Unnerved by my recent prostate diagnosis

rjrsmnyc
rjrsmnyc Member Posts: 17 Member
edited July 25 in Prostate Cancer #1

Recently, I had a general physical that included a PSA test. At 81, I thought it was not recommended to include it in the blood test. The results came back with a PSA level of 10.1

I made an appointment with my urologist, who recommended a sonogram, MRI, and CT scan. The results showed two lesions (PI-RADS Assessment Category: 4, and PI-RADS Assessment Category: 3) and no cancer outside the prostate. I understood from previous conversations with the urologist that prostate cancer is likely in many men my age. He recommended doing a follow-up PSA in 6-8 weeks and then discussing whether or not to do a biopsy. Are the others my age with a similar diagnosis and experience? Sure would like to hear your thoughts and experiences.

Comments

  • Rob.Ski
    Rob.Ski Member Posts: 171 Member
    #2

    Those scans are informative but, do not confirm cancer. If PSA is increasing, would think a biopsy is in order. If you do have PCa, you'll want to know if its aggressive or not. If it's not aggressive you could be on AS but, if it is you have treatment options. You don't want PCa to be what gets you in the end. I'm not in your age group, just my opinion.

  • rjrsmnyc
    rjrsmnyc Member Posts: 17 Member
    #3
    https://csn.cancer.org/discussion/comment/1716923#Comment_1716923

    Rob: Thanks for the reply. As this is all new for me, the terminology is new for me. What is AS?

  • Marlon
    Marlon Member Posts: 110 Member
    #4

    AS = Active Surveillance. It means that they would just keep monitoring the PSA levels to see how fast things are growing if at all, without doing any treatment. Prostate cancer normally being such a slow growing cancer, that at your age, you have to consider whether the side effects are worth treatment.

  • Clevelandguy
    Clevelandguy Member Posts: 1,177 Member
    #5

    Hi,

    AS stands for active surveillance which means you watch the progress of the cancer and if it becomes threatening you do something. The biopsy will grade your cancer on it’s aggressiveness with a Gleason score. X+y where X is the most cells seen in the sample and y is the least amount of cells in the sample. Usually rated 3-5 with a 3 being less aggresive and a 5 more aggresive. Mine was a 3+4. A lot of men with a 3+3 do AS with other biopsies in the future to monitor its progress. If they do find cancer I would suggest a PMSA PET scan to make sure the cancer is contained within the Prostate.

    Dave 3+4

  • jc5549
    jc5549 Member Posts: 57 Member
    edited July 25 #6

    Your physician should’ve discussed screening and goals with you prior to ordering the lab.

    It seems reasonable to just continue following your PSA and doing a bone scan if you develop pain or if it increases to greater than 20 to see if there’s any metastatic disease.

    It is almost certain you will have some degree of prostate cancer on biopsy supported by the MRI findings. The question is at 80 years of age do you care and do you really want to be on hormonal ablation therapy? I don’t think anyone would treat you unless there was metastatic disease, therefore the suggested management above seems reasonable.

    The first link I sent below includes the risk of bony metastasis in men with PSA of 10 or less (I consider you in this category) and negative lymph nodes. If there are no significant lymph nodes on your MRI, I would suggest it’s very likely you do not have nodal disease, hence “confined to the prostate,” and about a 2% risk of metastatic disease. The second article attached is recently published from Sweden in men exactly in your age group with a median age of 79 years. Nothing was done for their prostate cancer diagnosis and all men were watched. The majority died of other reasons than prostate cancer, men without symptoms or metastatic disease were spared the side effects or comorbidities of hormonal ablation.

    https://pubmed.ncbi.nlm.nih.gov/23803117/


    I hope this helps,

    jc

    ventimiglia_2024_oi_240497_1716576020.05476.pdf

  • rjrsmnyc
    rjrsmnyc Member Posts: 17 Member
    #7
    https://csn.cancer.org/discussion/comment/1716928#Comment_1716928

    Thank you. I have lot to learn.

  • rjrsmnyc
    rjrsmnyc Member Posts: 17 Member
    #8

    Thank you.

  • Wheel
    Wheel Member Posts: 138 Member
    #9

    A very non invasive test is a urine test called ExoDx. This test identifies biomarkers that are linked to high grade cancer. This helps decide whether to move forward with a biopsy or continue on AS.


  • rjrsmnyc
    rjrsmnyc Member Posts: 17 Member
    #10
    https://csn.cancer.org/discussion/comment/1716935#Comment_1716935

    Thank you, I’ll check it out

  • Old Salt
    Old Salt Member Posts: 1,505 Member
    #11

    Those are all good suggestions.

    In laymen's terms, your situation bears judicious follow-up. Depending on your overall health, you may still live a good number of years 😁

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