Right at the Beginning Line - Testing and Suspicious Results

Gus2023

Hello all, guidance is very much appreciated. Had a 3.2 PSA a year and a half ago. Unfortunately I did not follow through with a visit to the Urologist. Now I have 5.1 and a free/total of 10%. Monday I have an appointment with Urologist for a DRE. No additional symptoms other than frequent urination and a weaker flow. Before I started reading this posts, I was just guessing a Biopsy will be unavoidable. Under these circumstances and with much experienced folks here is there something I should know or consider that would help me Monday at the appointment. I appreciare deeply the advice.

Gus2023

Forgot to say I am 55 should that be relevant....

https://csn.cancer.org/discussion/326197/right-at-the-beginning-line-testing-and-suspicious-results

Forgot to say I am 55. Thanks to all

On_A_Journey

Hello Gus2023,

Please don't be too hard on yourself for not seeing a urologist or getting another test for 18 months after your first one. Depending on your source, a PSA of 3.2 might not be above the upper limit for someone in their mid 50's even though it is a high reading compared to the average: Prostate specific antigen levels in men older than 50 years without clinical evidence of prostatic carcinoma - PubMed (nih.gov)

I can only speak for myself. My very first PSA test came back at 6.5 at the age of 50. This was organised by my family doctor and he organised a follow-up PSA test straight away just in case it was an erroneous result. The next test came back at 5.9 and it was only then that he referred me to a urologist. When I saw the urologist, he conducted a DRE but couldn't really tell anything from it. Yes, he organised a biopsy after that, which was negative, but I was finally diagnosed with prostate cancer 18 months after that, after my third biopsy.

I think your doctor is following standard procedure and I am sure your urologist will too. Good luck, but I'm sure you will be looked after by your urologist.

lighterwood67

In my case, I had a fusion biopsy. That means they did an MRI; took those images and used them to assist in sampling of the prostate during the biopsy. A targeted biopsy so to speak. A few days later they came back with the results of the biopsy and a Gleason score. They gave me a valium about 45 minutes prior to the biopsy starting. I have never taken anything like that before so I was pretty much out of it but conscious. I could feel what they were doing, but really did not hurt. I think once you get the biopsy and results (if positive), then the questions are really going to ramp up. Anyway, good luck on your journey.

Old Salt

1. Yes, a fusion biopsy is more advanced, but requires specialized equipment (obviously) and may not be available.
2. A transperineal biopsy is the preferred method nowadays because the chance of a serious infection is lower.
3. Local anesthesia worked for me.

Max Former Hodgkins Stage 3

Gus,

Your two PSA tests show significant rise, but the PSA Vector (rate of increase over time) is not terrible. While a static result is usually no proof of much as regards PCa, the 5.1 is a bit higher than most doctors would likely be comfortable with. As the patient, you have the right to choose to continue monitoring your PSA via 'Active Surveillance' ( a doctor would likely recommend once every three month, or possibly go as long as six months), but your doc will likely recommend a biopsy. As regards DREs, a negative result is obviously to be preferred, but the DRE only detects tumors in the rear of the gland, not in the front. So while a negative DRE is good, it does not strongly argue for the absence of disease. Whether you go with A/S or biopsy, good luck. Me, a layman: I would have a biopsy. My PSa never tested higher than 3.2 in my life, and the biopsy and pathology results following surgical removal showed stage II disease. My one, individual view and history.

max

rickyfish

Gus: I had a PSA of only 3.8, but had risen from the mid 2’s. But I had strong family history, three out of four male relatives on Dads side had prostate cancer. Went to Urologist, mistake one. Should of gone directly to the area’s recognized “Center of Excellence for Cancer Treatment” in my area OSHU in Ptld Oregon or UW in Seattle Wa. This is what Dr. Schultz recommends ( PCRI - they have ton of very helpful videos on you-tube), they treat, in much greater detail and quantities , with prostate cancer.

So after wasting time at the local Urologist, who did my biopsy, 8 out of 12 cores positive for cancer, Without many answers to my many questions, I went to OSHU in Ptld Ore. Never looked back.

But the important point is, the sooner you get a diagnosis, if it is cancer, the more time you have to do the research that every man should do, it is normally fairly slow growing, so if you get your diagnosis, and it is cancer, you can do the research and decide what course of treatment to pursue.

Main thing is, I didn’t catch it early enough, so after having prostate surgerically removed, they couldn’t get it all, it was just slightly out of the prostate. If I would have been more proactive, good chance I would not of had biochemical reoccurance three years later. So do not ignore it, get it biopsies and or the new blood test, find out what’s going on!

Gus2023

https://csn.cancer.org/discussion/comment/1703680#Comment_1703680

Gus2023

I went back on my medical records and found PSA readings as follows:

2002 - 1.9

2012 - 1.88

2013 - 1.85

2015- 2.27

2016 - 1.76

2020 january - 2.93 & 3.14

2021 march and may- 3.28 & 3.19

2023- 5.1

Waiting for MpMRI results. Hopefully on the safe side or the low risk group.

Steve1961

Take the advice of lighter would an old salt and me go to fusion biopsy do not let them do a biopsy you get an MRI first if they don’t give you an MRI you find a doctor that will give you one the MRI will show there is any concern for cancer if so a fusion biopsy isthe only way If your doctor won’t give you an MRI then you find a doctor that will if you need a biopsy and you don’t have a place that does a fusion biopsy you get on a plane and you find a place that will do it on a plane will you have to have a biopsy you do it the fusion way it’s a guided fusion MRI biopsy You look it up and you read about it and you know why we are adamant about doing it this way all the other ways are old-school and not accurate you get countless painful biopsies like my useless urologist did to me