PSA rise from 20 to 30

He has had a negative biopsy and negative TURP pathology, which is good, but still has a huge prostate. It could be BPH, with an infection spike, but I would recommend an MRI as the next step. With that PSA, you want to take every test to rule out cancer.

Yes, it can be due to both the BPH and/or an infection. It is not unusual to have inflammation or mild infection following a biopsy or TURP that can affect PSA. Best thing now is to stay on a three month test schedule and see the trend. And I agree with AS, more investigation is required.

I would also suggest using Avodart or Proscar to treat the BPH. Both are very effective at reducing the prostate size and lower the PSA. If the PSA continues to increase then it is more indicative of cancer. How is his health otherwise? Where are you located?

Thanks a lot JNF for your inputs. We are located in India(Gurgaon).

Thanks logo. Your words are very comforting and I am really hoping everything goes well.

A few more pointers:

d) The right seminal vesicle is normal

e) Visualized pelvic bones are normal in cortical outline and marrow edema

f) No free fluid is seen in the pelvic peritoneal cavity.

Hi Djin,

The first 3 points are actually the summary of the findings.
One question please : Does a lesion mentioned above always mean PCa?

Thanks Djin.
My dad would be undergoing TRUS biopsy in a few days.
Everyone, does PIRAD 5 on MRI necessarily mean PCa or it can be BPH mimicing like it?

Not sure this helps you much but PIRADS rating system is below:

PI-RADS 1: very low (clinically significant cancer is highly unlikely to be present)
PI-RADS 2: low (clinically significant cancer is unlikely to be present)
PI-RADS 3: intermediate (the presence of clinically significant cancer is equivocal)
PI-RADS 4: high (clinically significant cancer is likely to be present)
PI-RADS 5: very high (clinically significant cancer is highly likely to be present)

The odds favor PCa with a PIRADS 5 but the biopsy will tell the story now that he has some clear targets to aim for. Lesions can be non-cancerous or low grade in nature or can be a higher grade and more aggressive which the pathologist determines with a microscope looking at the sampled cell structure.

Depending on what comes out of the biopsy, additional scans may be necessary to further define the "problem" for possible treatment options. You have to just wait at this point for the next pieces of information which is hard to do without some anxiety. Your father may be the calmest person in your family at this point given his age and experience.

Jumping ahead, which isn't usually the best thing to do, if there is either EPE (extraprostatic extension -- growth through the prostate capsule or SVI (seminal vesicle invasion -- growth into one or both seminal vesicles), the cancer is no longer prostate-confined and is termed locally advanced). The same holds if one or more pelvic nodes is positive for PCa. That said, it is still possible that local radiation therapy can reach all of the malignant tissue if it is localized to the pelvis.

Surgery is one treatment choice usually reserved for younger men, usually under 75. That said, it is done on older men in otherwise good health:

Perioperative and functional outcomes of Robot-assisted Radical Prostatectomy in Octogenarian Men (2020)

"Conclusions: RARP represents a feasible option to treat prostate cancer in well selected octogenarian men. Careful patient selection and counseling is critical prior to offering surgical treatment for these men."

Comparison of perioperative outcomes in elderly (age ≧ 75 years) vs. younger men undergoing robot-assisted radical prostatectomy (2020, Full Text)

"Conclusion
The present study showed that the oncologic and surgical outcomes in the elderly group were similar to those in the younger population. However, the duration of hospitalization seemed to be longer in older patients (age ≥ 75 years), despite similar complication rates."

All of us here have had to learn the value of patience. If your dad has PCa, it has been around for probably quite some time, so a delay before treatment is not going to change the situation. The difficult-to-implement advice is to relax, take one step at a time and put trust in your dad's docs and the treatment that may be advised. A quick googling turned up this: "The high survival rates for prostate cancer continue over time. The overall 10-year survival rate is 98%, and the 15-year survival rate is 96%."

Post Edited (DjinTonic) : 12/8/2020 8:08:57 AM (GMT-7)

And we are here for you, to help guide you, answer the questions we can, and suggest points you may want to discuss with your dad's docs. However, much depends on the exact pathology of the cancer and its location(s). Trying to prepare for all eventualities would mean learning about many scenarios -- some complex-- that won't apply to your dad's case.

The two next pieces of important information will be the biopsy report and the results of any additional imaging his docs want afterwards to help establish the extent of any cancer. There is no need to apologize! We have all been where you are now, whether for ourselves or our loved ones.

Djin

Post Edited (DjinTonic) : 12/8/2020 9:35:39 AM (GMT-7)

So we have the results of the biopsy.

Details:
A) Left Base
B) Left Base
C) Left Mid Gland
D) Left Mid Gland
E) Left Apex
F) Left Apex
G) Right Apex
H) Right Apex
I) Right Mid Gland
J) Right Mid Gland
K) Right Base
L) Right Base

TRUS Guided Prostatic Biopsy shows:
- foci of moderate lymphocytic infiltration. Focal granulomatous inflammation with multinucleated giant cells are also seen(section J). No necrosis is seen.
- Glandular hyperplasia is also seen
- There is no evidence of malignant pathology in the biopsies.

Diagnose - TRUS Guided Prostatic biopsies : Consistent with Granulomatous Prostatitis.

Trust transforms...Abhinav keep doing what you are doing...Ignore the noise...its all part of western "culture" id est...seeing is believing...personally I find believing to be seeing...your father and yourself will live many years...stay true to what you believe...like trust...belief transforms

Stay on top of things and have regular biopsies. It took 4 biopsies to find what was causing my elevated PSA.