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PSA 6.0 - CT Scan ordered

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Posted 5/26/2015 6:59 PM (GMT 0)
63 year old with elevated PSA last 5-6 years.

Just got a call from urologist office and spoke with nurse - said PSA from last weeks office visit was 6.0 and Dr. wants me to get a prostate CT scan, then 'discuss' possible prostate biopsy after scan results. I asked what my past readings were and got the answer 6.2 and, before that, 5.6.

What concerns me is that I've gone through 2 12-point biopsies over the past 5 years, the last one (2 years ago) messing up my intestinal tract big time for months afterward. Both came back negative. Also, this is the first time CT Scan was ordered or even mentioned.

My question is: What would CT scan show that digital exam did not? Digital result was the usual 'smooth, but slightly larger'

THANKS
Posted 5/26/2015 7:49 PM (GMT 0)
You are asking a great question. The answer is: not a darn thing. It's just another unnecessary test that raises medical costs for all of us. He's going on a fishing expedition to cover his ***.

What you can do is this instead:

1) Take a PHI blood test. It's inexpensive, and covered by insurance, but is only available from urologists who sign up to give it. Call the number in the attached link to find out how to get it. It's better than PSA and % free PSA and includes both.
Prostate Health Index (PHI)

2) PCA3 is a urine test after a prostate massage. It is more expensive than PHI but is complementary to it. It is covered by insurance after you've had a negative biopsy, yet suspicion remains. Ask your Uro for it and get pre-cleared by your insurance company.

There are several other biochemical and genetic tests but they are all much more expensive and none are covered by insurance.

So if both of these tests are negative, look for other causes of increased PSA like BPH, prostatitis and blockage.

If these tests are positive, ask for a "multiparametric MRI-targeted biopsy" next time. It's available at many tertiary care centers now - just be careful that the radiologist is experienced - it makes a big difference.

One question- exactly how large is your prostate? PSA goes up in direct proportion to prostate size - normal is .15 ng/ml of PSA per gram (or ml) of prostate. If it's higher than that there may be other contributing factors. If it's that or lower, consider taking Proscar or Avodart to shrink your prostate (and help you pee better). It improves PSA diagnostics too - if PSA fails to go down while taking it or continues to rise - something other than BPH is going on.

- Allen
Posted 5/26/2015 7:58 PM (GMT 0)
Welcome to HW.

There are areas of the prostate a finger just can't touch and the CT can see things smaller than the finger can feel. The standard biopsy is a bit hit and miss, so I think your URO is trying to be a bit cautious before recommending more needles. If the scan is clear or just confirms the enlargement, you might not need a biopsy.

I am not sure a standard CT scan is what you need, there are other methods that might better show what's going on. I'll let others comment on that. If another biopsy is recommended, you might wanted to ask about an MRI guided biopsy - anything that is a more targeted test.

Andrew
Posted 5/26/2015 8:59 PM (GMT 0)
Thanks to both of you for the quick replies.

Allen, the PSI test is a great idea. I will speak with my urologist regarding having it done. I get the feeling, however, that he'll say it's either unnecessary, inaccurate, or both. I find this problem with most doctors when you offer a different idea - they get defensive or dismissive. But I will ask him regardless. I have no idea about the actual size of the prostate - I'm not a very good 'note-taker' regarding my medical information - my main mission is getting the hell out of the office ASAP.

I have spoken with his office in the meantime (no doctors in today) and have learned that it is a MRI of the prostate that I am to have and that it will be done to see if a biopsy is necessary. The part I find very odd is that the MRI can't be done at the local Radiological Lab that I've used in the past, but a 'special' one about 30 miles from where I live. My urologist is part of a large group practice called Advanced Urology Centers of New York, so maybe they would like to keep the MRI 'in-house'. If that's the case, maybe it's time for either a second opinion or a new urologist.
Posted 5/26/2015 9:14 PM (GMT 0)
Frank,

That's "PHI," and I can almost guarantee that your Uro is ignorant of it (otherwise he would have suggested it). Just call the number in the link instead, and they'll tell you how to arrange it. Here's how you find out your prostate size - call or email your Uro and ask. They got the dimensions when they did your ultrasound-guided biopsy.

If the biochemical tests tell you something may be lurking, here's what you can do...

If you're near NYC, call Memorial Sloan Kettering radiology and tell them you want a "3T multiparametric MRI" to detect prostate cancer. They'll probably want you to see one of their urologists first, which isn't a bad idea. They also have some of the best radiologists in the country for reading the MRI - don't waste your time and money on someone who is not as expert. (NYU, Cornell & Columbia are good too) If they see anything suspicious, they can fuse the image with a 3D ultrasound to guide your next biopsy.

- Allen
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