PSA-11 , MRI+Contrast


I got my PSA raised up from 5 to 8.8 in the past 5 years and up to 11 after the PSA blood test last month.

I did the PHI test and the reading  is 15.4 with "Percent of Free PSA 15.3%" with the probabiiliy of prostate cancer 20%.

I don't have any critical or pain symptom.

I did the MRI+Contrast last week, the Findings in the report stated that "Suspicious T2 hypointense nodule is present at left transition zone around the mid gland. It measures approximately 2 cm in diameter". And the Impression of the report stated that "Suspicious signal lesion at the left transition zone, transition zone malignancy cannot be excluded. (PI-RADS 5)" .

Doctor recommend me to carry out the Biopsy and digital rectal exam in order to test the presence of cancer cell.

But my question and worry is:-

a. If the Biopsy and DRE result is positive then I might simply remove the postate right away it is quite straight forward approach.

b. Well, if the testing result found out in Biopsy and DRE to be negative then I am wonder I might require to carry the MRI, Biopsy and DRE each year in order to identify and determine the tumor status (Sizes and Extend) ?? That is causing a lot of worry and annoying.

c. I really don't know whether this "hypointense nodule" can be cured and/or reduced in sizes using the nowdays treatment and method.

d. At what PSA level will it be confirmed as having the prostate cancer ??





  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member
    What Next?

    You cannot rely on a DRE or biospy to definitely determine if you have PCa or not.  DRE is just a "finger" test; just gives an indication of abnormality, not the presense or absense of cancer.  A biopsy is also not definitive for PCa unless it's a positive result; there have and can be false negatives.

    1) If the biopsy result is positive, you need to make a treatment decision BUT surgery may NOT be the best course.  The "best" treatment depends on the pathology of the PCa -- how large/small, location (in or out of the prostate) and its aggressiveness (low vs high Gleason score and PSA doubling rate).  There are other options than surgery, which is the potentially the worst in terms of side/after effects, including but not limited to ED & incontinence.  There is also radiation and active surveillance if the cancer is manageable and/or chemo and hormone therapy if it's not.  Can't make a treatment decision w/o the biospy and pathology report.

    2) If the biospy result is negative, you could still have cancer (false negative) and should have your PSA tested regularly (@3 months) and, if it rises significantly over time, another biospy 1 yr or so down the road would probably make sense. The DRE can be done at any time you see your uorolgist; again, it is not determinative for cancer.  I would think that another MRI would be justified only if the biopsy was positive in order to locate it or unless there's some other reason why you or your doc thinks that you've actually got cancer than has not been revealed by the biopsy, as I gather was the reason why your doc ordered the MRI you have done recently.

    3) You do not know if the "hypointense nodule" found in your prostate is benign or malignant.  It was labeled "suspcisious" which means they don't know what it is.  So, you don't know if it needs to be "cured" or not.  The biopsy should target the location of the nodule to determine if it is cancerous or not.  You should know if it is malignant or not after that and, if it is, then decide one what course of treatment to pursue.

    4) PSA is only indicative of some "problem" in your prostate.  PSA can elevate for a variety of reasons, not necessarily because of cancer.  It could just be a BPH -- benign prostatic hyperplasia -- ie., an enlarged prostate.  Do you have to pee a lot or urgently?  If so, it's probably caused by BPH.  Cancer can accompany BPH and BPH can mask cancer.  Only a biopsy can tell you if you actually have prostate cancer or not.

    So, let us know what you find out after you get the pathology report following the biopsy.  Nothing to do or worry about until then.  Good luck!!!

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,813 Member



    You are too early in this process to speculate on what treatment you might best choose if you do indeed have PCa.

    My opinion: schedule a biopsy and get it done. Normally this is not urgent, but you results prove that it is manditory that you have one. There is no good reason to wait. 

    SSW is correct (as always): A digital exam does not "prove" anything if negative, same for a biopsy; it is just too easy for them to miss small tumors.  No level of PSA "pproves" prostate cancer, but high PSA does tell a doctor that the cause must be determined. 

    A clearly positive biopsy does prove that it is time to get to work, and will give you lots of useful information. There are numerous PCa initial treatments, if you end up needing one, but choosing one takes research and reading, and virtually never needs to be rushed in to.




  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,339 Member

    As I understand, you have never had a DRE. I am surprised since this test is recommended to screen for PCa. Generally 15%of prostate cancers are detected by this test. if this is so, I feel that your doc has been negligent. 

    As Swing mentioned PSA can rise due to a variety of reasons, to include but not limited to a urinary infection.

    At the Sloan Kettering site, you can measure the rate of change of your PSA's. 

    There is a test, called a PCA3 that you may wish to obtain, which basically is a urine indicator, for prostate cancer...

    At the point, I suggest you do some research about something  called "Gleason Score". The Gleason score indicates the aggressiveness of prostate cancer, if any found in a biopsy. Just in case, know what this is for a possible discussion.

    You did not mention your age. Basically the older one is, the more like to be diagnosed with prostate cancer.....the majority of these cancers are indolent, meaning not likely to at this point, do not be nervous, but keep on doing research as you are. There are local support groups that you can attend for knowledge. USTOO is an organization that you can google that supports and lists local support groups...there may be one near you.

  • Clevelandguy
    Clevelandguy Member Posts: 1,039 Member


    The biopsy will be the test as to wether you have cancer or not.  Even the biopsy can be hit or miss if they don't strike the cancer during the biopsy, might take a couple of biopsy's to find it.  Once you find out if it is cancer you can then start looking at treatments.  PSA alone cannot tell you if you have cancer, you will need other tests.  PSA is a good indicator that something is going on but it might not be cancer.

    My biposy was positive for cancer and I had my prostate removed with radiation as a back up if needed.  Plenty of time to decide which option you will need based on what the biopsy & doctors tell you.  The amount of treatments are staggering and they all have their ups & downs as far as side effects.  Good luck and let us know about future tests/procedures.

  • VascodaGama
    VascodaGama Member Posts: 3,668 Member
    Screening markers


    Welcome to the board.

    As you comment, you have not been diagnosed with cancer yet. All data shared by you relate to probabilities. The MRI findings and the increasing high PSA are of concern and you should try identifying their means. The best is to get a DRE and a biopsy which should include needles directed to the nodule(s). In the DRE the doctor will try to identify extruding bumps on the prostate surface or hard regions in the capsule. The biopsy is then done (which should include the results from DRE and MRI) with local anaesthesia in a simple performance. The pathologist will check the samples under the microscope and then report his findings including the aggressivity and type of cancer, if any. Based on the details your doctor will estimate your clinical stage, from which you can then find your options.

    The markers used by your doctor (PSA, fPSA and proPSA or PHI) are important in the overall screening for cancer but do not diagnose cancer. They are tools that may avoid biopsy in cases of certified hyperplasia (BPH patients). Some guys may have significant numbers due to benign hyperplasia but some with low levels are found with aggressive types of cancer (PCa). The biopsy will provide you an answer and, most probably, peace of mind.

    Best of lucks for a negative to cancer result.