Early stage investigations

Hi britguy,
I have recently gone thru evaluation of a higher than normal PSA along with an abnormal DRE and so will make some comments for your consideration. (Currently I am starting radiation (SBRT) treatments).
I would also encourage you to try to remain in good spirits because it is very possible you do not have prostate cancer and even if you do almost all forms are slow growing and there are other great treatments besides surgery.

1) Having an increasing PSA over 3 or 4 years that is currently at 7.1 and along with a suspicious or abnormal DRE will often trigger a recommendation for a biopsy and/or a MRI. The only confirming test
to know for sure if your prostate has cancer is by biopsy. It can be an excellent idea to have a 3TmpMRI prior to a biopsy because it may reveal suspicious lesions that could be cancer or other non-cancerous cellular tissue, and those areas can then be targeted by the biopsy procedure making the biopsy procedure potentially more accurate.

2) There are some other laboratory tests that could be run to help you to decide about progressing to a biopsy. Get a "free PSA" test in addition to the total PSA test and also consider getting a PHI test. Your urologist can order these and they have a degree more accuracy than just total PSA.

3) Typically Urologists recommend surgery as the best option for prostate cancer and this is generally because Urologists are trained surgeons. There are other excellent treatment options including radiation and for low risk cases doing "Active Survellence".

4) There is a lot of great information posted on this site and I would read thru the permanent top posted links at the top of this forum for great general information on prostate cancer.

Regards,

With the limited info and your current age I agree that additional attention should be given to your prostate. The recommended MRI/Biopsy is understandable and reasonable.
Good Luck and Keep Us Posted
Hero

After a DRE my prostate was described as "asymmetrical" and my urologist ordered an MRI. The MRI was an easy process and it gave me a lot of information about what was going on. I hope you find the same.

I understand the worry, you're seeing all the possibilities and it can be overwhelming. If you do need treatment (and I hope you don't), there are options, surgery isn't the only one. But first you need more information, and that's the path that you're on.

Good luck!

Mike T

britguy, I am going through a similar investigative process. As I was told, don't get crazy about treatment right now until you have more information (MRI, and or biopsy). You need more information before worrying about treatment. And everyone is different in terms of what is important to them - side effects of treatment etc. Don't stress until it is time to stress!

Britguy, welcome to our club that none of us went looking for. Let's hope your stay is brief.

A gradually rising PSA over a period of several years plus an abnormal DRE almost always triggers an MRI and biopsy. The MRI is used to look for hot spots, and the best protocol then uses the MRI pictures to target areas for the biopsy.

The typical 12-15 core TRUS biopsy is mostly a non-event. Unpleasant, and slightly painful, but over in a few minutes (except for the blood in your urine and ejaculate for the next few days or so). It is, however, the only way to show definitively if cancer IS present. A negative biopsy, however, does not prove your are cancer free--the miss rate is actually significant--which is where the MRI for targeting helps.

Question....you call yourself Britguy...is that because you are a guy IN Britain, or because you are an expatriate Brit somewhere else? Knowing where you are can help us suggest where to go if (and it is a reasonably big if) the biopsy comes back positive.

PS. In dome of the reading I’ve done, it appears that drinking a lot of water and ejaculation can speed up the elimination of blood? Was that your experience?

Thanks Bob. Yes, it’s a bit strange. What’s the abbreviation PCa? Sorry if that sounds like a stupid question. This is all quite new to me.

All the best.

Chris (britguy)

Britguy, well, a fusion biopsy is the ulitimate biopsy. Instead of the TRUS procedure (Trans Rectal UltraSound) (yes, the put an ultrasound probe up there and take the cores through the rectal wall), the fusion method takes a LOT more samples through your perineum--and you'll be asleep.

If it's there, they'll find it. An MRI can show "something"..but not cancer. We've heard good things here about the Vancouver Center. You're in good hands.

dbell, Prolaris is a genetic test, where they are looking for genetic markers within your prostate cells that indicate a probability of aggressive tendency. Totally different from fusion biopsy, where they take the MRI scans and 'fuse' it to the biopsy needles and take multiple samples in the suspect areas.

There is no Polaris biopsy. As was stated Polaris refers to a genetic test unrelated to the actual method of biopsy.

The method of prostate needle biopsy is little changed for a long time. The method has been enhanced by better use of scanning methods like MRI that can help guide the biopsy toward suspicious areas rather than the general 12 sections of aim normally used. This is what the MRI fusion biopsy does. This MRI image is overlaid on the biopsy ultrasound image to guide the specialist to aim the needles toward certain areas.

JNF said...
There is no Polaris biopsy. As was stated Polaris refers to a genetic test unrelated to the actual method of biopsy.

The method of prostate needle biopsy is little changed for a long time. The method has been enhanced by better use of scanning methods like MRI that can help guide the biopsy toward suspicious areas rather than the general 12 sections of aim normally used. This is what the MRI fusion biopsy does. This MRI image is overlaid on the biopsy ultrasound image to guide the specialist to aim the needles toward certain areas.

Thanks JNF and halbert for your explanation, thought my Uro oncology team referred to Prolaris as an advanced biopsy, my bad!