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PSA rising while on Active Surveillance

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Posted 8/30/2015 9:38 PM (GMT 0)
I have been on Active Surveillance since Feb. 2012. See my signature for details. For the last year and a half under the care of Dr.Behfar Ehdaie at Memorial Sloan Kettering. Two weeks ago I had a 3T MRI and at my resent consultation Dr. said the MRI came back Clean. Nothing on the prostate, Lymph nodes or bones. Game plan is another MRI guided biopsy in 18 months. My concern in that my PSA is starting to rise faster. Dr. said the rise in PSA can be due to the past DRE's and Biopsy's. Does the clean MRI trump the rising PSA?
Posted 8/30/2015 9:47 PM (GMT 0)
Yes

There are many benign factors which contribute to PSA, all of which can be going on at the same time. I bet that you've heard somewhere before that PSA is an "imperfect test" for PC... now you are seeing exactly why and how.

The MRI is more definitive and looks only for worrisome tumors.

Great results! Congratulations!!!
Posted 8/30/2015 10:34 PM (GMT 0)
When you have your next biopsy, I would insist that it be the "saturation" type, done in the hospital under general anesthesia. The typical 12 shot rectal biopsy simply can not reach the entire prostate gland no matter how it's guided....Your PSA velocity means something is going on. If your next PSA test continues that trend, I would insist on a biopsy ASAP......
Posted 8/30/2015 11:48 PM (GMT 0)
MSK is certainly among the best at reading mpMRIs, so you should have some confidence in that. mpMRIs as used by an expert radiologist are very good at detecting GS7 or higher PC. They are not very good at detecting lower grade cancers, but that's not what they're looking for. Some higher grade cancers actually put out less PSA than lower grade cancers, and as JackH said, PSA can go up for a whole lotta reasons that have nothing to do with cancer.

I like PHI better than PSA for AS tracking because it is less subject to confounding from those other sources. It was approved for use to prevent unnecessary biopsies but may be useful for AS too. It is inexpensive, but you can only get it from a registered physician - call the link below to find one nearby.

Prostate Health Index (PHI)

Another very similar blood test, 4KScore, was invented by MSK so I'm sure they must offer it, but it is very expensive (about $400) and not covered by insurance. Like PHI, it was developed as a more specific alternative to PSA to help prevent unnecessary biopsies, but it may be helpful for AS too. You might want to ask your doctor if MSK has any clinical trials going on for its use with AS.
Posted 8/31/2015 12:26 AM (GMT 0)
I want to concur with the above posters, who have pointed out the problems with psa results.

The 3T MRI's are now detecting prostate cancer at a confidence level of 97 percent or above, based on some post-surgery studies I have seen. So, if your MRI was clean, you can probably relax, as it is a much better detector of PCa than the psa test is.
Posted 8/31/2015 2:43 PM (GMT 0)
Just want to thank everyone for your insightful perspectives.
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