What questions to ask.

i'm 45 years old. about three years ago, i too had a blood test that put me at a low risk for PCa. as of this past thursday, i was diagnosed with G7 {4+3} PCa. ONLY A BIOPSY CAN DETERMINE PROSTATE CANCER now, there are four different biopsies i know of:

1. the TRUS biopsy,

2. MRI Fusion/Ultrasound guided biopsy

3. MRI In-Bore targeted biopsy

4. Saturation Biopsy

some say the 3rd is the best because it only targets the lesions seen on an MRI.

so if i were you i'd ask my uro about these different biopsies. which ever you decide to do next.

PLEASE do not agree to have a biopsy until you've first had a 3T MRI. this way if there ARE any 

lesions your doctor will know where to find them and there wil be no mistake that you do or don't

have PCa.

In my opinion, your urologist needs to define the issue.  The definitive test for prostate cancer is a biopsy.  I had a 3T MRI prior to the biopsy.  The results of this can be used with the biopsy (fusion) to target suspicious areas.  Then you and your urologist will know exactly what you are dealing with.  Good luck on your journey.

Iceman,

Your 17 years of experience in Kidney Cancer will help you in finding the answers to your questions. It follows similar steps in diagnosing, identifying and staging in terms of spreading. However, 17 years ago you were much younger looking for a radical treatment and now at 75 you may need to consider if a palliative approach is a more appropriated option.

The advices from above survivors are pretty good. A biopsy is the ultimate way to diagnose the prostate cancer and I think that you should try to find the reason behind the high PSA, but you need to be attentive to consequences from treatments if you get a positive diagnosis and then want to follow with a treatment. The truth is that PCa takes years to spread and become lethal, in particular if the issue relates to a low aggressive type as Max may be suggesting above due to the long PSA doubling time. The risks in PCa therapies are high and many of us not-so-young PCa patients die from other causes. In fact the NCCN guidelines recommend avoiding radical therapies to guys above 75 yo.

I wonder if your doctor is postponing the biopsy due to your age or due to the past diagnosis of BPH. Such condition, if still existent, would constitute a high portion of that PSA value but one should also consider that several aggressive cancers produce little amounts of PSA for its poorly differentiated type of cells, and this is what you need to know apart from finding if you have or not the cancer. In your shoes I would pursue a biopsy to get a Gleason rate. I also would question your doctor about any concern regarding your age and past interventions.

I have CKD (high creatinine levels) and my nephrologist in 2017 recommended me to avoid the traditional contrasts used in image exams. CT is the worse. MRI can be done with or without contrast so that it is not restrict to CKD patients. You can read this article on the issue from Mayo Clinic;
https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/expert-answers/gadolinium/faq-20057772

In any case, instead of a MRI you can have a PET exam to identify PCa lesions. The Gallium 68 (Ga68) PSMA PET/CT is now considered the standard in PCa diagnosis and it is not nephrotoxic. I am not aware if you can already have this exam in USA but it should be possible because the isotope is easily produced at a local nuclear facility using a generator. In fact the price of this exam is now an half of what used to be one year ago. I had a PET/CT with 18F CHC (choline) in January 2018 and last February 20, 2019, I had a 68Ga PSMA PET with no problems to my kidney issue. You can read about this sort of contrast used in renal diagnosis in here;

https://www.ncbi.nlm.nih.gov/pubmed/27612032

https://www.researchgate.net/publication/307521802_Gallium-68_EDTA_PETCT_for_Renal_Imaging

These links relate to the exam in prostate cancer diagnosis;

https://www.ncbi.nlm.nih.gov/pubmed/29976697

https://www.healthcare.siemens.co.uk/magazine/mso-pet-ct-imaging.html

Here is a past thread that may be of interest to you;

https://csn.cancer.org/node/304417

Best wishes,

VGama

First point: I recently had an MRI at Johns Hopkins, and was surprised that they did not want to do a blood creatinine test, since they planned on using the contrast. The techs told me that they had received guidance from the medical group whose protocol they followed, that kidney function testing was not longer needed unless the patient was on dialysis.

Second point, there is a new type of biopsy device that JH has helped develop. It is called Precision Point, and takes 12 cores through the perienum. While transperineal biopsies aren't new, this method requires only local anesthesia, and no antibiotics. They have never had an infection from using this device. So, you can add that type of biopsy to the list.

 If you get the biopsy hopefully they will do a fusion biopsy.  Basically they use the MRI to target suspicious areas.  My biopsy was a fusion one.  They gave me a valium around 45 minutes prior to the procedure.  Also, I was given some Cipro to take prior to the biopsy.  They attempt to numb the instrument that goes up your rectum, a needle  penetrates the intestines to get to the prostate gland and then it starts taking samples.  It is not that bad but just a necessary procedure.  Also, my first ejaculant after the biopsy was dark red in color.  As far as fun goes.  Well, you tell me.  Good luck on your journey.