Scheduled for an MRI. PSA 5.4 and 4K at 18%.

[ddurvibe]

I’m 57. Most recent PSA in Feb was in the low 4s. Have had an elevated PSA in the 3-4 range for 15 years. Dad had PC at 65.

Guess I’m naively wondering if this could still be nothing but BPH, or is it a clear sign of progression toward PC.

[Magnus1964]

I would not ignore it. You have a family history of Pca. If caught early you may have a good chance at a permanent remission.

[Tall_Allen]

Of course it may be BPH, and the stability of your PSA suggests just that. However, the cutoff usually used for the 4KScore is 7.5% and you are well above that. It's not a "clear sign," only a biopsy can tell you that.

[fluffyfur]

You need to get a biopsy.

[CHPA]

I don't think you really can tell at this point. Of course having a family history puts you at higher risk but absent a DRI, perhaps an MRI, perhaps a biopsy, who knows right. How did your dad do? Of course treatment options and prognosis have improved over the time since he had his. Still I'm sure this partially frames your expectations.

[timotur]

Your 4K Score says you have 18% chance of a Gleason 7 or higher tumor. I remember the cutoff for having a biopsy was 15%. Looking at it the other way, you have a 82% chance, you have a Gleason 6 (3 + 3) or less. My 4K score was 73% and later biopsy revealed GL 7 (3 + 4), stage t3b +SV +LN (see profile).

[j-o-h-n]

Get a biopsy and put your mind at ease..... Make sure you INSIST Doctor knocks you out (of course during the biopsy).... BTW have you had a DRE (digital rectal exam)? Also tell us more about yourself. Location? Treatment Location? Doctor"s name(s)? All info is voluntary but it helps us help you and helps us too. Thank you.... (good vibes)

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/06/20202 6:11 PM DST

[ddurvibe in reply to j-o-h-n]

Thank you for all your thoughts and advice. I’m now scheduled for a trans-perineal fusion biopsy, after an MRI revealed a 1 cm lesion on the left side near the apex. It was assessed PI-RADS 4.

I’m in Westchester County, NY and my uro for the past 8 years is Dr. John Philips at the Urology Center of Westchester. He will assist Dr. Christopher Dixon in the biopsy at Good Samaritan hospital in Suffern. Dixon has expertise in the Koelis machine used for the fusion biopsy.

This is all doing a number on me. My dad, at 83, just passed from a 2 year fight w/ bladder cancer in April, after being a 20 year survivor of PC. The brachytherapy seeds which stopped his PC had over the years scarred and deformed parts of his urethra and bladder giving rise to malignancies in his eurothelial cells. None of this was discovered until his urethra blocked up and he needed TURPS. As a result, I’m highly disincentivized to go this route in my own situation, as much as I’d like to keep my prostate.

The other thing that’s hitting hard is I’m a young(ish), fit guy even at 57, and I’ve just started a great relationship with an amazing 55 yo woman which has long term potential. It’s particularly poignant in that we both have a very healthy sex drive and I love getting erect and pleasing her, so the looming prospect of treatment-related ED is quite depressing.

She herself has been through a double mastectomy with complete recovery and reconstruction, and she says she’s willing to see me through whatever’s ahead. So perhaps the onus is on me and my attitude to be open to what is possible rather than what isn’t. I hope to take inspiration from guys here to come back as best I can.

Researching the best path forward to maximize life-span and life quality will soon be in the cards, but for now the biopsy results will be the next step in my particular journey. Thanks for listening and warm wishes for recovery and health to all.

Jim

[j-o-h-n]

57 is young and I can see trying to avoid ed, especially with an amazing 55 year old woman which has long term potential. Since your located in Westchester and if things dont work out with your current medical team.... you might consider MSKcc. We all had to make the decision of extending life or quality. You're damned if you do and damned if you don't. BTW we have an unwritten rule that "you never look back, coulda, shoulda and woulda does not work. I wish to offer my condolences on the passing of your Father this past April. Just a comment.... I would guess that brachytherapy has improved from 20 years ago.

So enjoy your lady and remember this hint...... stay on the bottom... less work...

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 06/16/2020 2:27 PM DST

[Surf7]

I know firsthand how this is affecting you: I was/am in similar age and with active sexual relationship and at first wasn't sure where to turn. I was diagnosed 2.5 yrs ago at 55, PSA=6, Gleason 3+4=7. It sounds like you are taking the right course with the biopsy. Also radically shifting your diet could lower your stress while you get this figured out. For me, a no-carb, no-sugar, hi-vegetable diet lowered my PSA by 25% within 6 weeks, and both my urologist and I felt this bought me some time. I just had my second biopsy yesterday so am waiting on updated results.

Sounds like you are taking charge of your own health, which is important. Good luck and stay calm.

[ddurvibe]

OP here. Wanted to update with biopsy results. Don't have the pathology report in hand yet, but my urologist called to discuss them. They took 26 biopsy samples, including 5 in the targeted lesion area. Three samples from targeted area came back positive, as well as 6 samples (out of 21) from the random sampling outside the target area. So there are "several" small foci of prostate cancer maybe 1mm in size, in addition to the 1 cm lesion. He also noted the foci being in "cells not nerve", but need to see report to further elaborate. Overall, he said my cancer was low-to-intermediate risk, with a Gleason score of 3+4, or Gleason Grade 2.

I pressed him on how urgent it was to start treatment and he conveyed that its not immediately urgent. Have to do a bone scan and CAT scan in the next couple weeks before seeing him again, and then determine the best treatment path, and hopefully the best practitioners with whom to trust my situation.

Kinda bummed it's still the radical prostatectomy era of treatment in 2020. Also very dubious of radiation because of my dad's trajectory from brachytherapy in his 60s to bladder cancer in his 80s. The majority of folks here are inspiring examples of persevering through these treatments, however, and the main goal is always to have this damn cancer not steal those years of happiness in the fullness of life with our loved ones. Jim