Worried about my friend

Another biopsy by a different urologist with a second reading of the slides?

It could be prostatitis. PSA due to PC generally doesn't bounce around.

Still a little imaging would be good. If anything suspicious shows up they can then target that in a follow biopsy.

He should also get the PHI test (prostate health index). That might tell him more about what's going on.

Andrew

GG had a trans-perineal biopsy conducted under a general anaesthetic. We weren't fans of the urologist who performed the procedure and sought a second opinion. This second opinion was highly complimentary of the first urologist, saying he'd done a sterling job to find GGs cancer, under the circumstances (considering its tricky location). GG had an MRI, the report from which stated there was nothing of concern, however there was one questionable area, and the urologist specifically and very accurately targeted that exact spot, finding his 4+3 tumour with only six cores taken. Your friend should ABSOLUTELY have an MRI and targeted biopsy - something is going on for him. I really hope they find his cancer (assuming there's some there). Sometimes it's like boxing at shadows (literally), so he needs someone to take the time, care and skill to locate that sucker and banish it for good! I wish you and he all the best. Jaybee

I talked to my buddy again last night and he is going to have the MRI in a few weeks. If that is inconclusive then his dr suggested he could do a PSA3 test. His dr. told him that there is probably a 50-50 chance that he has PC. I don't know much about the PSA3 test and if it is something that will help as he would have to pay out of pocket for it.

jmadrid- he had his Bx about a year and a half ago.

Thank you all for your input.
I'm getting concerned for him as his PSA has steadily increased over the past 1/12 yrs and is now at 16.9. (I misspoke about the 18)

Like Michael's experience, I too had negative 12 core 1st biopsy but PSA continued to increase slowly. I had several PCA-3 tests, all <5. I requested saturation biopsy of 24 cores which found my cancer. I do like the option of the mpMRI if it's in a good teaching hospital interpreted by a radiologist with considerable experience in prostate cases. Also, the ability to collaborate with a urologist who can do a fusion biopsy from the MRI is highly desirable.

Much of this is not new to some readers. It is verbose for the benefit of relative newcomers.

With highly elevated PSA, and BPH ruled out (original post), MRI is the logical next step.

But if you just go to a nearby facility, and get whatever type of MRI they know how to do, on whatever type of machine they happen to have, run by whatever technician happens to be assigned, analyzed by whatever radiologist is available, you will be wasting time and money a high percentage of the time.

Cancer is discoverable by MRI due to differences in appearance between normal cells and cancer cells.

The differences are more pronounced as the cancer risk level increases, but they range from almost impossible to see for Gleason 6 to very subtle for Gleason 7 to 10.

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What is required for a trustworthy MRI report:

1. A powerful machine. Three tesla (3T) is the current standard.

2. A multi-parametric protocol.
This allows comparison of cell similarities/differences using multiple different criteria.

3. A technician who knows the requirements and insures they are met.

4. A patient who can remain still in the unnatural position during the procedure to insure good images.
Affecting this is the use or non-use of the endorectal coil. The coil is intended to improve imaging by being positioned closer to the prostate. But having the "baloon" that houses the coil inflated in the rectum is described on a spectrum from mildly uncomfortable to seriously painful. If the coil leads to patient movement, it does more harm than good. Some practitioners are confident of their ability to achieve an accurate analysis without the coil, others are not. Don't let the endorectal coil be a surprise.

5. A radiologist who has deep experience in analyzing the MRI images.
I suspect that this is where most facilities fall short.

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In a perfect world, every patient would have a multi-parametric MRI at an expert facility before biopsy (even the first biopsy). But expert facilities are few and far between. Due to cost of equipment and technician training, and the small number of truly expert radiologists to analyze the images, a high percentage of patients are constrained directly or indirectly by money considerations.

I flew from Oregon to Chattanooga, Tennessee, to receive the services of Dr. Joseph Busch, who (at the end of 2017) ran an operation specializing in prostate cancer diagnosis.
DAY 1 morning: multi-parametric MRI without endorectal coil
DAY 1 afternoon: one-on-one session with Dr. Busch to analyze the images, deliver conclusions
DAY 2 morning: targeted biopsy in the MRI using live imaging, insuring exact needle placement into suspicious area(s)
DAY 2 overnight: pathology report
DAY 3: pelvic/abdominal CT scan and bone scan

A PSMA PET scan was recommended (for Gleason 4+5) if foreign travel was plausible.

Medical charges paid 100% by traditional MEDICARE and MEDIGAP PLAN F.

Yeah, prostatitis. There's a possibility that something else is there or that the biopsy missed something.

All he can really do at this point is to keep monitoring the PSA and see what it does.

It's a tough case to DX, but in the absence of a positive sample from the biopsy all we know for sure is prostatitis.

Andrew

Well, that’s a good outcome considering the other possibilities. I think I would be quite happy with that.

There are only two possibilities, prostitis or an undiscovered transition zone tumor. If psa keeps rising at a steady rate then a TZ tumor should be suspected. If psa jumps around after antibiotics then prostitis is a more likely reason.
There are areas of the prostate that cannot be reached easily with a transrectal biopsy. I had 13 biopsies, over 150 cores and an MRI all negative. After 10 years a color Doppler guided biopsy found a large 2.5 cm tumor. You could clearly see the tracks of my previous 26 core biopsy clearly miss the tumor. Doc said he only knew 3 doctors in the world could have hit that tumor location and I was lucky he was one of them. Dr Duke Bahn in Ventura Ca specializes in hard to find cancers.

no you did not imply that it wasn't...nor did Mattamx...

Have your friend see if a genetic test can be done on the samples. I had the ConfirMDX test done and it saw nothing suspicious. I have another follow-up this Friday, but there is another biopsy in my future and likely your friends as well.