High PSA Advice Needed

Since your PSA went up and then dropped back a bit, your doc was not concerned enough to recommend a biospy, opting instead to do an semi-annual PSA test instead of waiting a year. 

A consistent rise, year to year, would be more concerning.   That's what happened to my PSA, going from 1-2, to 2-3 to 4+, which called for an immediate biospy w/a finding of a low grade Gleason 6 prostate cancer.

Your PSA results don't seem concerning enough to call for a quarterly PSA test at this time BUT I think what you want done is really up to you.

If you are worried that you "may" have prostate cancer and just want to alleviate that concern, just ask for a biospy.  That's the only test that will tell you with reasonable certainty whether you have prostate cancer or not.  

There is the possibility of a false negative  but continued PSA testing with increasing returns will be a red flag indicating the need for another biospy.  Semiannual PSA testing should be sufficient to catch such a problem before the latent cancer grows beyond control.

More frequent PSA testing will not EVER tell you whether you actually have prostate cancer or not.  A rising trend in PSA is only an indicator of the possibility of prostate cancer.  High PSA levels can also be caused by other things having nothing to do w/cancer.

So, if you want to know NOW whether you have prostate cancer or not, the only thing to do  is to request a biopsy.  An MRI, bone scan and other testing is only called for if there is already a positive biopsy result.

You just need to decide whether to get a biospy now or not.  Good luck!

Hi,

Keep an eye on it with more PSA testing, I feel it's the rising of the PSA number after several tests that should be monitored.  My doctor told me he had a man with a PSA in the 2.5 range that tested postiive for PCa.  My PSA slowly rose over a period of years, then my doctor ordered the MRI to check me out.  If you continue to see a general rise in your PSA numbers after multiple tests it could indicate that something is going on with your prostate.  My doctor monitored my PSA every six months for a few years. IMO, an MRI should be done before the biopsy to pinpoint where to take the biopsy samples.  If you don't do the MRI 1st then you are just shooting in the dark with the core samples.

Dave 3+4

zina55 said:

Dave,

Dave,

Thank you for your reply. It makes all sense to have an MRI done first to know where to take biopsy. Fow how many years did your doc just monitor you? Did you have an endorectal MRI done? 

 

Zina: It is not generally accepted practice YET to have an MRI done before it is determined that a patient is cancer positive based on a biopsy.

While some doctors may order a pre-biospy MRI, a medical insurance carrier may NOT approve the procedure because it is not yet viewed as medically necessary.  Biopsies on the other hand are routinely ordered to determine the existance of prostate cancer.  So, while you can request a pre-biospy MRI, your insurance carrier may not approve it and (unless you're rich) you definitely do not want to pay for it yourself. 

On the other hand, a post-positive MRI to determine the location of the cancer would be more routinely approved and, if you are going to do that, the best test to do is not just a simply MRI but a combined MRI/MRSI (also known as a 3T MRI) spectrographic scan which will scan for choline which is a marker for cancer and would be the MOST accurate pre-treatment scan you could do in order to determine the locaiton and extent of the cancer.