New member looking for help in analysing my PSA results

Hello Everyone.


Great to have a forum where we can share our experiences. Six months ago I had a MRI. Found no suspicious areas. It was negative. My doctor claims now a days MRI is about 90% accurate My PSA was 14.02 back than. Prior to that a year before it was 12.00 so its been slowly increasing, so my doctor scheduled another PSA blood test in six months.


Six months later I now have my results but this time my doctor ordered PSA-Total and PSA-Free. Beside the PSA ratio is says not informative. but below provide some standard stuff


[quote] Free PSA/Total PSA Ratio
Reference Range
Total <4: Prostate cancer unlikely
and Free is not informative.
Total >10: Prostate cancer likely
and Free is not informative.
Total >=4 and <=10: If Free/Total
ratio >0.27, chance of prostate
cancer is about 10%. If ratio is
<0.17, chance of prostate cancer
is about 50%.

My PSA total is 16.00. My PSA-Free is 2.21. ug/L How do I calculate the PSA Ratio ? Is there some formula to use. ?


Obviously looks my results are worsening but still wondering what to make of it because my previous two tests were PSA only.



Is it not important to calculate the PSA-Ratio ? Too see how that plays into it. ? I do have an appointment with my doctor next week but as many as you know its an anxious nervous time so any input would be appreciated.



Thanks in advance for help.



Carmax17

It's time for a biopsy...

I think my Uro who I saw for the first time took the MRI and DRE tests as both negative and since my PSA did not go up that much since a year and a half ago wanted to try meds and monitor it in 6 months. That six months has come and am pretty sure he will want to do a biopsy now.


As far as my MRI test I am not familiar with the different types of MRI tests. Is there a way to attach a screenshot of it on a post ?


On the test it says it was performed on an open 1.5T unit without the use of an endoreactal coil. Multiparametric imaging was performed to include T1 multiplanar sequences axial diffusion weighted imaging as well as Gadolinium enhanced imaging - Does that info mean anything to any of you ?


Thanks again


carmax17

carmax, your PSA has been high for a while now, and it sounds like your docs have done the usual non-invasive things to try to bring it down. Antibiotics are notoriously poor at treating prostatitis. Unfortunately, in order to rule out PCa, a biopsy is your next step. A typical TRUS (ultrasound guided) biopsy is really a shot in the dark, as TA said, a fusion biopsy is better.

Best of luck to you, and let us know what you learn next.

carmax, PSA is a marker for prostate activity and irritation, it is not a cancer test, per se. Fluctuating PSA is not usually a marker for cancer, which is more often about slow, steady rises over a period of time.

I'm not going to venture out on the limb about whether he should or shouldn't have biopsied by now.

halbert said...
carmax, PSA is a marker for prostate activity and irritation, it is not a cancer test, per se. Fluctuating PSA is not usually a marker for cancer, which is more often about slow, steady rises over a period of time.

I'm not going to venture out on the limb about whether he should or shouldn't have biopsied by now.

Fair enough.



carmax17

Saw my Urologist today. I will be having a biopsy this Thursday. He was not happy that my PSA had risen in spite of taking Finasteride as he said it should have dropped by around 7 points.


He will be taking 12 samples when doing the biopsy. Said it could take up to a month to get the results. darn which it was not so long.


Any questions I should ask about the biopsy exam ? says its uncomfortable but not painful and will take about 10 minutes. Said I would probably have blood when I pee for awhile after the exam but that it is normal. He said about 1 in 500 can develop a problem from the biopsy. He gave me 3 Antibiotics to take starting the morning on Thursday plus an enema


Anything you guys think I should know or ask before Thursday please let me know.



carmax7

A month seems like a long time. I had my biopsy on a Monday, and "the call" came on Friday the same week.

You'll pee blood for a few days, watch out, passing clots isn't any fun. Make sure you drink lots of water to keep things flushed. And "a little blood in the semen"???? More like it'll look like strawberry jam the first time, then get darker till it looks like used motor oil. I can't say how many 'shots' it takes to clear up, but you might want to warn your partner--or use a condom till it clears up.

halbert said...
A month seems like a long time. I had my biopsy on a Monday, and "the call" came on Friday the same week.

You'll pee blood for a few days, watch out, passing clots isn't any fun. Make sure you drink lots of water to keep things flushed. And "a little blood in the semen"???? More like it'll look like strawberry jam the first time, then get darker till it looks like used motor oil. I can't say how many 'shots' it takes to clear up, but you might want to warn your partner--or use a condom till it clears up.

It is but I am in Canada. We have some very good positive things about our healthcare sysyem but we have some negative as well. Wait times is one of them. My brother waited 3 weeks to get his results. Spoke to someone else in Canada and he waited just under 3 weeks.



carmax17

carmax17 said...


I believe my Uro said something about freezing the area. I told him I am a big baby. He gave me 2mg of Ativan to take before the biopsy.

carmax17

My first biopsy was very uncomfortable, the urologist did not numb one lobe effectively or didn't wait long enough for the local anesthetic to kick in. I felt nothing for the 6 samples from one lobe and almost jumped off the table for the other 6.

Took 2 mg lorazepam (generic Ativan) an hour before the second biopsy and was much more relaxed - went home and slept two hours afterwards. Be sure to have someone drive you to and from your biopsy.

I got back my biopsy results today. Negative, no cancer. Now have to decide to have Transurethral resection of the prostate or not. ? Has anyone have experience with that ?


I feel kind of guilty I lucked out while many of you haven't.



I wish the best for everyone.


carmax17

As I've said, a TURP is a barbaric procedure, not for the faint of heart. What it really solves is debatable, the SE are serious, there are better options. Do some in-depth research.

Hello Everyone Again

Sorry for my disappearance. A lot of happen since but not till recently with my 4th Biopsy that came back July 27th, 2020. I had 4 Biopsies and 2 MRI's. The problem is my PSA kept rising through the roof but had 3 negative Biopsies. My PSA went up to 35. Yes that high, but I was taken off the medication to control the PSA. It actually went up to 42. I went back on the med and after 3 months it dropped down to 35. It might have dropped further I don't know, as it was the last PSA test I did in July, 2020. Than we went for a second MRI. The First MRI came back with no suspecting areas.( Dec , 2016 ) The second one ( June, 2020 ) did with RAD score 5/5.

The 4th Biopsy sure enough found the presence of Cancer. One sample was Gleason 7 and the other was Gleason 8. The reason it keep missing the Cancer is the previous Biopsies is that it was in a rare far exterior area where the standard Biopsy needle does not reach that far. Why don't they make that needle a bit longer ? Since with the MRI showing the location my Urologist pushed the needle further to reached the location to take the samples.


I had a Bone Scan. Negative. I had a CT scan. Negative. I had a Pet Scan. Yesterday I caught a call that the Radiation Oncologist has to meet me in person this Wednesday to discuss the results of my Pet Scan. He would not talk to me over the phone. I tried. The CT and Bone Negative results were given to me over the phone, no problem.

I am sure the Oncologist would not drag me in during Covid to discuss my Pet Scan results unless there was something that showed up positive that he has to discuss in person with me. Might alter my Treatment plan which was radiation and hormone therapy treatments.

I understand Cancer could spread outside the Prostate in 2 categories.

1) Regional area

2) Distant.


I understand there is a significant difference between the two. Naturally I am very uptight/nervous on what the Pet Scan picked up that the other 2 scans did not. I also understand the CT and Bone scan is about 65% accurate where the Pet scan is about 92% accurate. When I say I understand I might have it wrong, just what I read.

As far symptoms I have urinating ones like frequent urination, the urge to urinate and nothing comes out or very little. Things like that but no burning or blood. I can't think of other symptoms I have going on that stick out.


What do you guys know about these different Scans, being Negative on the 2 and very likely there is something positive on the Pet scan. If it was negative this same Oncologist who told me my other scans were negative would just have said the same thing. The other thing that concerns me that if the spread is Regional would not the treatment plan be the same as planned, radiation7 hormone anyway ? Could he just not tell me that over the phone. Yes I am really worried about distant spread.


Thank you.

carmax 17