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Time for MRI and 3rd Biospy - not looking good

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Prostate Cancer
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Posted 11/8/2013 10:58 PM (GMT 0)
My PSA has continued to increase over the last 3 and a half years. In the 4's in 2009 and 2010, into the 5's in 2011 and 2012 and the last four tests in 2013 are 5.2 in January, 6.2 in May, 5.8 in July and 9.4 last week. Not sure why the huge jump, no drinking or ejaculations for 10 days prior to test. I was hoping it would go back down into the low 5's or high 4's. I have had 2 negative biopsy's, the last one was in August of 2011 and there were two suspicious samples possible for asap and hgpin. I am to see the uro December 23rd but I may call and tell them to go ahead and book the mri and the biopsy. I do not want to have the surgery and go through the recovery but I am going to have to get this taken care of. My free psa is 7% so I have been very awre that this was likely to go bad for me. I think my luck has run out.
Posted 11/8/2013 11:09 PM (GMT 0)
Sorry to hear your PSA has jumped. Hate you see you have to do another biopsy but it does seem like what you need to do.

I wouldn't worry about treatment yet. Get the biopsy report and then see where you are.

Hang in there and keep us updated on what happens.
Andrew
Posted 11/8/2013 11:10 PM (GMT 0)
You might also consider a PCA3 test.  It's a simple urine test, a couple ounces of "first catch" after a somewhat more vigorous DRE.  Easy.  It measures a ratio of certain types of RNA from prostate cells, good ones vs bad ones.  If it's above some value, typically 25 or so, it's more indicative of needing another biopsy.

I feel for you.  I had some similar numbers back around 2001, especially concerning with the very low fPSA %.  Inflammation is capable of doing all of that, and can be very hard to clear up, lasting for a really long time.  It's very frustrating, but don't push the panic button yet.  Stay with it, but you don't yet need to freak out, your luck may still very well be with you!

Have you been on any courses of antibiotics yet for possible prostate infection?

 

Posted 11/8/2013 11:22 PM (GMT 0)
Thanks for the reply guys, we talked about a PCA3 test a while back but he seemed to let that go and was more interested in an MRI, apparently the MRI scan has come a long way and it would be helpful in deciding where to take extra samples from the biopsy should it show anything. When I had my last biopsy the PSA had gone to 5.7 from 4.7 and the biopsy indicated some inflamation. It went down to 5.o and then 4.9 on the next two PSA tests over the next 8 months. It then went 5.7, 5.2, 6.2, 5.8 and 9.4. My wife thinks I should get another PSA test. Greg
Posted 11/9/2013 2:09 AM (GMT 0)
Not sure if you have heard of this test from U of Michigan, pretty new. Perhaps you Uro can help you order one.

http://www.cancer.med.umich.edu/news/early-detection-for-prostate-cancer-2013.html
Posted 11/9/2013 3:12 AM (GMT 0)
Get the biopsy whats the point of an MRI. If your'e planning surgery all the evidence will be there. I personally do not see the point of taking a test to see if you should take another test to see if , well you know!! Im assuming you are looking for feedback fwiw….
Posted 11/9/2013 4:34 AM (GMT 0)
I would suggest one more PSA test, to confirm what seems to be the case, then I would agree to do another biopsy, not sure a MRI would show anything useful at this point, but its typically done by most urologist regardless. It took 3 biopsies to find my PC, and in my 2nd one, lots of HGPIN was showing up, and my uro said that was a pretty good indicator that cancer was there, somewhere.

Good luck, I hope you can dodge the PC bullet, but if found, this is a great place to be for support, help, and advice.

David
Posted 11/9/2013 3:29 PM (GMT 0)
I think the MRI-guided biopsy is a great idea. With the latest technology, you'd have the multiparametric MRIs with endorectal coil on a 3 Tesla machine first. Then the images from that are analyzed by a top rate, experienced radiologist who identifies any suspicious areas. It really does take a great radiologist to do this, so check his credentials and the number he's done. The images are then computer-fused over a real-time ultrasound as the biopsy is done. The accuracy has gotten very good in recent years. If that doesn't find anything, nothing will.

Surgery is only one of several options if cancer is found. We can talk more if it is.

- Allen
Posted 11/10/2013 12:42 PM (GMT 0)
I would send your last biopsy slides (the ones with ASAP) to Epstein for review. Often ASAP is diagnosed by an inexperienced pathologist who is not 100% sure of a diagnosis. The experts have very low rates of ASAP diagnosis.
Posted 11/10/2013 3:00 PM (GMT 0)
Thanks everyone for your comments and yes I was looking for feedback. My uro said the MRI would be done at our Regional Health Centre as that is where there is an expert in identifying suspicious readings. He said there are areas of the prostate that a biopsy cannot hit and the MRI may be helpful in picking an area to take additional samples. Dr. Epstein is in the USA I think and I am in Canada so I am not sure if sending my last biopsy slides there is an option.

The additional PSA test could be just a distraction but the more I think about it the more I keep saying to myself, does a 300 - 400 point increase make any sense at all? I could understand a reading over 6 and maybe even a low 7 but 9.4, really? Was the result 4.9 and not 9.4 and its be a typo? If it is 9.4 then I need to get a biopsy and get on with the action necessary to take care of this before it gets outside the prostate.

Thank you for any comments. Greg
Posted 11/10/2013 3:56 PM (GMT 0)
It took me 3 biopsies before I was dx with PCa. Hope it doesn't for you.
Good luck!

Bill from Florida cool
Posted 11/10/2013 5:02 PM (GMT 0)
A PSA test, is just a blood draw. You might want to consider a retest, just to confirm but is the anxiety level worth it?

An MRI isn't that big a deal to do and it's impressive what that machine can see.

It's not fun figuring this all out but you need more information to plot a plan of action. In your place I'd possible redo the PSA and go ahead with the MRI and biopsy.

Andrew
Posted 11/10/2013 5:19 PM (GMT 0)
Based on new understanding of MRI new capabilities, provided, by Allen, I agree with another biopsy guided by the MRI images , if there are any suspicious , and there is still hope there won't be, and that you have a hard to reach case of prostatitus. Another psa test… seems moot... not so after a negative biopsy, within a proper post biopsy time span.
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