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Very High PSA

Posts: 2
Joined: Oct 2017

I have a PSA of 250. 2 of 6 Biopsy probes showed presence of cancer. But my Whole Body Bone Scan and Pelvic Pet Scan show no spread.

(a) My Urologist says there is no spread and hence has me scheduled for prostectomy.  But my Oncologist and another Uroloist are convinced that the Very High PSA is because the cancer indeed has spread and have advised hormone therapy followed by radioacive therapy, and no surgery. Who is right?

(b) What causes such a high PSA?

VascodaGama's picture
Posts: 3356
Joined: Nov 2010


I am curious about your diagnosis. I wonder where you have been cared. Sextant biopsies are rare nowadays as most urologists prefer the traditional 12 or 14 cores template. In fact the high PSA demands more detailed analysis.

Can you share more details on the findings.What is the size of the gland?

What is the location of the two positive biopsy cores (out of 6)?

Is there any reference on hyperplasia in the pathologist report?

What are the units of the PSA test? Is it 250 ng/ml?

Can you provide the contents of the radiologist reports on the Bone Scan (BS) and PET. Surely the high PSA is confusing and suspicious. In your shoes I would retest the PSA at a different laboratory.

Welcome to the board.


Old Salt
Posts: 803
Joined: Aug 2014

Based on the very limited info provided (see Vasco's comment), I would agree with the oncologist.

I believe that there is an argument that has been made, that even if the cancer has spread, removal of the source of the cancerous prostate can be beneficial. But I haven't done enough reading to state that this is a protocol that is recommended by the majority of oncologists. Please do your own due diligence!

And provide us with more background info.

Posts: 2
Joined: Oct 2017

Continuation - With a 250 PSA and prostate cancer confirmed with biopsy, and suspicion of spread outside prostate, can a dual treatment be used so that:

(a) radical prostactomy is used first to remove the prostate,

(b) folllowed by hormone therapy (2 years) and radiation therapy (3-4 months after starting HT, for 5.5 weeks).

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3647
Joined: May 2012


Actually, the answer is "yes", either way.  We hear of such plans to do RP occasionally, despite metastasis.

But what is more common is to simply not do the surgery in such a situation, and proceed with radiation and hormonal therapy (HT).   Surgery with metastasis known is ordinarily done only for purposes of debulking or when serious urinary blockage is an issue.   

Your doctors need to lay out the pain and side-effects this brings, verses any benefits they envision.  Again: With spread outside the gland, NOT getting surgery is more common than getting it.  But any plan must be exactly tailored to the man's precise individual situation. The fact that surgery is less common does not mean that for you it might not in fact be best.


hopeful and opt...
Posts: 2327
Joined: Apr 2009

There are several treatment options that may or may not be appropriate, however I am unable to provide intelligent input for your consideration without further input from you.


hopeful and opt...
Posts: 2327
Joined: Apr 2009

Good advice above


 get a copy of the pathology report, a copy of results of each of the image tests that you had, so you can answer the above questions. simply call the doctors office and ask the office manager for copies of all tests....which is yours, since you paid for them.

What did the digital rectal exam (finger wave that the doc did in your rectum) reveal?

What is the Gleason of each of the cores where cancer was found....what is the involvement,  that is the amount of the core that is  positive for cancer

Did you have a 3T MRI?

What is your PSA history?

What is your age?

Also I am surprised that the urologist did only 6 cores. To be honest I am suspicious that he/she wants to do surgery at this time.

At any rate please post more info. 



Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3647
Joined: May 2012

I agree with each comment submitted by the others.

Your urologist made the comment "Since the cancer has not spread..."  Based on what ?   A bone scan and PET of just the pelvic region do not prove that PCa has not spread.    As Vasco and hopeful both noted, 2 core pulls in a biopsy are almost never heard of any more.  What was your Gleason ?  (the one most important numer on any PCa biospy).

A PSA of 250, if accurate, is extremely high. It does not "prove" anything either by itself, buyt very highly suggests a lot of disease.  Me, I would be listening to your oncologist and the second urologist, and part ways with the initial urologist completely.


Posts: 159
Joined: Apr 2017

With a PSA of 250, a prostatectomy may not be the right course of action, and may do more harm than good, as other treatments may then be be necessary to get your cancer under control.


You have been given great advice, above. Please try to answer the questions they asked, and, cancel that prostatectomy. You simply do not have enough input to be confident that is the proper action to take.

SubDenis's picture
Posts: 130
Joined: Jul 2017

Sorry for you news and concern but take a breath.  There is no need to rush but move forward.  You may want to get a second opinion from another Urologist.  The path will become clear but ask questions!  Denis

Posts: 688
Joined: Jun 2015


You need to get good support info from both your urologist & oncologist on why they each have a different diagnosis.  Once you hear both sides you can make the call to which way you want to go.  Base on the limited info in your post I think you need more info on diagnostic tests(MRI, gleason score, location of the cancer inside of the prostate) and scans.


Dave 3+4

Posts: 473
Joined: Mar 2017

Just me, but I would do the what they suggested above, especially getting another PSA test from another lab ASAP like VdG said, a lab unrelated to the local urology clinic, since so many decisions are riding on the PSA score. You have too many important decisions to make not to double check everything.

Posts: 1013
Joined: Mar 2010

OP: The only thing that will tell you for certain if the cancer has spread is to get a spectrographic MRI -- also called an MRSI -- will detect the presence of choline which is a marker for cancer within the prostate and adjoining region. 

An MRSI is administered in conjuction w/a 3-Tesla MRI, which is a very useful procedure in itself but will not  as precisely detect and identify the spread of the cancer as will the MRSI.

Here is a link to one study on the combined procedure: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1578527/

FYI: I had an MRI/MRSI done at UCSF in 2014 after my PSA has increased 3x's following treatment w/CK in 2010.  No cancer was detected indicating that the PSA the increases were just a post-treatment "bounce" that reversed after the next PSA test and has declined ever since.


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