PSA now 5.46 MRI or Biopsy

PSA was 4.8 in 2016
Biopsy was clear
PSa 6.9- 4.5- 5.6- 5.0- 6.46- 5.46
Urologist wants to do MRI or Biopsy. Thoughts please.

Hi jd. Can you provide your age, any immediate family with PCa? BPH? I had a long history of BPH with a fluctuating, but slowly rising, PSA. This led to many negative biopsies; eventually one found high-grade PCa.

Biopsies can miss existing cancer perhaps a third of the time; and MRIs can miss cancer too. The solution, which no one likes to hear, is repeat biopsies, or imaging and biopsies. This brings the false negative rate drastically down. If you have cancer and you start to multiply 1/3 x 1/3 x ... well, do the math and you'll see the PCa will eventually be found.

Your insurance should cover the MRI now that you have had a negative biopsy. Don't be surprised if your uro wants the biopsy even if the MRI is negative for clinically significant lesions.

If I may make one suggestion based on my reading of studies and the strong consensus given about fusion biopsies. If you do have suspicious PIRADS targets identified on an MRI and have either a fusion biopsy (or a standard TRUS using the MRI as a guide), I would insist with my uro that the standard 12-cores be taken in all zones in addition to extra cores in the identified targets. In other words, don't be talked into a biopsy of the targets only -- a very shortsighted policy. I have seen Forum brothers have their biopsy come back where a PIRADS 5 target turned out not to be cancerous and at the same time have a random core hit a lesion(s).

"Only" about 20-25% of prostate cancer is high-grade, but you want to know if you are in that group. If you procrastinate and have serious PCa diagnosed years down the pike, you will kick yourself for not investigating earlier. I speak from experience when I say that early diagnosis is the key to this disease. If no cancer is found, you have some added peace of mind, and an MRI now will provide a good baseline if future investigation is needed. If low-risk, Gleason 6 cancer is identified, you can go on an active surveillance program if you like and know that you'll be monitored. If there are changes that require treatment, you'll be told, but you still have a good chance of never needing that treatment.

A tough-love approach would say if you trust your uro, follow his/her advice; if you don't, find another uro ;)

Djin

I will be 62 in June. He has always told me it was smooth but slightly enlarged. I have had a uncle and cousin on my father side with Pca. Thanks

jdcd57 said...
I will be 62 in June. He has always told me it was smooth but slightly enlarged. I have had a uncle and cousin on my father side with Pca. Thanks

A dad or brother with PCa (and at an earlier rather than later age) would be more concerning as far as family history. The problem with BPH and other conditions that can increase PSA is that they can coexist with PCa, clouding the picture.

Keep us posted, please.

Djin

Thanks FranPro. I have a good friend who had his come back. That was 3 yrs ago and his readings were worse than yours. You hang in there.

Ok I did my MRI on Monday. No results yet. What will they tell me?

Any lesion with a PIRADS of 3 or higher will likely result in a biopsy.

Stress and worry can cause all sorts of GI issues and interfere with good sleep which could explain everything you are feeling. So yes, it is related in a way to PCa but not usually the part you are worried about. Try to eat regularly and maintain a decent diet while not trying to overthink the PCa possibilities. It will be what it will be which becomes more clear over time then you can wrestle with the findings one at a time, if any. Easier said than done as many of us know firsthand but you can try to keep things in perspective until you get some real data.

I’m back with 7.5 psa I had a clean mri 1 yr ago and had a 6.46 at the time. Any suggestions will be appreciated.

Thanks for the input.