Rapid rise in PSA, recently diagnosed

wworker

I have recently been diagnosed with prostate cancer following a biopsy in early January (gleason 6, 6 cores positive, 5%-50%, PI). At my follow up appointment my urologist recommended active surveillance with an MRI in 3-4 months. At that point, he said the cancer was "far from scary". They told me to get another PSA last week.

My PSA in Oct. 2022 was 3.72, Oct. 2023 4.58, Dec. 2023 5.24 and last week 7.55. That seems like a rapid rise to me but I'm just starting to learn about all this.

Thoughts?

oldspice

If it were me I would definitely be looking for another opinion. After Gleason 6 comes Gleason 7 after Gleason 7 comes cancer treatments. You have reason to be concerned so I would advise you to do your due diligence. Wishing you well.

Clevelandguy

Hi,

A second opinion would not be a bad idea. Do you know where the cancer is located within your Prostate? AS can be an option at 3+3 as long as it remains 3+3 and is not close to escaping the Prostate. Do you know how many quadrants the doctor biopsied and the amount of samples in each quadrant? Typically they take several samples/quadrant, my point is it would be nice to know the volume of each sample and the Gleason score. You could have very little cancer or a Prostate loaded with cancer, if it was me I would want to know that. Your Urologist should have this info in the biopsy report. Low volume /3+3, stay on AS. High volume/3+3 or 3+4 maybe take another route on your cancer?

Dave 3+4

centralPA

Hi @wworker , sorry you find yourself here.

First, I wish you'd have had the MRI first, so they could have identified and targeted any lesions during your biopsy. It would also give you the prostate volume, allowing you to estimate PSA density.

Do you have urinary problems? Taking anything for them?

Were the positive biopsy samples all on one side? Spread across both sides?

If you post the biopsy results, we can comment on them. Unfortunately, we've seen quite a few.

No matter what, with 3+3=6 you have the ability to take your time and sort everything out. I concur with @Clevelandguy that there's no downside in getting a second opinion, especially after the MRI comes in.

wworker

Thanks for your input.

I agree, it would have been nice to have the mri first. Unfortunately, I didn't know to ask. I'll definitely look into getting a second opinion.

I don't have the details with me right now but I know out of 12 cores, 4 cores on the left side and 2 on the right side were positive. 1 was 5%, 1 was 10%, 2 were 20%, 1 was 30% and one was 50%. P.I. was noted.

I've been on Alfusoin for a few years due to flow issues.

Should I be concerned about the rising PSA at this point or is that less important now that I have had the biopsy?

wworker

Here are the specifics

R lateral apex 20% of one biopsy core - Prostatic adenocarcinoma Gleason 3+3=6

R medial apex 20%

L medial base 10%

L medial mid 50%

L medial apex 5%

L lateral mid 30%

Perineural invasion is identified in this case.

Clevelandguy

Hi,

If you have Perineurial invasion(PI?) if it was me that would be an automatic “do something” other than AS. Perineurial means the cancer is entangled with the nerves on the surface of the Prostate. It’s getting ready to leave the barn as they say. I would ask for a PMSA PET scan to confirm the cancer is still totally contained within the Prostate. If PI means Pirads-# then that number will tell you how aggressive your cancer is, need to get that clarified. Alfusion is a medication given for Benign Prostate Hyperplasia(BPH). BPH will also make you PSA higher than normal so if you have BPH that could be part of your PSA rising numbers.

Dave 3+4

neilm

I agree with the comments above ,

Good news only Gleason 6 was detected but I agree a second opinion would be helpful. In this day and age MRI should come first , I had a urologist who did not offer that to me early on and I sent him down the road as this is important to get right ( and now may require a second biopsy depending on the MRI ). My PSA bounces around but tends to come back down, yours looks like a steady climb so worth understanding what is driving that, may not be cancer but it might be. I found on my second targeted biopsy a sliver ( less than 5% ) of 3+4 in a single core which changes my diagnosis. Like you I had multiple cores of 6 but I think the first biopsy was just not as efficient. To your question high PSA if not understood could be very important but so is the cancer grade. I know its hard not to be stressed by this and I am not a doctor but it appears you have time, sometimes fear can drive treatment and the key for me was educating myself which was calming. This group can analyze biopsy reports pretty well, early on I posted mine and the CSN team helped me navigate it. Again no one here I know of is a doctor but has generally had a lot of experience with this disease. Below is a link to a group that I have attended off and on, they meet on Zoom and cover newly diagnosed patients. I have found them helpful and my Urologist usually doesn't have the time to just chat so these guys can fill in a little bit.

https://www.prostateforum.org/

Steve1961

How old are you and what brought you to have a biopsy done with a PSA of less than 4 without having an MRI? Just curious.

wworker

Thanks for the input.

My psa was in 2-3 range for a number of years prior to the numbers I posted above.

I'm 59. My PSA in early December was 5.24. My biopsy was in early January.

Understanding my biopsy was done without a prior mri, my concern is that there may be undetected cancer with a higher Gleason score.

This concern really only came up following the 7.55 psa I got last week.

neilm

PS Perineurial Invasion would concern me as Cleveland Guy indicates and I would be looking to treatment.