Biopsy is done. 26 cores extracted. All benign. What is the next step?

frank1956 · February 25

I posted earlier with my data below:

"I am 68. I live in Southern California. I have Medicare and medigap insurance. In early 2022, my PSA was 3.9. By November 2023 it went up to 5.3. My PCP gave me referral for a urologist who asked me to do a 3 Tesla MRI, and a urine test.

My MRI shows my prostate size: 47cc PSA density: 0.12.

In peripheral zone, I have 2 lesions: one with 6X9mm PI-Rads 4; another with 5X3mm PI-Rads4.

Urine test shows ExoDx Prostate Test score: 18.77"

My MRI fusion transperineal biopsy was performed on 2/12/24. I saw pathology report on urologist's member portal: total 26 cores of sample, all benign. He also targeted total 3 lesions though MRI only lists 2.

Urologist called me earlier this week. He is sending my sample for a Confirm MDX test, to check if I have aggresive cells. This is the only test he said that can be done when you have a benign biopsy. No PSMA PET scan test unless there is a diagnosis.

He will call me again in a month when Conform MDX results are ready. I guess if the news is bad, we will need to discuss the next step. Otherwise, he said retest PSA in 6 months. But I am going to go to a lab to test it in 3 months, self pay.

My question is, should I do a second biopsy, say in 6 months? What is the protocol when a biopsy shows benign, but PSA is elevated?

Clevelandguy · February 25

Hi,

I would follow the doctors orders or go to a different health provider network with new doctors for a second opinion. Just count your blessings that they found nothing in 26 samples, not a bad thing. A few more PSA tests should determine a trend to see if your PSA number is definitely going up or just jumping around a bit. Until then enjoy life, you had good news.

Dave 3+4

centralPA · February 25

With 26 samples and then guided samples from the MRI, there really isn’t a lot of places for the cancer to hide in your prostate.

Your PSA density of 0.12 is reasonable. do you have any urinary problems, signs of BPH?

frank1956 · February 25

Thanks for the reply. My prostate size is 47cc. It is larger than normal (20cc to 30cc) but I do not have any symptom or urine issues. I keep a sleep log, and see that about half of the evenings, I would get up and pee, just once. During the day, I do not feel that I have an urge, or unfinished pee, or dripping.

So, the elevated PSA, the 2 lesions, and the urine test of higher ExoDx, are my concerns. I looked at what Conform MDX test does:

"The Confirm mdx test examines your negative biopsy tissue at the DNA level to help identify undetected cancers that may be present anywhere in your prostate."

From the website of the company, it says biopsy can only extract 1% of the prostate tissue. Confirm MDX can detect DNA from surrounding area (how large?). It may depends on how many samples my Urologist sent.

This appears to be an in-exact science.

Clevelandguy · February 25

Hi,

It says it examines your negative biopsy tissue that may help identify undetected cancers anywhere in your Prostate. How can the removed tissue sample find changed DNA on the other side of your Prostate? It can’t, it can only look at the DNA in the removed sample. I think what they are saying is that if they find DNA changes in the sample you could maybe have those same changes in other areas of your gland. The big word here is maybe. If you do find this changed DNA, what are you going to do about it anyway? So when does this changed DNA turn into cancer? I hope you get my point. Pca is slow growing so I don’t think you should worry too much about the results of Confirm DX test. The Confirm DX test in my humble non medical opinion does not tell you much.

Dave 3+4

frank1956 · February 25

I hear you, Dave.

They talk about halo effect, meaning the cancer cells permeated around the tumor. So, the area being tested is larger than biopsy cores.

Anyway, if the result is positive, I will go to UCLA to do another biopsy. If it is negative, I basically become AS. Test PSA or MRI until whenever....

centralPA · February 26

Well, I'm not glad of your quandary, but I am smarter now after googling on the tech based on your post.

https://mdxhealth.com/confirm-mdx-for-physicians/

Arthurdent · March 14

Prostate Cancer Research Institute videos( produced near you) by Dr. Scholz and Alex are GREAT. He is an oncologist, well respected, with no financial interests in promoting diagnosis or treatments. Give it a watch(S).

good luck

frank1956 · April 25

So, after my February benign biopsy, I did go to UCLA for a second opinion consult with a urologic oncologist. He thinks I am fine for now, but did order a 7 month follow up PSA test, and a MRI, to be done in September. Then, a consult with him to see if a new biopsy is needed again.

Meanwhile, I can't wait on this so I paid out of my pocket and got a new PSA number (5 months since last one from Nov, 2023), and it went up from 5.3 to 6.8 now. I am now anxious if waiting 5 more months till September for UCLA tests will see my PSA rise again to a level that is too high. I do not know if there is anything I need to do other than waiting 5 more months for new tests.

VascodaGama · April 26

Frank,

In your shoes I would follow with periodical PSA tests. Your gland is large and produces more PSA serum that a normal size gland.

The trend of the increases/decreases could justify the hyperplasia as BPH and sort of infection.

These "elements" apart from, having sex or maturation, or riding a bike, or, etc, the night before drawing blood for the test can lead to increases of the PSA.

I am curious on the DNA test that manage to stratify prostatic cancerous cells from those none cancerous. I wouldn't gamble on that.

So far you are "clean". Enjoy the moment 😉

Old Salt · April 26

Did you use a different lab for your out-of-pocket test? If so, different labs will occasionally give different results on the same sample.

Other than that, I second Vasco's message/advice.

frank1956 · April 26

I used the same LabCorp for the PSA test. I also made sure no exercise and no sex 4-5 days prior.

Clevelandguy · April 26

Hi,

Your Prostate size 47cc is on the large size, normal is around 20-30cc. Did any of the doctors mention BPH(benign prostate hyperplasia) as a possible cause for your PSA increases? Vasco noted this earlier, might be worth checking out.

Dave 3+4

frank1956 · April 26

I saw my urologist and a UCLA urologic oncologist for a 2nd opinion. UCLA doctor did mention on his appointment notes:

"In summary, the patient has a slightly elevated PSA, which is most likely due to BPH and his biopsies confirm the diagnosis of BPH without any evidence of prostate cancer."

Though, I worry that the rate of increase from 5.3 to 6.8 in just 5 months is something to be concerned about.

Old Salt · April 26

IMHO, your next step is to enjoy life…

and follow up with regular PSA tests, as Vasco recommended.

Clevelandguy · April 26

https://csn.cancer.org/discussion/comment/1714911#Comment_1714911

Dido on what Old Salt said, put it out of your mind until the PSA test.

Dave 3+4

centralPA · April 27

Do you have BPH symptoms? Poor stream?

frank1956 · April 27

No. That is the thing. I do not have any urine issues that I am aware of. I kept a log for a month and I see that I pee around 7-8 times a day, a little more frequent than the average: 6-7 times a day. I might get up to pee once most nights.

I do not experience pain, urge, or dripping after. I am 68 so sometimes when I pee in a public place, I can see young people next to me go faster. That is about it.

Biopsy is done. 26 cores extracted. All benign. What is the next step?

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