out about the HIFU option (US doctors said nothing about it). They went to Mexico and had the procedure done (2004). He has been cancer free for the last 20 years with PSA levels in the normal range.

What is even more crazy to me is this treatment was available 20 years ago in Mexico, but "outlawed" in the US. It's only now getting approval and "coded" so insurance will pay for it. I don't understand why the delay was "necessary" in the US as the procedure was fully refined years ago.

History of HIFU:

There's nothing nefarious here. It was never "outlawed" in the US. It seems the technology and application for prostate cancer has existed for a long time, however, while there was improvement, most cases still required additional treatment using the "standard methods" to get results equal to the standard methods. In this context, it showed improvement, but less than the other techniques. It is coming into focus again because technological advances are removing some of the limitations. The standard of care in Mexico is less than that of the US and while your friend may have seen a miraculous benefit, the evidence just hasn't been there to justify this a sole treatment option until more recently.

"Currently, the main urological application of HIFU is for the treatment of prostate cancer; although, in the 1990s, several groups investigated the potential of HIFU for the treatment of benign prostatic hyperplasia. While all investigators saw some improvement in symptom scores and flow rates, many needed further interventions and HIFU dropped out of the therapeutic armamentarium. These studies were reviewed by Kennedy et al. [23]. Early studies of bladder cancer had a similar fate. Preclinical work led to a feasibility study by Watkin et al. in pigs [24] and a Phase II study by Vallancian of 25 patients with a single superficial bladder recurrence [25] that showed 67% tumour-free results at 1 year. However, the technology was much more complicated than cystoscopy and still required general anaesthesia, so fell into disuse."

A Review of High-Intensity Focused Ultrasound in Urology

High intensity focused ultrasound is a novel and non invasive treatment for an increasing number of cancers and benign diseases. The principal is similar to focusing the sun’s rays with a magnifying glass, causing a burn at the focal point. This ...

www.ncbi.nlm.nih.gov

 

[97K15004WD]

There's nothing nefarious here. It was never "outlawed" in the US. It seems the technology and application for prostate cancer has existed for a long time, however, while there was improvement, most cases still required additional treatment using the "standard methods" to get results equal to the standard methods. In this context, it showed improvement, but less than the other techniques. It is coming into focus again because technological advances are removing some of the limitations. The standard of care in Mexico is less than that of the US and while your friend may have seen a miraculous benefit, the evidence just hasn't been there to justify this a sole treatment option until more recently.

"Currently, the main urological application of HIFU is for the treatment of prostate cancer; although, in the 1990s, several groups investigated the potential of HIFU for the treatment of benign prostatic hyperplasia. While all investigators saw some improvement in symptom scores and flow rates, many needed further interventions and HIFU dropped out of the therapeutic armamentarium. These studies were reviewed by Kennedy et al. [23]. Early studies of bladder cancer had a similar fate. Preclinical work led to a feasibility study by Watkin et al. in pigs [24] and a Phase II study by Vallancian of 25 patients with a single superficial bladder recurrence [25] that showed 67% tumour-free results at 1 year. However, the technology was much more complicated than cystoscopy and still required general anaesthesia, so fell into disuse."

A Review of High-Intensity Focused Ultrasound in Urology

High intensity focused ultrasound is a novel and non invasive treatment for an increasing number of cancers and benign diseases. The principal is similar to focusing the sun’s rays with a magnifying glass, causing a burn at the focal point. This ...

www.ncbi.nlm.nih.gov

HIFU (in the US at that time) that Luke found was only available at Duke University as a research study, and they would not qualify him for the study as they said he was not a good candidate. He told me they said it was not "legal" for use in the US for his type of cancer and said he only had those two options I mentioned earlier.

I am no doctor, and only can speak of what I have been told. I hope this new work can improve chances for guys like the OP without extensive loss of function. I worry for myself as a man - I don't want to have loss of function if it can at all be avoided.

Thank you for posting that information. I am obviously not versed in the research of this procedure, and have a knowledge of only one case. His case may be a fluke, but for him it was an awesome outcome.

Speaking for myself only, I would rather try HIFU first, and continue to have full "function" for a few more years, and then have the "final" treatment that might result in loss of functions. I sure hope HIFU is better now. It's been a long time since his treatment and he's still good.

 

[PWMDMD]

HIFU (in the US at that time) that Luke found was only available at Duke University as a research study, and they would not qualify him for the study as they said he was not a good candidate. He told me they said it was not "legal" for use in the US for his type of cancer and said he only had those two options I mentioned earlier.

I am no doctor, and only can speak of what I have been told. I hope this new work can improve chances for guys like the OP without extensive loss of function. I worry for myself as a man - I don't want to have loss of function if it can at all be avoided.

As of Nov 2021 when this paper was published, no large randomized clinical trials had been performed meaning this treatment still didn't have even the second highest level of research support for its use in 2021, the highest being a meta analysis. Other countries are much more cavalier because they have many fewer safeguards in place. HIFU was still experimental when your buddy had it done. If the evidence isn't there then the evidence isn't there and at the time there was more evidence for other treatments. It would be unethical and just the wrong thing to do to recommend something that "might work" over something we know works.

"Although no large randomised clinical trials of HIFU in prostate cancer have been conducted, the ‘Partial ablation versus radical prostatectomy in intermediate-risk prostate cancer: the PART feasibility RCT study’ [51] demonstrated that randomisation of men to an RCT comparing partial ablation with radical treatments of the prostate is feasible. The full study has received funding from the NIHR and was scheduled to start in autumn 2020."

 

[pvs2487]

This is an excellent thread on all aspects of prostate health/imaging/treatment that I follow from the MG Experience board:

Prostate cancer : Off Topic Forum : The MG Experience

After my annual checkup it was found that I have early prostate cancer. I'm not overly fussed about this, as early treatment is 93% effective. What I'm after is subjective feelings, from those of you, who have had treatment, about the longer term effects, that you've e

www.mgexp.com

 

[97K15004WD]

PWMDMD, thanks for that article. I especially like the conclusions !

"4. Conclusions
Sir William Osler, who ended his career as the Regius Professor of Medicine in Oxford and died in 1919, is reputed to have said that “diseases which harm require treatments that harm less”. Technology does not go backwards. There is no doubt that HIFU works and is now an accepted treatment for localised prostate cancer..."

I hope this procedure is going to become more accessible here in the US. Prostate cancer led to my father's death, and I would prefer not to follow in those footsteps.

Having a less "damaging" procedure (comparing death from prostate cancer to loss of function, I understand Sir William Osler's statement and how it relates to older forms of prostate cancer treatment - better to lose some function, instead of losing life.)

Nonetheless, "function" is still important to quality of life, and I hope this becomes an "interim" form of care that may not be a "cure", but allow longer, higher quality of life until there is no other option left to prolong a good life but the radiation type of treatments, or surgery.

 

[97K15004WD]

I like this doctor's personal experience write-up. I agree that we all need to discuss this topic more, even though it's sort of taboo among men.

Meet Ken: Gerontology Expert Opts for Focused Ultrasound to Treat Prostate Cancer

Dr. Ken Dychtwald is a psychologist, gerontologist, best-selling author, and a public speaker.

www.fusfoundation.org

 

[PWMDMD]

PWMDMD, thanks for that article. I especially like the conclusions !

"4. Conclusions
Sir William Osler, who ended his career as the Regius Professor of Medicine in Oxford and died in 1919, is reputed to have said that “diseases which harm require treatments that harm less”. Technology does not go backwards. There is no doubt that HIFU works and is now an accepted treatment for localised prostate cancer..."

I hope this procedure is going to become more accessible here in the US. Prostate cancer led to my father's death, and I would prefer not to follow in those footsteps.

Having a less "damaging" procedure (comparing death from prostate cancer to loss of function, I understand Sir William Osler's statement and how it relates to older forms of prostate cancer treatment - better to lose some function, instead of losing life.)

Nonetheless, "function" is still important to quality of life, and I hope this becomes an "interim" form of care that may not be a "cure", but allow longer, higher quality of life until there is no other option left to prolong a good life but the radiation type of treatments, or surgery.

I'm not getting in younger and if this technology means I don't have to get radiation/surgery just to be incontinent and have my winky not work then I'm all for it!

 

[SumGuy]

Most or all of the responses here are dealing with various treatments and removal options once prostate cancer has been detected. The OP is wondering about a new urine genetic screening test (MPS2) that seems to have proven itself as a deciding factor in whether or not a biopsy sample proceedure is useful. Here is what I found out about the test (this dated April 29, 2024):

"the test can be used by any clinician as long as a sample is sent to a CLIA-certified reference laboratory. The MPS2 assay has transferred to LynxDx, a diagnostic testing company Chinnaiyan founded to translate genomic biomarker tests into clinical practice. The company is working to have the assay reimbursed through Medicare and private insurance, but in the meantime, fees may be covered through an early access program. Ultimately the U.S. Food and Drug Administration will need to review and approve MPS2 if the test will be publicly marketed."

So, practically speaking, it really is not yet available in the US. Presumably given time, this MPS2 test will replace the PSA test. Here in Ontario, I've twice paid for a PSA test since it's not covered by OHIP for screening. Cost was $30 or $40 for the test, they were done maybe 6 years apart?

I understand the PSA test can be better utilized if you have several of them done over the course of a decade, their predictive value increases when you have trend or change information, a single PSA test on it's own might have little value.

 

[hemioiler]

Trying to keep this question "classy", but does removing the prostate affect your love life or does everything usually return to normal after some time?

 

[michaelluscher]

I'm keeping an eye on this discussion
I'm probably on the younger side to be concerned about this, but my grandfather had (radiation cured) prostate cancer
My dad had to have the greenlight prostatectomy in his early 50s, they warned him that had he let it go a few more years, it's benign tumor nature could've become not so benign in time

I'm due for a physical, I should ask for a PSA test as well

 

[BMWTurboDzl]

I am almost 52, and have been monitoring my Prostate health with the PSA blood test for about 7 years.

My father has also had an enlarged prostate for almost 30 years, & it is hereditary.

They have never done anything to treat it, & he will be 82 this fall.

I understand there is a urine test that they can check prostate health as well, but it might only be available in the USA.
has anyone had the MPS2 urine test?

They are talking about taking 12 biopsy samples from me to check for cancer. Have an appointment with the urologist next week to discuss.
I am not sure if I want a biopsy taken unless they can see with MRI or ultrasound that something may be an area of concern.

I don't really want them poking blindly in there when it might be caused by something else.

They say inflammation can cause the PSA to rise, but blood tests don't show any inflammatory markers.
I have been fighting some hip pain and lower back pain for 3 years, (degenerative arthritis) & also have an MRI booked for next Sunday.
I sometimes get a sharp shooting pain in my lower back, & I still think I have a herniated disc causing sciatica.

They say the MRI that I am booked for doesn't use the right magnet strength to get an image of the prostate.

In Canada our healthcare is covered through taxes we contribute, but our healthcare can be a waiting game.
Is healthcare options south of the border better with health insurance?

Wish this was just another oil sample off to the lab.
They say the PSA is 2 x normal level for a man my age.

US healthcare system typically has reduced wait times as demand is constrained by the ability to pay. In the US the customer is the health insurance company and the patient is a passthrough entity.

Public payer systems withhold supply to reduce costs since there is no constraint on demand.

My stepfather had a few patients from Canada over the years.

 

[supton]

Trying to keep this question "classy", but does removing the prostate affect your love life or does everything usually return to normal after some time?

My reading has been, some portion of men suffer incontinence and ED. Some recover fully and still have a full love life, but if it is a full removal, then orgasm can be still had but no more ejaculation. Radical prostatectomy removes some of the plumbing here. [But that's not the only operation option.]

Well worth spending a few minutes reading up on. I don't want to say it's "inevitable" in a fear mongering way, but, as others have stated, live long enough, you're going to learn about it.

 

[benjy]

interesting info for me soon 76 YO. in the USA its all about the $$$ + info shows many not needed tests + procedures are PUSHED, + info shows PSA tests are sketchy. in my 30s i had a higher PSA + doc wanted to poke around i said NO + just took nutritional supplements from research + still doing well!!! diet has an affect on EVERYTHING including the prostrate. good luck to anyone with issues!! we are all individuals + DON't be afraid to speak up + ask questions, after all its YOUR health! i might add many of todays foods + drinks are WORSE than ever, hence the high diabetes + cancers so read + learn how to help yourself, sugar + seed oils, yes they are NOT vegetable oils are the worse according to savy nutritional gurus!!