New here with some questions
I’m posting with regard to my husband’s situation. His PSA level came in at 5.5. He doesn’t remember if he ever had a test before, so not sure how long it’s been high. Our PCP referred him to a urologist who recommended an MRI. The results showed PI-RADS level four. Doctor said he could wait six months and have PSA levels checked again or do a biopsy. He scheduled the biopsy, but is having second thoughts. Any recommendations? Some background—he’s 66 and in excellent health. Only symptom is urinating often and sometimes urgently. However, he’s been that way for at least 10-15 years. His dad had PC and had it removed. TIA for any comments/suggestions.
Comments
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A PSA of 5.5 ng/mL doesn't seem particularly worrisome for a 66-year old man. What's the size of his prostate (see the MRI)? Or, in simple terms, a bigger prostate will generate more PSA.
What did his DRE show (digital rectal exam)?
There are some additional non-invasive- tests that could be done, including some genetic ones. His Dad's prostate cancer is a concern.
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Thanks for your thoughts. I agree the PSA level isn’t too concerning. The doctor was unable to do a DRE because his prostate is so large. I was thinking of going the genetic test route first, before the biopsy. Not sure if any relatives besides his dad have had it.
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Only a biopsy can tell for sure and grade the cancer if there is any. Not that big of a deal. Fusion targeted would be more preferable and more accurate than a random transrectal biopsy. At 66 he needs to know what he's dealing with. Just my opinion, but I would not wait another 6 months. I was diagnosed at 66 with 4.3 PSA and after biopsy found 4+3 GG3 cancer. My PSA had been slowly increasing over the last few years. I wish I had a biopsy earlier. Finding it sooner may increase his treatment options.
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Please convince him to get a biopsy as soon as possible, for his own good and for your good. 12 years ago, my PSA rose to 5.2 before my PCP advised me to see a Urologist and get a biopsy. My biopsy revealed that I had prostate cancer (PCa) throughout my prostate and it had escaped the prostate. I've been through surgery, radiation twice, and hormone therapy twice, and I now have locally metastasized PCa, which is fortunately in remission at this time.
If he knows what his PCa situation is (or is not) through a biopsy, and if it turns out to be PCa, there are many options available for treatment and a resulting long life for him and you to enjoy together. An ostrich with its head in the sand is not the way to go with PCa.
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Hi,
I would agree with josephg, he should go the next step and get a biopsy to determine if he has cancer and how aggressive it is. My Internal medicine doctor told me he had men with a PSA of 2-3 range that had Prostate cancer. After he finds out his gleason score(if any) he can decide what his next steps will be. Hope its nothing more than his large Prostate producing too much PSA but the level four pi-rads is concerning.
Dave 3+4
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That was me, PSA 5.5, PIRADS 4 lesion on MRI, big prostate, issues with urinating (BPH) for a long time.
How big is his prostate? The info will be on the MRI report, which you should have a copy of. It would be on your patient portal.
I had a biopsy, which showed I had low-grade prostate cancer. I ended up treating the BPH with a HoLEP procedure and I am on active surveillance now.
Your husband should get the biopsy for sure.
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FYI, image guided fusion biopsies are much more accurate than the random ones which can miss cancer. Under imaged guidance they can accurately probe the suspicious areas indicated by the MRI. Also the transperineal biopsies are safer when it comes to infections and I personally would insist on having this type. I once had a transrectal biopsy and although it wasn't that bad, I had some significant intestinal issues for many days due to the antibiotics given. No antibiotics are needed for transperineal biopsies. I did a three mile hike the day after my last transperineal biopsy. Anyhow, just my opinion and some here may disagree, but being safer and more accurate sampling of prostate tissue it's a no brainer for me. I think most all of the image guided biopsies are done now under general anesthesia which makes the experience a lot more tolerable.
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If he is reluctant what could help his decision is a quick ExoDx urine marker test. The test measures prostate genomic bio markers. This test is to assist in decision whether to get a biopsy. There is a numeric number threshold that gets reported that if it is over that number it is a stronger likelihood of a higher grade cancer and a biopsy is warranted or if under the number more likely low risk cancer. This test is often used in monitoring during active surveillance but the test is so easy and non invasive. Its just a urine sample taken. Please check with your Doctor. This could tip the scale and he is full on board with the biopsy.
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