PSA

I had a PSA reading of 5.5 about 6 months ago so my doctor sent to a urologist and he suggested I have an MRI, the MRI did not reveal any cancer but he said it's about 90% accurate,also had the finger test, just recently I PSA reading of 7.3 a big jump from 6 months ago, doctor said I should get another PSA test in 6 weeks and if it the reading is high to have a biopsy, he also said it could be a urinary tract infections, or prostatitis, anyone have the same problem.

[FCoffey]

You didn't mention the type of MRI but those can be very good, and can detect cancer in places that are often missed by DRE or biopsies. You can ask to see a copy of the radiologist's report, and/or get a second opinion. I always, always get a second opinion on important tests like MRI results.

The MRI is called a multiparametric magnetic resonance imaging (mpMRI) of the prostate. If the mpMRI shows suspicious areas with a PI-RADS score (prostate imaging reporting and data system) of 4 or 5 then a biopsy might be justified. If the report doesn't mention Pi-RADS then you probably did not get an mpMRI.

A clean MRI is a good thing. PSA can go up for many reasons, only one of which is cancer. If the MRI and DRE are negative, best to eliminate the other possible causes before accepting the risks of a biopsy.

Good luck!

[Hidden in reply to FCoffey]

I did have a mpMRI, what I forgot to mention is that my doctor said I have a Gleeson level 3

[407ca in reply to Hidden]

Spyridon50,

You say your doctor tood you that you have Gleason level 3 without mentioning having had a biopsy? Is that correct?

[Hidden in reply to 407ca]

Yes, he told me that after the results from the MRI

[FCoffey in reply to Hidden]

Perhaps your doctor was talking about the PI-RADS score rather than Gleason grade. PI-RADS scores range from 1 to 5. While it is possible to infer Gleason grades from MRI, most radiologists won't do it, and few doctors read their own scans.

A PI-RADS score of 3 means "intermediate (the presence of clinically significant cancer is equivocal)". So its 50/50 that you have cancer.

The purpose of any test is to change what you will do. A biopsy may confirm cancer, and you would have to decide what to do about a positive result. Waiting for a while, monitoring PSA, maybe another MRI could accomplish the same thing. Things will either get better, not change, or get worse. No test, including biopsy, is 100% accurate, but watching trends can tell you a lot.

You might start thinking about what you would do if you did have cancer. There are many choices, although doctors won't tell you about most of them. But you can clean up your diet, exercise, and most importantly start living every day like it might be your last. You can do all of those things without a biopsy. It's good advice for all of us, but trying to live with cancer focuses the mind wonderfully.

Good luck to you.

[Currumpaw in reply to Hidden]

It has been years since the Gleason grading system has used any number lower than 6. Dr. Klotz, a Toronto urologist of some fame, respected world wide was instrumental in dropping numbers 2 through 5 simply because Gleason 2 through 6 all acted the same. A man would have very little chance of having prostate cancer in his lifetime with a stable Gleason grade 6.

Your urologist gave you a 3? If he is still using the old grading system and you have a 3 according to that it should be reassuring to you. It is unusual to find a uro who still uses the old Gleason grading system.

I have unfortunately been biopsied too often. Each biopsy after the infamous 12 core TRUS was more or less a shot gun approach. Artemis biopsies using a 1.5 MRI taken before and then fused to an ultrasound screen. The urologist that performed these biopsies told me to my face that he couldn't tell the difference between a scar or lesion before the second Artemis biopsy. He was using a 1.5MRI, not the mp 3.0T MRI! I had scars. Previously 12 and 27 core biopsies and an ablation. I was biopsied 32X. Pathology results were all benign. The following year I was sent for a mp 3.0T. The report from that biopsy found no cancer anywhere, prostate, bladder, colon, rectum, lymph everything within the area encompassed by the MRI was clear, cancer free whereas the year before there were 32 "suspicious" areas that needed to be biopsied. Could the 32 "suspicious" areas have been scars from the previous 12 and 27 core biopsies? Did the 27 core biopsy re-biopsy any of the12 scars from the first, 12 core TRUS? Were some previous biopsy sites being biopsied during the 32 core being biopsied for the third time simply because of scarring? The year after the very reassuring report following the mp 3.0T MRI my uro insisted that I have a biopsy against my protestations. I finally relented after a 5 to 10 minute consultation and submitted to the biopsy. It was a 20 core biopsy. One core was HG PIN.

If you have a biopsy I would strongly suggest having it done real time, in bore, with a 3.0 MRI, biopsied only as necessary, no exploration to cover all bases. These biopsies are roughly twice as accurate as what I had and also distinguish tissue differences much better. Once you sign the consent form and lay down on the table, the number of biopsies taken may well be out of your control. 32 cores, all benign! The following year a mp 3.0T MRI showed no cancer anywhere. Biopsies can create complications as can the drugs used to prevent sepsis, the fluoroquinolones. If you are biopsied insist that Rocephin or Cefdinir be used rather than the dangerous fluoroquinolones such as Cipro or Levaquin. What those drugs did to me is another story but perhaps I was one of the lucky ones. I lost both shoulders and a ligament in my back. Injuries long ago healed in the 1980's. These drugs have an affinity for and damage old injuries. I was diagnosed by a chiropractor that has a lot of experience in that. The fluoroquinolones should have never been used on me again.

Currumpaw

[Tall_Allen]

You might want to try another blood test called Prostate Health Index (PHI) before you decide to get a biopsy.

[Hidden]

I've had two 3T mpMRI's one that showed a PiRad 2 and 3 lesion and another with no lesions. These were done 18 months apart. The technique was the same in both cases so I don't think that the statement, "If the report doesn't mention Pi-RADS then you probably did not get an mpMRI" is accurate.

[Knallkopf]

In my opinion if the doc believes it could be prostatitis you should take antibiotics first and see if PSA goes down to normal. Usually the MRI shows cancerous areas, if it's made right. To improve the accuracy of the MRI, they should use an endorectal coil, placed inside your rectum for the scan. Only when the MRI shows suspect areas I would take a biopsy. The best I think is a transperineal biopsy and the next best a

"in-bore biopsy", guided by MRI. I had the in-bore b. and it didn't really hurt.

grandroundsinurology.com/tr...

[Hidden]

I found out a month ago my PSA jumped from 2.1 to 5.5 in the last two years. It had been going up very slowly so I was only getting it checked every other year. I do suffer from chronic prostatitis/CPPS and had ran over 3 miles the day before the PSA test. I'm headed to see a urologist on Monday and hopefully get another PSA test and get scheduled for a T3, Tesla MRI if my PSA is still elevated. I've been doing a lot of research on PSA, MRI's and biopsies and it sounds like if you had a T3 MRI then it's highly likely you have something other than prostate cancer going on. At least with the MRI results and the negative DRE it's nothing advanced. With a T3 MRI I don't believe they have to use the endorectal coil. Good luck with all this,,,believe me I know it gets your attention.

[Disko72]

Yes here's my post. Same thing but I dont have a Gleeson score as nothing showed up in the MRI. Currently on antibiotics with another PSA test in July.

healthunlocked.com/prostate...

[wuwei37405]

I feel that biopsies are not worth the risk. The information that you get from a biopsy is of questionable value. An MRI should yield more useable information. One man's opinion.

[FCoffey in reply to wuwei37405]

I concur. As far as I can tell, the risk of negative outcomes far outweighs the benefits. I can get all the info I need in other ways.

One thing a biopsy does is strip away all denial. People don't like the idea of having cancer. I know men, including me, who spent years watching PSA slowly rise and still not accepting that it was cancer. MRIs at the time weren't as good and didn't spot anything.

But once you get that pathologist's report, and they've looked at your tissues through a microscope and see cancer, there's no more denying it. That's the one good thing I know of that you can get from a biopsy and nowhere else, at least not today.

[AllFixed]

when my PSA hit 8.3 I had the mpMRI, it revealed that I had 1 - 7,3+4 and 1- 6,3+3, biopsy recommended and performed. the Biopsy revealed that in fact I had 2 - 7, 3+4's and 2 - 6,3+3's for a total of 4 lesions or tumors. so the mpMRI doesn't tell all

[Filotimo62]

Make sure they investigate further - be pushy!!!! My partner was in your position 18 months ago. He had rising PSA and Urinary track infections (2). They gave him antibiotics and his PSA went down a bit. So problem solves.... NO IT WASN'T.

PSA went up again and they did an MRI and biopsy and found that he has Gleeson 8 - Grade 4+4 cancer with metastatic into lymph nodes. OOPS.... I was very angry at the doctors but what could we do. He has had radical surgery and is about to start radio, ADT and later chemo.

Our neighbour is in the same position - PSA 4.5... his wife is a GP. They wanted to wait another 6 months and have another PSA but given what had happened to my partner his wife was pushy and he had MRI and biopsy and has Gleeson 7 cancer.

BE PUSHY. You have to be your own health advocate! Good Luck.

[wmcrgood]

I an not a doctor....but my guess is that PSA level will be higher. The biopsy will show cancer. Then you will have to decide what to do.

[Jeff85705]

A biopsy is the most accurate way to detect cancer cells and to give you a fairly accurate Gleason score. Biopsies are relatively painless these days with local anesthetics. It is invasive, but that is how my cancer was detected. I never went through an MRI--right to biopsy after gradual increase of PSA to around 10.

[cathyfongus61]

PSA usually is closely connceted with prostatitis, and antibiotics produce drug resistance and you've got to change the medicine from time to time, and it seems you can't get a complete cure by it, that's how the psa remaining high. However there're natural therapies available to avoid the drug resistance, for instance herbal treatment of diuretic and anti-inflammatory pill, and there could probably others.

[Disko72]

I think I am in a similar situation. PSA 2.4, 4, 6 over 3 years. I had a an MRI in April. Multiparametic on prostate gland 3.0T using body coil, with hi-res T2 images diffused weighted imaging, and dynamic postcontrast performed. Image quality good. Central gland unremarkable, however Peripheral Zone indicated Diffuse intermediate T2 signal in the peripheral zone without restricted diffusion (?).

Interpretation was that this might be related to previous prostatitis. They noted that there is no restricted diffusion which was reassuring but that the extensive changes decreased diagnostic quality somewhat. Suggested repeated MRI in 1 year. PIRADS 2 Low.

Doctor never discussion what the T2 signal in peripheral could be, and whether I should be more concerned about this.

Finished 1 month of antibiotics last week, new blood test in July. Fingers crossed PSA stabilizes or goes down.

[tallguy2]

Time for a biopsy.

Best wishes!