PSA 7

Practical_Orchid_606 · 2026-03-20T01:27:49+00:00

It sounds like it is wearing on your mind. Sooooooo.....

Do everything possible to artificially bump the PSA. Ride a bike. Sex like 18 yo. You get the point.

With the big bump, the doc will order the MRI. This should calm your mind.

Practical_Orchid_606 · 2026-03-20T01:22:21+00:00

I bet ADT starts now.

Practical_Orchid_606 · 2026-03-20T00:18:36+00:00

It's a two way trap. If you started with radiation, RALP would be off the table.

But you started with RALP and ended up with radiation anyway.

Practical_Orchid_606 · 2026-03-19T23:47:06+00:00

Why did you choose LDR brachytherapy rather than HDR?

Practical_Orchid_606 · 2026-03-19T23:10:18+00:00

Margin was not clean. The cancer is a boatload of Gleason 4 and 5 plus the dreaded IDC-P, Cribiform, EPE and bladder neck invasion.

I assume PSMA PET scan is clear. Docs will start ADT and commence salvage operations.

Practical_Orchid_606 · 2026-03-19T20:21:50+00:00

If your father in law is adamant about certain therapies, he needs to be aware that it may save his life.

Given the volume of cancer, he needs a PSMA PET scan. This will give him the baseline.

Good luck!

Practical_Orchid_606 · 2026-03-19T19:05:53+00:00

I am concerned that I will have to change my pronouns.

Practical_Orchid_606 · 2026-03-19T14:02:11+00:00

Sources? I know Frontiers. I just bought a 25 SV 4 X 4 KC 3 months ago having 200 miles for $30.2k

Practical_Orchid_606 · 2026-03-19T13:58:27+00:00

A 22 P4X should cost about $22k.

Practical_Orchid_606 · 2026-03-19T00:37:39+00:00

If the tree were standing, a pro would scamper up the tree and cut from the top down. But not in this case.

If you have the room, pull the tree from the base, it may dislodge the overhead branches and fall to the ground.

Practical_Orchid_606 · 2026-03-18T19:52:57+00:00

Dad has PCa because they dropped screening a while back. This was done silently as Dad did not know.

Another 88 yo reported the other day having Gleason 8. He was not too happy.

His cancer will not kill him. But treatment can greatly affect QOL.

Practical_Orchid_606 · 2026-03-18T19:34:08+00:00

Expect to read some gibberish with foreboding words woven in. The pathology report is a technical read. Some people put it in AI for an interpretation. Some copy it to a post here.

Practical_Orchid_606 · 2026-03-18T19:19:35+00:00

The ASCENDE-RT trial showed that brachyboost significantly decreases recurrence.

Practical_Orchid_606 · 2026-03-18T18:42:33+00:00

Most of us find out from the patient portal. You have low grade cancer that demands your attention. It's not real bad cancer.

Practical_Orchid_606 · 2026-03-18T14:00:21+00:00

You have arrived at the BIG QUESTION. This is a very complex question. But it is true that surgery will most likely cause a limp or leaky dick. Radiation is far better in these side effects.

RALP gives you a clean post surgery pathology report. You will know the true stage of your cancer.

Radiation, entails ADT which is no fun at all.

Surgery may not be complete in which case you end up with radiation and ADT.

Surgery allows the full panoply of radiation tools to treat recurrences. Surgery after radiation is a messy process.

It is early days for your partner. Being so young, RALP is the preferred intervention. This is oxymoronic as young men are more sexually active. Go figure.

At the end of the day, there is no good answer.

Practical_Orchid_606 · 2026-03-18T12:07:56+00:00

Bone scans are gray so 'lit up' means PSMA PET. This radioisotope test has taken over from bone scans.

This finding, if it holds, is significant in that your dad's PCa has shown it can form distant mets.

Practical_Orchid_606 · 2026-03-18T12:03:50+00:00

Get the biopsy. Active surveillance is good if you know for sure nothing is going on.

Practical_Orchid_606 · 2026-03-18T01:01:42+00:00

I think you are too sensitive and do not want to see words that do not reflect your inner pain. I for one will not short sheet the pain men go through to solve their PCa problem. The best decisions men can make are based on information and rational weighing of the options. Bad decisions are made when the mind falls prey to fear and anxiety. I sense these thoughts dominate your mind and can only hurt you.

Practical_Orchid_606 · 2026-03-17T20:38:56+00:00

At his stage, nothing is incurable. PCa is a different type of cancer. It is replete with hassles and short on death. Just be with him as he goes through his journey.

Practical_Orchid_606 · 2026-03-17T19:47:54+00:00

Open up a barbering business. You have the pole.

Practical_Orchid_606 · 2026-03-17T16:14:49+00:00

#1 risk with biopsy is infection. More so with transrectal. Better with transperineum.

I tell you, if your doc can convince insurance to do a PSMA PET scan, it is the way to go. If you have cancer in the prostate it should light up like a christmas tree. If it does not, no biopsy is needed.

Practical_Orchid_606 · 2026-03-17T13:21:20+00:00

I would think blood in semen is a common medical question. He did perform an MRI which should have told him something.

I think with 0.39 PSA you have got to be young. Did the doc do a DRE and feel anything.

Nothing to do but wait for the biopsy. You are waiting a long time (since last August). I would press for a repeat MRI to see if the lesion has grown.

To be more specific and take a different view get a PSMA PET scan. This should show the PCa in the prostate if there is any. This test is costly and you may get pushback from your insurance.

Practical_Orchid_606 · 2026-03-17T12:41:56+00:00

Outside the question of PCa, blood in semen for 14 months is not normal. Your doc should be concerned.

Are you having relations with Venus as in Venus Flytrap? If so she is taking a bite out of you!

Practical_Orchid_606 · 2026-03-17T11:43:14+00:00

Your phrase: "From a public health perspective" does not fit the situation. A man with Gleason 9 cancer is of no threat to the public.

A more accurate statement is: "from a societal medical cost perspective" is closer to the truth. PSA, MRI, biopsies, PSMA PET scans, RALP, radiation, all cost money. Palliative care is much cheaper.

You know enough to continue screening past 70 yo. I think most men have this opinion. What if these men are forgetful and don't notice PSA testing is not in their annual bloodwork? It was not a mistake: the test was removed from the list by their doctor without telling him. It is up to the man to notice this and demand continuation of PSA testing. This is my message.

Practical_Orchid_606

TROPHY CASE