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OK to wait 3 months on testing?

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Posted 4/16/2015 8:33 PM (GMT 0)
Although I've lost 55 pounds since Dec 15th. I still have a ways to go at 340. My urologist wanted to do a multiparamic 3T MRI, but at the place he scheduled the imaging for they do not have one of the bigger open bore MRI's, and I'm a little too big for the machine.

I think I should just wait 3 months to see where we are rather than search out a open MRI 3T. Here's the background.

63 years old. PSA History (that I have recorded)

May 2013 - 2.8 (just part of regular test by regular Primary Care doc)
Aug 2013 - 1.3 (same doc)
Feb 2014 - 2.4 (same doc but he says since it jumped from previous he send me to urologist).
Early May 2014 - Urologist does DRE (no problems) and then does Cystoscopy. He tells me my Prostate is HUGE but sees nothing other than that. Asks about symptoms and I say I have essentially none. Flow is good, no incontinence, sleep through the night without peeing, when the did the test to see if I was emptying bladder they said I did. He prescribes Jayln (later switched to Finasteride and Tamsuloslin) for my "symptoms".
June 5, 2014 - Primary care doc's PSA reading was 10.3 but when I told him that I had the Cystoscopy 3 weeks prior and had not taken any antibiotics after he says "it's probably just that, let's do some Cypro and then re-test)
Jul 8, 2014 - PSA 2.6 Free Pct 12%
Nov 2014 PSA 2.7 Free Pct 12% Pro2 PSA 3.93 PHI 21 (estimated chance of cancer 11%)
Mar 2015 - PSA 2.6 Free Pct 11% Pro2PSA 5.27 PHI 24.8 (estimated chance of cancer 11% - just within the range)

When I saw the PSA number did not increase I told Primary Care I was relieved since I heard bad things about biopsies, and I had appt in 2 weeks with urologist). He said no way he wants a biopsy with 11% chance.
Apr 2015 - Urologist sees the numbers and says you need to double everything since I'm on Finasteride and Tamsuloslin. That makes it 22% chance and he wants to schedule the MRI.

So, I've been on the Finasteride and Tamsuloslin for 11 months. My numbers have not hardly changed at all since my first reading after having been on the Finasteride and Tamsuloslin (Jul 14).

I thinking I just wait and get tested again in July and see where we are. I don't think I have a problem other than BPH.

Any thoughts?

Post Edited (JaxTom) : 4/16/2015 2:52:40 PM (GMT-6)

Posted 4/16/2015 9:12 PM (GMT 0)
Welcome to HW, sorry you need to be here.

You can wait. Your PSA is bouncing around more like BPH or prostatitis. Not say that you may not have some PC in there, but your BPH is likely why your PSA is up there.

Still, at some point you might want to get the MRI. I wouldn't think about a biopsy yet, but when you need one, it's not that big a deal and don't believe all the horror stories you hear about that. Most men tolerate it just fine with just slight discomfort.

Even it the worst is true and you have a bit of PC, it's still likely very early stage (speculation on my part). PC generally grows very slowly so waiting for a retest in July, isn't going to hurt.

Hang in there and keep us updated on your progress,
Andrew
Posted 7/9/2015 3:43 AM (GMT 0)
OK, the 3 months are up, I just had my re-test done, urologist appt on the 15th, here's where I stand:

Was 340 pounds then, about 330 now.

My PSA this time was 2.5
Free PSA 0.33. Free % 13%
PHI 27.9

So, the PHI reading has taken me from just barely within the 11% cancer risk group (at upper end) to 1/3 of the way into the 18.1% cancer risk group.

The number that is driving that is the Pro2PSA which has gone up both of the last 2 times we tested.

So I suspect when I see the Urologist, he is going to want to address the 3T MP MRI again.
Posted 7/10/2015 4:59 AM (GMT 0)
I'm glad you got the PHI test. That tells you that your risk of prostate cancer is only somewhere between 11% to 18%, and the risk of a Gleason 7 or higher (the only kind you should really care about or will show up on an mpMRI) is only about 4%. That sounds pretty good to me. The typical cut-off for "concern" is 35. Why do you think you or your urologist would be concerned?

- Allen
Posted 7/10/2015 11:45 AM (GMT 0)
My urologist had prescribed the 3t MP MRI back in April. So since these numbers are slightly worse I assumed he would do the same.

Your post had two bits of info that seemed new to me. Where did you get the 4% chance of a Gleason 7? The only thing I had found was that a rising Pro2PSA score was suggesting an aggressive cancer. And I'd never heard the 35% cutoff score before. Can you give details?

My appt was changes to Monday, so I'll hear his opinion soon.

Post Edited (JaxTom) : 7/10/2015 5:49:11 AM (GMT-6)

Posted 7/10/2015 5:42 PM (GMT 0)
Those numbers come from the 2011 Catalona validation study that was used to get FDA approval. You can see an abstract of it at the following link, but those details are available in the full text only. 35 is the cut-off that simultaneously gets a decent sensitivity and specificity from the the test (65% each).

A Multicenter Study of [-2]Pro-Prostate Specific Antigen Combined With Prostate Specific Antigen and Free Prostate Specific Antigen for Prostate Cancer Detection in the 2.0 to 10.0 ng/ml Prostate Specific Antigen Range

Of course an mpMRI is a much better diagnostic test, but it is also much more expensive, and you don't have ready access to an open bore. There are other biochemical tests, but they are much more expensive, and not covered by insurance (PCA3, for example, is only covered after a first negative biopsy; 4KScore costs about $400).

- Allen
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