newly diagnosed prostate cancer
I am 71 yo male in fairly good physical shape. Had an MRI done after an elevated PSA of 11.3 on early January 2025. The diagnosis as per UCLA was a Locally Advanced Prostate Cancer. I am scheduled for a biopsy on February 11th. I have visited with several different urologists to learn about my options. I am also looking into Proton Therapy at Loma Linda. One issues that is concerning to me is that my PSA in climbing rapidly - the last one yesterday was 14.3. I am hoping to receive some advice and words of hope and encouragement. Thank you
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Hi @Zoli, sorry you find yourself here.
Couple of questions. On your MRI they should be giving you a PIRADS score. Do you know what it is? Also, the MRI should tell you how big your prostate is, which factors into things. What is its size?
On your PSA, those things can bounce around significantly. When was your first PSA at 11.3 done?
One thing you’ll learn in dealing with PCa (if you have it…an MRI can only suggest you do) is that it involves a lot of w a I t I n g. Sucks that it is that way, but you just have to train yourself to not dwell on it 24/7 in between appointments. Your biopsy is just around the corner, and then you’ll have ground truth data.
Sending positive thoughts!
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Hi,
The MRI cannot determine if you have cancer, only the biopsy will determine and grade your cancer via a Gleason score from mild to aggressive. If the MRI saw suspicious areas your Urologist will use that data on where to take the biopsy samples. Another tool you can use to determine the spread of your cancer outside the Prostate is a PMSA PET scan and a bone scan, you doctor(s) might order those to get a good picture of where the cancer is located, hopefully it will be contained in the Prostate. Proton therapy is a very good treatment due to the nature of the fixed length beam which does not go completely through your body and potentially damage other tissue and organs. If you have a very large Prostate there is a chance your high PSA number might be due to Benign Prostate Hyperplasia which is usually not cancerous. Hopefully your diagnosis will be more defined in the next few weeks.
Dave 3+4
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i had salvage surgery done ar ucla dr robert reiter he did a fantastic job saved my life. The man is very knowledgeable one of the best in California. I suggest either way that you make an appointment with him. He’ll tell you your options and he’ll tell you what he thinks is best for you look this man up on YouTube he has many many many videos.
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This site is a good place to read up and get informed, keep in mind, mostly patients here vs. Docs. You are a bit premature to get treatment suggestions without biopsy results. You may not have cancer. As the others have said, biopsy is the info you are after. Also, biopsy can confirm you do have cancer, it doesn't confirm you don't. If biopsy is neg and PSA keeps rising, they can do it again.
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Zoli,
It’s too soon to know for you to decide the best route that you want to go if you are diagnosed with cancer. Although your MRI might have found a suspicious PIRADS lesion that could be clinically significant for disease, my PIRADS 4 was benign. I am speculating that they found a lesion since you are describing they found locally advanced prostate cancer, but it surprises me they say that with just the MRI. I don’t know if they gave you a ExoDx urine test that could have indicated that your cancer is more likely to be advanced. It certainly does not hurt to begin your research into the possible treatments but that they depend on your individual circumstances. Until the biopsy you do not know the Gleason grade of your cancer and how advanced it could be. Almost all Gleason 6 are active surveillance and many favorable Gleason 7 (3+4) can possibly be. Gleason 8, 9 and 10’s are advanced and if you have surgery in those cases they would probably want to do Adjuvant Radiation Treatment (ART). Surgery and Radiation also depends if it has breeched the capsule and is Gleason 8 +, or lymph node involvement. Even with just a Gleason 8 or Unfavorable 7 (4+3) with a breeched capsule if the margins are clear after surgery you may not need Radiation. If you decide on Surgery their are types of surgery, Multi port or Single Port Robotic surgery, Nerve Sparing, Rezius Sparing, Puboprostatic ligament sparing. Radiation also has options. There is a lot to take in. Fortunately you are at a outstanding cancer center hospital with UCLA. After the biopsy and grading of your cancer, they should then order a PSMA Pet, and Decipher testing of your tissue. I did hear of that Doctor that Steve mentioned. Good luck on your biopsy that is really a walk in the park for most.
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Zoli,
I think UCLA is a world class operation. If you are looking at Loma Linda be sure to ask about Spaceoar. I believe it is critical with Proton and my last information was they were not using rectal spacers. Your RO I bet will have an opinion on that. UCLA is at the frontline on MRI guided SBRT as well.
Let’s hope your Gleason score is 0 then you won’t have to think about it!
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Hi, I am 73 and have prostate cancer. I am leaving information to you as to what I went through and hopefully in some small way it will help.
Last May, I received a PSA of 16+. However, my PSA had risen 7 months earlier but I was never informed. After learning of my PSA results, I was advised to contact a urologist.
I contacted a urologist, and my urologist ended up performing a biopsy. The biopsy showed that I had prostate cancer with a gleason score of 8. My urologist explained my options, surgery vs radiation. He said it would be best if I had surgery because having radiation first might prevent surgery afterwards.
Last July, I had surgery. In and out in one day. When the results came back, I learned that I was a gleason 9. I also had a 2 mm positive surgical margin. I was told that they could not get it all, because it was too close to my bladder.
I followed up with my oncologist, who had treated me in 2020 with unrelated cancer (Appendix cancer). He recommended radiation for my prostate cancer based on my gleason score of 9 and my 2 mm positive margin.
I received 7 weeks of IGRT (Image-Guided Radiation Therapy). During that time I also began receiving ADT (Eligard) injections (once every 3 months). After surgery on two separate occasions, my lab work showed my PSA at 0.04.
I was told by my nurse practitioner that my PSA of 0.04 is considered undetectable. But in my participation in a Facebook social group for prostate cancer, others in the group said a PSA of 0.04 is not undetectable. So, I am now confused.
I also read where a gleason score of 9 may not receive total benefits from ADT. I will have to wait and see when I receive further results. Literature on the internet regarding Eligard states that it is effective. However, I decided to contact Eligard by email and was surprised when they responded but did not give me a definitive answer. They referred me to other prostate cancer groups and to my oncologist. So again, I am confused.
One thing I have learned, and I cannot over state this, you need to do your own research and advocate in regards to the treatment you receive. Typically, you will most often receive good information but on occasion you will you will receive bad advice.
Hope this helps, Rick
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Zoli,
You are now getting information that you can start to think about the direction that you are going to proceed. At unfavorable 7 you are likely looking at a treatment protocol. You still need some additional pieces to make your decision. A PSMA PET is likely to be scheduled next and I would request Decipher testing of your prostate biopsy tissue to find out how likely it is aggressive. Also your biopsy report should have additional information as to whether a cribriform pattern was identified. Your treatment center at UCLA is tops and certainly their recommendations will be playing a significant role in your decision. My only advice is if it looks like surgery is a good option I would jump at it at your age. Most Surgeons have a cutoff of 75 for prostate surgery. Your health can deteriorate at any time and then preclude you from surgery regardless if you are still younger than 75. Also Salvage Radiation is easier as a backup that would be more readily accessible to you as you get older if you need it. There are Surgeons and one at UCLA that do Salvage Surgery which is still not common, but if you do Radiation at your current age and you need salvage surgery you could A. Be too old or B. Your health deteriorated possibly from effects of the Radiation treatment that although under 75, they won’t do it.
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Zoli, my guess is that calls for treatment. Likely hormone therapy and radiation as you say it is locally advanced. If you have the option with locally advanced disease to do MRI guided SBRT it might be worth a look. If not IMRT has had trials which show it to be equivalent to proton. I am not a doc please do research and speak to a few urologists and radiation oncologists for advice. https://www.astro.org/news-and-publications/news-and-media-center/news-releases/2024/astro24efstathiou
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I am leaning toward Dr. Wayne Brisbane at UCLA for treatment. He is already setting up a schedule date for the surgery. He is suppose to very innovative in his approach . However, I will continue to do reserachresearch. Do they ever do surgery without PSMA? My Scan is not scheduled for another month. everything take so long .
My Doctor, Brisbane, as per may request , prescribed Bicalutamide to keep the cancer in check while waiting for the surgery and treatments.
All your comments and suggestion is very appreciated. I have a 19 yo daughter which I am most concerned about.
thanks
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It certainly feels like it takes a long time for each schedule piece of the puzzle. A week or two to get a urologist appointment, appointment to get blood draw, awaiting results, bak to getting appointment with Urologist to discuss results, referral for MpMRI, couple weeks, then awaiting results, back to appointment with Urologist, referral for biopsy, couple weeks for schedule, awaiting results and another appointment. Referral for PSMA PET, again awaiting results, referral to Surgeon and Radiation Oncologist’s for consultation’s, usually another month, then more time if wanting a second opinion. Then getting on the Surgeon’s calendar another 4 to 6 weeks. Studies have shown that six months from Diagnosis to treatment regardless of Gleason grade makes no difference in outcomes. I went from initial appointment with Urologist after having monitored PSA for decision of MRI in Dec 2023, MRI mid Jan 2024, biopsy in Feb 2024, PET Mar 2024, 1st Surgical and Radiation consultation’s late April/early May, 2nd opinions late May/early June 2024, actual Surgery mid August. I could have had my surgery appointment mid July, but wanted to wait until our daughter returned to college. Had Surgery scheduled 3 days after dropping her off.
I think they want the PSMA Pet before Surgery to confirm whether it has spread outside the capsule for Surgery decisions.0
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