Just starting my journey

marco1910

Greetings,

My PSA went from 3.4 in 2019 to 6.9 in 2022. Went to my urologist and was diagnosed with prostatitis, 6 weeks of antibiotics, and PSA was still high (6.4), Free PSA% 14. Recommended an MRI with contrast. Results are 1 PIRAD 5 lesion left side peripheral zone 1.8 x 1.3 cm. no other exceptions..etc

Headed towards a fusion biopsy and just trying to educate myself. I'm 66 and very active/healthy and would like to keep it that way. Eye wide open on this one, assuming cancer.

Any guidance greatly appreciated,

Mark

centralPA

Welcome aboard, @marco1910 , although I’m sure you’d rather be elsewhere. Sounds like you are doing the right things with the fusion biopsy. Some points to ponder…

Do you have any history of urinate problems? Weak stream, etc.?

What was your prostate size? Your MRI report should have that, which will allow you to compute PSA density.

For your biopsy, get a perineal biopsy rather than rectal if you can. Safer.

Plan now to get a second opinion on it, especially if adverse. Also a genomics test.

Keep reading any and all info, goal is to anticipate what the doctor will tell you, so you can truly make shared decisions.

Fingers crossed your biopsy is a nothing burger.

marco1910

Do you have any history of urinate problems? Weak stream, etc.?

yes, problems urinating, weak stream..etc diagnosed initially with BPH, DRE's have always been good.

What was your prostate size? Your MRI report should have that, which will allow you to compute PSA density.

Prostrate volume: measure 4.4 cm AP x 5.3 cm TR x 4.8 cm CC, volume 58.6 cc.

How can I compute PSA density?

For your biopsy, get a perineal biopsy rather than rectal if you can. Safer.

Plan now to get a second opinion on it, especially if adverse. Also a genomics test.

Keep reading any and all info, goal is to anticipate what the doctor will tell you, so you can truly make shared decisions.

Fingers crossed your biopsy is a nothing burger.

marco1910

btw, no suspicious marrow lesions, no adenopathy (lymph nodes), Neurovascular bundles - normal, seminal vesicles - normal.

I will do the research and just purchased Walsh's book.

VascodaGama

The density is 0.12 (6.9/58.6 cc=ml), therefore in the mid term for any consideration regarding high risk in Gleason rates.

At 58.6cc, you have a large prostate which is consistent with your bph experience. The low density signifies that the large volume of prostate tissue is making relatively little PSA, but doesn't tell if the lesion found on the MRI is cancerous.

The free psa of 14 % is also ambiguous as it places you in the mid term for a possible positive result.

The biopsy is the ultimate result. Let's wait for the results. Meanwhile you doing well in researching and educating on the matter.

I have not much to add to Central's opinion. Just try doing things wisely and coordinatly. Do not rush without second opinions.

We will help you with advices based on our experiences.

Best wishes,

VGama

marco1910

Thanks to both @centralPA and @VascodaGama for the insights. I will continue to research and educate.

“If we try to adapt our mind to the regular sequence of changes and accept the inevitable with good grace, our life will proceed quite smoothly and harmoniously.”

– Epictetus