Rising PSA

2019 Guy, if you keep shopping for urologists I'm sure that you will find one who recommends treatment. At age 65, with one core of confirmed G6 and a color doppler by one of the best, it sure sounds to me that you remain a good AS candidate. Rather than uro shopping why don't you call Duke Bahn and speak to him about your latest PSA test. My guess is that he will tell you that your PSA is still pretty low and that continuing with a strict AS protocol makes sense.

Anyway, that's my 2 cents worth.

Jim

Do you know if the spot picked up through UroNav procedure was where the Pirads 5 was picked up on the MRI? I am far from qualified to really comment but I do understand that a PIRADS 5 is indicative of the greater likelihood of clinically significant cancer (G7 plus). I am sure others will be along to comment. Think you are doing well to investigate while remaining positive.

Welcome 2019 Guy,

I would be interested in the Pi-Rad 5. Was your MRI at 3T? I'll guess it was. Other than that, I'd say AS.
Of note, I've had 2 MRI's and the results were different although I had no higher than a Pi-Rad 3. I'm not that big on continually changing health care providers in general. I think it would be a good idea to look at it as a team approach and just ask questions.

Thanks, Guys. I really appreciate everyone's input. Let me clarify a few things that might have been fuzzy.

I'm in the Kaiser system, which means that all my medical care - even now on Medicare - has to take place at one of their facilities and with one of their doctors. Unless of course I want to pay for it myself, which is what I did with Dr. Duke Bahn and with Dr. Clayton Lau at City of Hope (an LA-area CCC).

My original uro at Kaiser is the only one to date who recommends treatment rather than AS; in fact he told me that he "would not support surveillance". The second uro recommending AS was also Kaiser, but he is a general urologist rather than an oncology specialist. One would naturally think that the specialist's opinion would prevail. This is why I went to City of Hope, as they are a cancer-speciality place and very highly regarded.

The third uro I plan to see in a couple of weeks is at Kaiser and was recommended by Dr. Lau at City of Hope. So presumably his would be another weighted opinion. This is not to say that I do not respect that of my initial uro. I do indeed... but if I eventually have 4 doctors recommending AS, I will breathe easier.

It was the Kaiser pathologist who made the comment about PI-RADS 5, which was indeed the 1.6cm lesion that was subsequently biopsied with UroNAV. My first urologist said that in his estimation it was actually a 3 or 4.

I have a total of 3 positive 3+3=6 cores at 5%, 15% and 20% (the last in the "Pi-RADS 5" lesion, and an uptick from 10% by Dr. Epstein)

My MRI was unfortunately not 3T but 1.5T. However none of the doctors I've asked about this felt it mattered, and that a good reading was obtained. (all the uros have seen my MRI images)

PSAs #1 (1.2) and #3 (2.2) were at the same Kaiser lab; the middle one of 1.8 was at Dr. Bahn's. So indeed the same lab showed a full 1-point rise over 10 months.

Again, you're all terrific to take the time and comment so intelligently about my situation. I learn something every time I come to this forum!

Hope you are following beaverduck’s “Just diagnosed” thread, a lot of similarities yet differences to contrast.

Might be a shorter AS term than you would like but plenty of time to consider all the options. Sounds like you are doing all the right things.

My father has recently diagnosed with advanced prostate cancer with psa level 400 mg. It has spread to bones also with multiple mets. Doctor has injected leuprolide for 3 months and suggested a surgery to remove testicles
Pl advice what is the next best step to lower down psa level

Thanks, Mumbo and Fairwind. I'll definitely drive on over to that other thread, Mumbo - thanks for tipping me off. And Fairwind... well, your point is very well taken and thoughtful. I think part of my willingness to go through this seemingly-tortuous process is that I've been down the cancer road before: 10 years ago I had a dicey head and neck cancer and went through surgery and rads and a year of my life. So although I'm not treating PCa with anything but the highest respect, I'm able to compartmentalize.

I also am not nearly ready to roll the dice on permanent SEs until I absolutely have to. Of course, those last three words are open to much interpretation! Let's say that I plan to take the rest of this year to puzzle it all out. Maybe the next PSA reading will go stratospheric on me and the decision will be no decision at all.

Oldbeek: thanks for that about City of Hope. That's disheartening to read and I'm sorry you had to be dealt with in such a cavalier fashion. That is, yes, getting rid of cancer is Job #1. But there's so much more to it, as I'm learning all the time. At any event I was just there for an opinion. Any eventual treatment will be in the Kaiser system... unless I opt to try focal therapy somewhere. A bridge to cross in future.

Again, I so much appreciate everyone's input. Every post is valuable, and I think them all through.

2019,

It sounds like all the doctors you've talked to are urologists (surgeons). Be sure you talk to some radiation oncologists before you give up on AS and commit to treatment. Some of the newer forms of radiation appear to offer a better story on side effects than surgery or other more-established forms of radiation. I think Kaiser's Southern California cancer center does SBRT. I dunno where you're located but you mentioned LA.

Thanks, Peter and FW. Yes, I've been researching various forms of rads. There are 2 guys in my local support group who've had SBRT - one quite recently, the other 10 years ago - and if I had to choose today I would lean that way. That said, it might not be the best for the persistent (and so far drug-resistant) nocturia that keeps me from ever getting a good night's sleep. And this with a relatively small prostate.

The RO who treated my neck cancer years ago is still around to help, and she's tremendous. So I would run any final steps toward treatment by her before making a decision. She is well-versed in Brachy, etc. And yes, I'm in southern Cal so would have any Kaiser facility in the area open to me. In fact the uro I'm going to for my last "2nd" opinion is at a different place from where I receive treatment.

Really appreciate it, guys.