Newly Diagnosed Very high PSA

lynnar1332

My husband was recently diagnosed. Very health, fit 65 year old. Went in for a physical because he never goes to the doctor and they ordered a blood panel. Doctors office called him and told him his PSA was 44.74 and they referred him to a urologist.

Since then he has had an MRI which showed 2 lesions rated PIRAD 4

Biopsy which showed 17/18 cores positive for cancer with most 3+4=7 and two cores with 4+3=7. Report also showed PNI present.

He is scheduled for a full body bone scan and ct scan in 2 weeks.

I am trying to do all the research as he doesn’t want to even face this.

My concern is his PSA is so much higher than most that I see on these boards. Could they have made a mistake on his blood work?

Clevelandguy

Hi,

It is possible they made a mistake on his PSA but with that many cores 17/18 & the 44.74 PSA, it could also be correct. You said there were two lesions caught by the MRI, were they external to the Prostate? If yes what is the location? Perinueral invasion is never a good thing as is the 4+3. I might suggest a PSMA PET scan to pick up any areas outside of the Prostate with cancer. The PET scan is more sensitive than an MRI for picking up metastatic cancer. Depending on whether his cancer has escaped the Prostate in my humble non medical opinion would determine if surgery or radiation is the best treatment path. Sounds like in a couple of weeks you should have the results of the bone scan, then you can start thinking with your doctor team input the best plan of attack. I have included a link to give you some info on various treatment types.

https://www.cancer.org/cancer/types/prostate-cancer/treating.html

Dave 3+4

lynnar1332

Hi Dave! Thank you for responding. The lesions they found on MRI were on prostate and everything so far has said cancer is contained within prostate. Doctor said the bone scan was just because of his high PSA. He didn’t even mention the PNI on the biopsy. I just discovered it when I was researching how to read your biopsy report. I guess we just wait and see. Biggest issue we are having is my husband is severely depressed about all of it. He doesn’t want to talk about it, research anything or even think about it. He is kind of I. Denial or disbelief that this is happening to him. We have an appointment tomorrow to hopefully get him on some anti-depressants.

Old Salt

Assuming the scans will be clean, you can tell your husband that his case can be treated successfully. In other words, it's likely that he will have many more years with a good Quality of Life after therapy. Moreover, do convey in the gentlest terms possible, that his full cooperation will be important to get the best outcome.

lynnar1332

Well my husband got his bone scan and ct scans back. Doesn’t show any metastasis. Now the doctor has ordered a PSMA PET scan because his psa number is so high they want to check for any micrometastisis that maybe didn’t show up on bone scans. He will have that on 2/28/24. We are trying to decide on treatment plans. His urologist recommended the Davinci robotic prostate removal surgery. We met today with an oncologist who gave us options on radiation. He suggested external beam radiation along with catheter type of brachytherapy (no internal seeds) and ADT. They also are retesting his PSA and we will get result back tomorrow. Any guidance on whether to choose surgery or radiation therapy from anyone who has a similar story.

Clevelandguy

Hi,

If the PET scan comes back clean it’s really up to you and your husband. Both surgery and radiation can have side effects from mild to more than mild. I would study those to know what could be ahead. Get the best doctors+facilities to get the best results. Unfortunately there is no correct choice, both should provide very good results at killing the cancer. If he ops for radiation make sure he gets the gel between his rectum and prostate to protect his rectum from possible radiation damage. Good luck….

Dave 3+4

Otis335

https://csn.cancer.org/discussion/comment/1713511#Comment_1713511

The "catheter" type of brachy is high-dose. It's more involved than seeds, but still (usually) an inpatient procedure. Under sedation, a number of catheters are inserted into the prostate which then deliver high doses of radiation to target areas. The radiation is applied only for a few minutes and men are not radioactive following the procedure.

A PSMA scan is a must and probably should have been done when they discovered 4+3. I'm 71 and was diagnosed with 4+4 (later reduced to 4+3). I started ADT on 11/1/23. I had HD brachy later that month and 16 IMRT sessions (external beam) in December. Oncologist originally said 12 months of ADT, but the 4+3 diagnosis may reduce that to six. My PSA is now undetectable (was 7) and testosterone is single digits (good early results for fighting cancer). Certainly some side effects, but mostly tolerable.

lynnar1332

Otis335

Good to hear you are having early success with the same procedure they are recommending as an option for my husband. It will be good to have the psma results so we can finally move to fighting instead of waiting. On a not so good note, they retested his PSA and it went from 44.74 on 11/15/23 to 56.32 on 2/22/24. 😔Not sure what that means but it can’t be good.

lynnar1332

Clevelandguy

Thanks for the heads up on the gel! I will pass that along to my husband.