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Posted 4/25/2019 7:54 PM (GMT 0)
2003 had my first elevated PSA 6-7. Had Bx and it was negative. This was followed by three more bx over the next 8 years all negative. Started on finasteride in2011 and PSA has been running 8-9 pretty steady. Had one episode of fairly severe prostatitis after the third bx. Urologist I have been seeing told me to stop PSA testing and to only come back if I had mets. Second opinion in another system recommended the 4K which revealed I had a 70% chance for CA of prostate. T3MRI of prostate was negaive for any signs of Cancer. Consultant reommended repeat PSA.
Posted 4/25/2019 9:39 PM (GMT 0)
Wouldn't hurt to get the PSAs done as suggested.

I went through good news / bad news / good news / bad news / bad news / good news / very bad news / great news / bad news / bad news / good news. All in just under a year. It can be difficult to handle as many here can attest to.

Hang in there - if you need an ear - there are plenty who stop by here each day
Posted 4/25/2019 9:44 PM (GMT 0)
Stop testing and come back when you feel the symptoms of mets? Wow!!! Time to start looking for a different Uro
Posted 4/25/2019 10:19 PM (GMT 0)
Much like you, had three biopsies over several years. All negative. Came back from vacation with some serious urine retention. The local urologist, who had done the biopsies, wanted to remove enlarged prostate. Yikes! So went to clinic. The did a photo selective reduction. They should have done biopsy first, as you cannot biopsy what you get from ablation. Year later had another biopsy at the clinic. Gleason 9. Also, I may be wrong but a psa on Finasteride should be doubled. Therefore if your psa is 10, while on Finasteride, then you should double it. Your actual psa is 20. As I said not 100% sure on that. You should check with uro.
Come back when you have mets? Now that is scary.
Posted 4/25/2019 10:43 PM (GMT 0)
So, let's get this right...you've had moderately high PSA for years. Several biopsies, all negative. BPH and treated with finasteride. MRI suggests you might (MIGHT) have cancer.

Well, you don't have cancer. At least not diagnosed. You could have a transperineal fusion biopsy, which takes a lot more cores, and the core location is mapped from the MRI.

But, you have persistent high PSA, and yes, Mr. Bill is right: double your PSA because of the finasteride. Find another doctor, preferably at a major academic center, and get to the bottom of it. If you're in South Carolina, you could check out Duke or Emory, they are both relatively in your area. Good luck.
Posted 4/25/2019 10:49 PM (GMT 0)
IMO a reliable negative mpMRI together with a stable psa and several negative bxs are good reasons to be confident. I am not familar with the 4K test but I guess it should be considered in your particular case context. I mean, a psa close to 10 implies a PCa probability of 50% in general, but after considering the different tests you had together the prostatitis episodes the probability is much lower. In any case, I would not discontinue psa tests. The advice to wait for mets is very unusual. It looks like a kind of black humor joke.
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