New guy here darn it

@harry100
A lot of times there are urinary issues and BPH problems when somebody has an enlarged prostate. Sometimes antibiotics can reduce the size, I know cases where it’s come down dramatically after being treated with antibiotics. I would imagine some people just have larger prostate than others, but that could produce more PSA and still be normal.

Frequently a larger prostate will have a higher PSA. As I’ve mentioned, I know somebody who had a really large one and his PSA was 50, but they never found any cancer after multiple biopsies. Unfortunately, he died of a different cancer so I couldn’t ask him how large his prostate was.

@jeffmarc
Thank You, Jeff.
This disease is a beast
So many moving parts...
Thanks again for answering my question.

my prostate was 95ml in March and 70 ml in October. My PSA’s have fluctuated between 8.1 to 4.4. My prostate density is less than 0.15. No focal lesions at the moment. So I’m doing another PSA in December. For some reason getting a PSE is not easy. In my case a high PSA even up to 9 is not uncommon with an enlarged prostate from what I have read.

I'm 68, diagnosed in July 2024. I was Pirads 3 and the doctor recommended a biopsy. My biopsy showed a Gleason 4+3 - 7 and he recommended surgery. I had the surgery 11/11/24 and they determined I was Gleason 4+5 - 9 with some adverse factors (bladder neck and others). After the surgery the doctor told me it could have been fatal if I had waited. A year later I'm not preparing for radiation to get the rest of it.

We're all different, and our cancers are uniquely ours. In my case an aggressive approach was the right choice. Wishing you well.

@jeffmarc

In my experience most respected physicians do not make recommendations based on personal financial gain. Rather, they are guided by their clinical experience and understanding of the particulars of each case. Certainly concerns regarding a missed diagnosis may lead to a tendency to err on the side of caution.

@rbtsch1951
I’ve heard multiple stories about urologists holding off doing testing and declaring that what looked like prostate cancer probably wasn’t so there was no need to do something about it. As a result, people have had advanced cases that could’ve been avoided. I attend nine advanced prostate cancer meetings every month. I hear these stories pretty frequently.

Over it ancan.org Weekly advanced prostate cancer meeting one of the doctors who’s there all the time Dr. Jack (Last name not shown) Had exactly that happened to him. He relied on his urologist who was well respected to diagnose him properly, He ended up a gleason nine when the doctor ignored early issues that ended up being an advanced prostate cancer diagnosis. Jack was not happy with his doctor.

@jeffmarc

The perspective of hindsight is always 20/20. Doctors aren’t infallible and cancer isn’t always predictable. Bad outcomes occur, but the tendency too often is to blame the provider when, in reality, it is the nature of the disease.

But that wasn’t what where my comment was directed. You wrote earlier in the trail:

“You should ask your doctor, whether your PSA density shows there really isn’t an issue And see what he is basing his desire to do a biopsy on. They do make a lot of money doing it. Then again there is a PIRADS 3 lesion involved.”

It was the implication that the physician’s motivation for recommending a biopsy based on his/her personal financial gain with which I take exception.

The majority of providers are trying diligently to provide the very best possible care for their patients.

@rbtsch1951 In my & husband's experience over the last 7yrs, I have learned to suspect everyone & trust a few. I was an RN & met a lot of great doctors, but as a patient and patient's wife, not so much. We are both happy as of recently, though! The doctors' ratings are helpful. Thanks for sharing.

@rbtsch1951 I hear what you are saying and I do agree with most of it. Doctors DO develop relationships with patients over time, and the way they express their emotional stake often varies.
Some test to the max because they really do care - and like!- the patient…others try to avoid or postpone tests for the exact same reason: they don’t want to see the patient embark on a dark path because they truly feel for them.
I know it sounds ridiculous, but I’ve done it myself (as a dentist) many times; some patients I would test and refer for the littlest thing because I knew they preferred that approach.
Others, at the mere mention of a referral would literally writhe in the chair and beg me to just forget it…and I would, just not to make them miserable!
The same scenario even happened with me; my first urologist (whom I visited many times) told me that I should have a biopsy (PSA 4 point something) and when I groaned and made a face, she said, “but we won’t because I know you don’t want one.”
I have NEVER faulted her for that because IF she had biopsied and found cancer at age 58, I would have felt that my life was over (correctly or not) and she would have felt terrible for me! But getting the wake-up call from a different urologist - I had met only once - at age 64 with a gland full of Gleason 4+3, made it easier to accept since we had no relationship whatsoever…
Sounds weird, but there it is…
Phil

Here's my opinion on what to watch for. Only quacks do biopsy first. Quality DRs use MRIs followed by fusion biopsies. Only quacks do transrectal. Quality DRs use transperineal. Only quacks recommend prostatectomy, IMRT/SBRT because that's where the money is and there's big money is this game. Quality DRs use LDR/HDR brachy. I just hope you do the research.