I have a gleasson 6 and a PSA 24 . My doctor is suggesting to have a prostatectomy. He states that a gleasson 6 would not make the PSA 24. The PSA test was repeated twice in the last 6 months . PSA went from a 10 to 24 in a two years. Had a MRI/ultrasound fusion biopsy twice.
He feels that there is a aggressive cancer not being detected with biopsy/MRI and suggest prostatectomy.
What other test that can give a definitive diagnosis before removing the prostrate completely? Was wondering about the PSMA-Pet-Scan?
I found this site while doing research for my husband. This question is regarding my husband.
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Sandrd04
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If the PSA is over 20, that can suggest a bone scan is in order. If it revealed probable mets, then you would know that the Gleason is probably higher than 3+3. I am not trying to be alarmist, but it wouldn't hurt to look for metastases before deciding how to proceed.
I am surprised that the urologist has not mentioned this. That PSA of 20 as a cut-off is somewhat arbitrary, but I was exactly at that mark when diagnosed. I delayed the suggested scans until my PSA progressed, and they indeed suggested mets when they were finally done.
The good thing about removing the prostate is that the resulting pathology report will be quite accurate about what the real Gleason score is. But that won't tell you if the cancer is metastatic to the bone, which PC quite commonly is, even when it is not highly aggressive or highly lethal.
I put off the scans because 1) I had already planned to delay treatment regardless of results, and 2) I really didn't WANT to know if I had mets at that particular time. I had enough bad news and was intent on enjoying my summer. But eventually, ya kinda wanna know, ya know?
Consider also an Axumin Pet Scan which can be more sensitive vs bone scan. A PSMA Scan would likely be the most sensitive but in the US would be out-of-pocket &, since there are few centers offering PSMA, there is likely to be a delay in getting this study vs Bone Scan or Axumin PET.
Just what I found when I had surgery almost 2x years ago.
Does your biopsy pathology show evidence of acute or chronic inflammation? PSMA PET scans are not very sensitive at detecting prostate cancer in and around the prostate, but may find occult metastases.
Thank you for your response. It did show inflammation. So the doctor had him take ibuprofen 2 times a day for 10 days before the last PSA. And the numbers haven't changed. One other interesting note, he was tested on a saturday Oct 31, then on Monday, Nov 2, he was diagnosed with covid. This was the first PSA test that spiked to 24. The next PSA was done in Feb. 2021 which the number was 25.4. We wonder if Covid somehow had an effect. He is being treated by Dr Scott Eggener, of University of Chicago. Have you heard of him?
Would it were that easy! Prostatitis is EXTREMELY hard to get rid of. I suspect that once you have it, you always have it. NSAIDS, corticosteroids, and antibiotics don't touch it. But now that you know that his elevated PSA is certainly because of prostatitis, you can treat him as low risk.
Yes, I'm certainly aware of Scott Eggener. And it doesn't surprise me that he's pushing surgery. I suggest you get some other opinions.
Can you please elaborate why you say that you are not surprise he is pushing surgery?The only reason we picked him was because of the internet reviews and he is close to home. University of Chicago seems to be a place alot of people go to.
I've read they're still used when inflamed tissue cuts off circulation. It's like maggots for debriding wounds, or fecal transplants for C. Difficile - high on the yuck factor.
Generally a fluctuating PSA would indicate prostatitis, whereas a steadily rising PSA would indicate a tumor. I was PSA 23 and GS (3+4), and my biopsy indicated extensive tumor that had spread to the seminal vesical and one lymph node. One test that helped me differentiate whether to get the biopsy was the 4K Score, and it was definitive in pointing to a tumor (mine 4K Score was 77%, which indicated a 77% chance of a GL 7 or higher tumor, and the biopsy bore that out). You should probably get a MO on board to help navigate through this, because you may want to get a PSMA test to look for mets before you start ADT, if indeed that course is taken. PSA > 20 if not prostatitis puts you in a high-risk category. BTW, %-free-PSA is also useful confirming info, if it's less than 10% it suggests further investigation.
I too did a 4K and mine came back 9%, which even at that low level (7.5 being the cutoff) I still wound up with a Gleason 4+3 even though my PSA was only a 6....so confusing!! Had the RP and the patho report was 4+3 thru and thru.
Interesting that the 4K score didn't strongly indicate your outcome. It's really a probability ranking, that uses an algorithm of 4 different factors, one being PSA, so maybe your relatively low PSA threw it off. The other factors are proteins unique to PCa, so maybe yours did not generate those at a high level either.
Sandra, at this point with a PSA of >20, I would want to know if there are mets by getting a PSMA scan, which would more accurately stage the disease, if present. If indeed, he is Stage 3 or higher, the treatment outcomes lean more positively toward radiation, such as SBRT or Brachy therapy and adjuvant ADT, which a MO would prescribe. I saw below you mentioned radiation is out, but wouldn't a MO or RO be more qualified to make that decision than a Uro?
We had a 3T MRI guided biopsy. It is the MOST reliable indicator of PCa and ours was PIRADS 5 which indicated aggressive cancer. You need a second opinion. Removal of prostate carries risks of incontinence and erectile dysfunction. If he is confirmed as a G6 then monitoring his PSA and lifestyle changes might be better indicated. Please research, research, research. There is a lot of info out there! Good outcomes to you both.🌺
Yes he had the 3T MRI guided biopsy, twice. The fact that his PSA is 25.4 (which was repeated 3 months later with the same out come) which has tripled over 2 years, that is concerning to the Dr.
I would still seek a second opinion. It can't hurt! My husband rushed into his prostate cancer decision for surgery and at times I wish he had not. When he needed further treatment you better believe we consulted with several doctors.
PSA levels are an indirect marker of prostate cancer.
Cancers with low Gleason Scores generally produce more PSA than high scoring tumours, thus it is possible to have a very low PSA level but a cancer that has already metastased.
If your husband has prostatitis as well then that throws another complication into the mix insofar as some of the PSA is coming from the prostatitis but the question is how much?
The safe course of action is a prostatectomy or some other course of treatment, so most if not all doctors will advise this, but treatment has downsides.
Yes, he unfortunately isnt a candidate of other course of treatment. Focal ablation therapy, you need a PSA that is lower. Radiation therapy is ruled out because he has Crohn's disease.
PSMA PET CT would be my choice. In Australia there is an ongoing trial just like this (PSMA before RP for high risk patients). My guess is that this will be the norm in the future.
Yes, IU Health has it and it is just a couple hours away from us. However, you have to part of the study. They have not been approved by the FDA like UCLA and UCSF. We would be willing to pay out of pocket.
I am on the other side of the pond, so I could had the scan, by paying out of pocket, any time I wanted to. I decided to participate to a trial, although I have to wait for my turn, mainly because the scans will be read by two readers who will also read and compare with another 80-100 cases. It goes without saying that I will also get the CD for a third (independent) assessment and subsequent treatment planning.
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Just my story, age 56 GP ran first ever PSA, came back 156, within a week I had a DRE, confirmed a prostate was hard and lumpy, another week biopsy. PC is Gleason 7 (3+4) based on 2 pathology reports unfortunately didn't hear about Epstein until a few months later. 1st and 2nd opinion Drs all suspect more cancer than SOC imaging showed but insurance refused Axumin scan. I suspect better insurance would have allowed it. All Drs said it would not change my treatment so no need to pay out of pocket. That was probably not true as far as the radiation, if I had the axumin scan and something else showed up I probably would not have gotten as much radiation as I did. But no benefit looking back. I am doing well and would like to stress whatever happens if your husband is not fit or into exercise now is the time to start. There's no down side and if treatments are in his future it will help with side effects and mental health IMO. If he is active now tell him to keep it up and increase as much as possible.
He and you cannot go back up the one-way street. You are a victim of the fact that diagnostic testing is not very helpful in this setting of prostatitis + elevated PSA. At least, get a second opinion from an oncologist with lots of prostate experience. A surgeon will always want to cut.
His colitis precluding future radiation is a consideration. From my view: he is young. He has prostate cancer. He may not be a candidate for “watchful waiting” as he cannot afford to have it spread to pelvic lymph nodes. A prostatectomy with limited lymph node sampling would give you much more information and make monitoring easier. But the side effects of the surgery are not insignificant (sexual and urinary) primarily. Agree with the 2nd opinions.
I would be proactive on getting treatment before it advances . I was a4+4 Gleason but my Psa high was only 20 . If fully contained an RP is a possible cure . Let it out of the prostate and it’s a more vicious dog to fight . Early action is critical .
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