newly diagnosed prostate cancer

Zoli · February 5

I am 71 yo male in fairly good physical shape. Had an MRI done after an elevated PSA of 11.3 on early January 2025. The diagnosis as per UCLA was a Locally Advanced Prostate Cancer. I am scheduled for a biopsy on February 11th. I have visited with several different urologists to learn about my options. I am also looking into Proton Therapy at Loma Linda. One issues that is concerning to me is that my PSA in climbing rapidly - the last one yesterday was 14.3. I am hoping to receive some advice and words of hope and encouragement. Thank you

centralPA · February 5

Hi @Zoli, sorry you find yourself here.

Couple of questions. On your MRI they should be giving you a PIRADS score. Do you know what it is? Also, the MRI should tell you how big your prostate is, which factors into things. What is its size?

On your PSA, those things can bounce around significantly. When was your first PSA at 11.3 done?

One thing you’ll learn in dealing with PCa (if you have it…an MRI can only suggest you do) is that it involves a lot of w a I t I n g. Sucks that it is that way, but you just have to train yourself to not dwell on it 24/7 in between appointments. Your biopsy is just around the corner, and then you’ll have ground truth data.

Sending positive thoughts!

Clevelandguy · February 6

Hi,

The MRI cannot determine if you have cancer, only the biopsy will determine and grade your cancer via a Gleason score from mild to aggressive. If the MRI saw suspicious areas your Urologist will use that data on where to take the biopsy samples. Another tool you can use to determine the spread of your cancer outside the Prostate is a PMSA PET scan and a bone scan, you doctor(s) might order those to get a good picture of where the cancer is located, hopefully it will be contained in the Prostate. Proton therapy is a very good treatment due to the nature of the fixed length beam which does not go completely through your body and potentially damage other tissue and organs. If you have a very large Prostate there is a chance your high PSA number might be due to Benign Prostate Hyperplasia which is usually not cancerous. Hopefully your diagnosis will be more defined in the next few weeks.

Dave 3+4

Zoli · February 6

https://csn.cancer.org/discussion/328967/newly-diagnosed-prostate-cancer

https://csn.cancer.org/discussion/comment/1720793#Comment_1720793

https://csn.cancer.org/discussion/comment/1720791#Comment_1720791

Hi, thank you for your feedbacks. it is very helpful. My PSA was 11.5 on 12/3/24 and was raises to 14.3 on 2/2/25. The size of my prostate is 5.8 x 5.1 x 5.9 cm and Overall PIRADS Category is 5/5.

Steve1961 · February 6

i had salvage surgery done ar ucla dr robert reiter he did a fantastic job saved my life. The man is very knowledgeable one of the best in California. I suggest either way that you make an appointment with him. He’ll tell you your options and he’ll tell you what he thinks is best for you look this man up on YouTube he has many many many videos.

centralPA · February 6

https://csn.cancer.org/discussion/comment/1720795#Comment_1720795

That’s a sizable prostate. Mine is/was too. The PIRADS 5 lesion is certainly suggestive of cancer.

Do you have any urinary problems? Slow flow or bouts of retention? That can influence your decision regarding radiation, which kind to consider.

Zoli · February 6

https://csn.cancer.org/discussion/comment/1720800#Comment_1720800

Thank you for your feedback. I have no noticeable urinary issues: flow and frequency is same as always. do you suggest to do just radiation or surgery plus radiation?

Zoli · February 6

https://csn.cancer.org/discussion/comment/1720797#Comment_1720797

Thank you for your feedback. I have not been assigned a surgeon yet. I will definitely ask for him. What is a salvage surgery ? did you get radiation or hormones therapy as well?

Rob.Ski · February 6

This site is a good place to read up and get informed, keep in mind, mostly patients here vs. Docs. You are a bit premature to get treatment suggestions without biopsy results. You may not have cancer. As the others have said, biopsy is the info you are after. Also, biopsy can confirm you do have cancer, it doesn't confirm you don't. If biopsy is neg and PSA keeps rising, they can do it again.

Wheel · February 7

Zoli,

It’s too soon to know for you to decide the best route that you want to go if you are diagnosed with cancer. Although your MRI might have found a suspicious PIRADS lesion that could be clinically significant for disease, my PIRADS 4 was benign. I am speculating that they found a lesion since you are describing they found locally advanced prostate cancer, but it surprises me they say that with just the MRI. I don’t know if they gave you a ExoDx urine test that could have indicated that your cancer is more likely to be advanced. It certainly does not hurt to begin your research into the possible treatments but that they depend on your individual circumstances. Until the biopsy you do not know the Gleason grade of your cancer and how advanced it could be. Almost all Gleason 6 are active surveillance and many favorable Gleason 7 (3+4) can possibly be. Gleason 8, 9 and 10’s are advanced and if you have surgery in those cases they would probably want to do Adjuvant Radiation Treatment (ART). Surgery and Radiation also depends if it has breeched the capsule and is Gleason 8 +, or lymph node involvement. Even with just a Gleason 8 or Unfavorable 7 (4+3) with a breeched capsule if the margins are clear after surgery you may not need Radiation. If you decide on Surgery their are types of surgery, Multi port or Single Port Robotic surgery, Nerve Sparing, Rezius Sparing, Puboprostatic ligament sparing. Radiation also has options. There is a lot to take in. Fortunately you are at a outstanding cancer center hospital with UCLA. After the biopsy and grading of your cancer, they should then order a PSMA Pet, and Decipher testing of your tissue. I did hear of that Doctor that Steve mentioned. Good luck on your biopsy that is really a walk in the park for most.

Wheel · February 7

Zoli,

I had this in draft and just saw you mentioned they found a PIRADS 5 lesion. That is more likely clinically significant than a 4, but again until the results of the biopsy it is difficult to chart a course yet.

neilm · February 9

Zoli,

I think UCLA is a world class operation. If you are looking at Loma Linda be sure to ask about Spaceoar. I believe it is critical with Proton and my last information was they were not using rectal spacers. Your RO I bet will have an opinion on that. UCLA is at the frontline on MRI guided SBRT as well.

Let’s hope your Gleason score is 0 then you won’t have to think about it!

newly diagnosed prostate cancer

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