Prostate Cancer Survivors






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Re: PSA, MRI and Biopsy

Tony, guys on this site can give some useful advice, but we might need to know a little more information. First is your age. If you were 80, the advice would be much different than if you were 60. Secondly, since normal PSAs generally run in the 3-5 range, a PSA of 9.6 is surely a "red flag" of some kind. What were your PSAs 2 or 3 years before the 9.6 reading? Also while an MRI might reveal interesting views of a prostate, they cannot diagnose PCa, only a biopsy can do that and I assume you haven't had one. Lastly I think it is a good sign that your PSA fell to 7.1 (still high) from 9.6 over a 12 month period. Since the PSA of actual PCa rarely declines without treatment, I would suspect something else is going on that needs investigation. And if your current urologist feels he doesn't need to see you again, it might be time to find a new urologist.

Re: PSA, MRI and Biopsy

OK Joe, you are right, here is a little more info. I am 64 yrs old caucasien. Location: Canada
PSA History
2007 .94
2009 1.3
2012 2.91
2014 finger exam - no issues
2015 finger exam - no issues
2016 finger exam - no issues
2019 8.47 May Family doctor diagnosed
2019 8.00 May First visit to urologist
2019 July Ultrasound and M.R.I.
2019 9.6 August Urologist determines tests show no PCA
2019 7.5 December free psa .88 ratio .12 - urologist suggests he does not need to see me anymore.
2020 7.1 June free psa .78 ratio .11

The volume of my prostate is 16ml.

Thus far, no biopsy. 14 days of Septra antibiotics July 2019.

Next week, July 21st 2020, I asked for a phone consultation with the same urologist and he agreed.Can you think of anything I can ask? I will mention to him that a 16ml prostate is on the smaller scale as the average is more like 20ml so a 7.1 PSA should be considered high for that size.
Thanks for sharing.

Re: PSA, MRI and Biopsy

Tony, thanks for the additional information. It seems the quandary exists because your PSA was not checked for 7 years (2012-2019). Now you have a high PSA, especially for a small prostate. I am not a medical doctor, but I suspect that sometime during that period you developed prostate cancer. It's probably a slow growing Gleason 6. The only way you are going to know is a biopsy (preferably a 12-core). That said however, I've had 4 and have sworn I would never have another. My advice is to monitor your PSA every 3 months and see the direction (up or down) and its "velocity" (rate of change). Personally, if it was me, I would wait until your PSA was >10 and then get a biopsy. If you do actually have PCa, a biopsy will tell you how "aggressive" it is. With a few cores of Gleason 6, you might consider Active Surveillance for a few years to maintain your current Quality of Life. With a Gleason 8-10, some treatment might be in order. As to what to ask you urologist next week, I would ask him what would your PSA level need to reach before he recommended a biopsy.

Regardless, at 64 you still have many more years ahead to enjoy life.

There you have my thoughts, perhaps others on this site would like to give theirs.

Re: PSA, MRI and Biopsy

Hi Joe, You must be thinking along the same line as my urologist in that had I hit the PSA 10, he would have probably done a biopsy. I will ask him. Thanks for the advice.

Re: PSA, MRI and Biopsy

The only other thing I can recommend is to be cognizant of your activities the day prior to your PSA test as many activities (riding a bike, having sex) can artificially raise your PSA scores and create an unfounded concern.

Re: PSA, MRI and Biopsy

Thanks Willian and Joe for your suggestions. 6 months later and PSA still bopping up and down within my range 9.6 to 7.1 to 9.1 so I consulted with 2 different cancer centers since and they both say the only way to really know what is going on is with a biopsy so I agree and will have a 12 core done in 2 weeks. I am now OK with the biopsy idea as my older brother had one and his experience was comparable to a colonoscopy. There are more options available now to treat Pca than say 12 years ago and I rather know now in the early stages. Problem is, even a 12 core biopsy may miss cancer cells and give false results.

Re: PSA, MRI and Biopsy

Finally got my Biopsy done. Honestly, the after effect of the antibiotic needle hurt more than the biopsy itself. The pathology report says I have a Gleason score (3+3) 6. 12 Cores biopsy. Number of cores positive = 3. There was high grade PIN in 3 cores. Will be meeting with Urologist to discuss but I would truly appreciate comments from the fine folks here at YANA.