Concerning follow up PSA test. I'm worried this could be bad How concerning is this.

Old Salt

I second the above post by Wheel.

I don't understand what you wrote here:

Additionally, the way it works in their system if you have no Gleason 3 or higher indications they don't do the MRI guided biopsy.

Can you explain please?

centralPA

My vote is to get the MRI done. It will tell you if there s a lesion to target, (I am guessing they won’t target a lesion if you are PIRADS 3 or less, not G3 or less), give you the exact prostate volume to calc PSA density, see if there is extra prostatic extension, and give a look at the surrounding area for weirdness.

If you have a biopsy first and they find something, you’ll want an MRI anyway. At that point you need to wait for the prostate t heal from the biopsy so they can get a clear picture. The overall time to treat will be even longer.

Marlon

No expert here, but I didn't think anyone would do a biopsy without an MRI first to tell them where to poke. Otherewise it's just random. And as mentioned it does take some time for the biopsy situation to heal. I also would think insurance has some say in what they will pay for.

Wheel

It makes sense if you have no PIRADS 3, 4, or 5 lesions to target , their really is nothing to target or the additional logistics of an ultrasound guided MRI. I concur with Old Salt and CentralIPA that you must have used Gleason in place of PIRADS. PIRADS terminology comes from the MRI, while Gleason comes from the biopsy grading your cancer. You still need to nave the MpMRI BEFORE the biopsy in case their are PIRADS 3, 4, or 5 lesions that then need absolutely guided biopsy. Even with a guided biopsy into specific lesions, confirm in addition a well number of additional cores are still taken in a random grid fashion. If your MRI did not show PIRADS 3,4,5 and you were still having the biopsy, just confirm a well number of random grid cores are then being taken.

anotherday

https://csn.cancer.org/discussion/comment/1721476#Comment_1721476

Hi, I meant PIRADs not Gleason.

anotherday

Alright thank you everyone for your feedback. I am staying with the MRI first based on information from here and elsewhere.

KittySlayer

I followed a consistent routine before my PSA test so I did not have to worry about my activities causing fluctuations in the results. Starting five(5) days before my test I would refrain from heavy exercise, bicycling, and ejaculation. Would enjoy my weekend and then Sunday night start my PSA abstinence routine and then get my blood draw on Friday.

Did Active Surveillance for three years. A couple biopsies and then an MRI. Ultimately decided to have my prostrate removed with a RARP. I am a six(6) weeks post surgery and pleased with my urinary continence progress seeing improvements every week. I went into my surgery with incredible fitness following a summer hike. As you navigate your testing and decisions take this time to focus on your fitness and weight as it makes surgery and recovery go much smoother. Also start a Kegel routine a couple months before surgery.

Clevelandguy

https://csn.cancer.org/discussion/comment/1721540#Comment_1721540

Hi,

Good pre PSA test advice from KittySlayer………

Dave 3+4

Tim4plus3

I was 55 when I first learned of my elevated PSA (5.0) and it was exactly 6 months from that test date to the date of my RP. Along the way, I had my PSA re-tested in every possible way, had ultrasound, MRI and Pet scan and spoke extensively with both surgeon and radiologist. The wait and uncertainty sucked, but I ended up fully comfortable with my decision to go through with the RP. You have several great options - take the time to explore them all.

anotherday

First update. My MRI results are below. PIRADS 1 by God's grace. I also have a large prostate for my age. They wanted to do a biopsy without an MRI to begin with so I might still be in line for that. My prostate is large so that might account for the PSA. Waiting for the doctor's feedback but I am relieved. I plan to post one more update for the biopsy but I am more hopeful I am heading out of the woods.

IMPRESSION: 1. PI-RADS score: 1 2. No significant additional findings.

Narrative

MRI PELVIS (PROSTATE PROTOCOL) WITHOUT AND WITH CONTRAST PROVIDED CLINICAL INDICATION: R97.20-Elevated prostate specific antigen (PSA) Elevated prostate specific antigen (PSA) ADDITIONAL CLINICAL INDICATION: None available COMPARISON: None available TECHNIQUE: MRI of the pelvis was performed on a 3 tesla magnet, using a multiparametric prostate protocol before and after the dynamic intravenous administration of 10 mL of GADOBUTROL 1 MMOL/ML IV SOLN. FINDINGS: PROSTATE SIZE: 4.9 x 4 x 4.8 cm PROSTATE VOLUME: 48 cc The prostate borders were marked in 3D and size was calculated using DynaCAD. PERIPHERAL ZONE: No suspicious lesions. TRANSITION ZONE: No suspicious lesions. Moderate benign prostatic hyperplasia. ADDITIONAL FINDINGS: No adenopathy. Seminal vesicles are symmetric. No significant additional findings. PI-RADS v2 Assessment Categories 1- Very low (clinically significant cancer is highly unlikely to be present) 2- Low (clinically significant cancer is unlikely to be present) 3- Intermediate (the presence of clinically significant cancer is equivocal) 4- High (clinically significant cancer is likely to be present) 5- Very high (clinically significant cancer is highly likely to be present)

Tim4plus3

Congratulations - very good news that your MRI indicates low probability of cancer!

Wheel

Consider having your urologist obtaining the urine genomic ExoDx test. It is highly accurate measuring some 20+ markers for cancer and its determination of low risk to high risk. Google the test, it’s totally a non invasive urine test. With the results of your MRI and if this came back low risk, it could be a case for watching your PSA, and for the time being holding off on a biopsy. Then if another MRI is done a year later if no changes in your PSA then the Radiologist can compare your new MRI with your past one. Also anything in the results of the ExoDx test will give more decision in definitely going ahead with a biopsy or holding off temporarily.

Clevelandguy

Hi,

Good news on the MRI, sounds like your elevated PSA is due to your large Prostate gland. Normal gland volume should be somewhere near 25-30 range. I would follow up with PSA tests in the future.

Dave 3+4