I had focal laser ablation in 2017. Since then, my MRIs have shown nothing suspicious, but my PSA has bounced around causing some angst. Somewhere between 1/4 and 1/3 of my prostate was ablated in the FLA procedure.
My latest MRI from 10/21 measures my prostate at 48cc. My latest PSA is 3.8. So, assuming that all 48cc is functional, my PSA density would be .08. Worst case, if 1/3 of my prostate is scar tissue that does not produce PSA, then the density would be .12 (3.8/32)
My PSA history (Post FLA) has been:
12/15/17 - 3.9
2/9/18 - 5.1
12/20/18 - 3.2
3/18/19 - 2.5
9/20/19 - 2.4
05/18/21 - 3.2
08/2021 - 2.6
10/25/21 - 4.5
01/25/22 - 2.7
05/09/22 - 3.8
I have an appointment with the Urologist next week to go over the PSA results. I assume the options at this point are 1. continue on AS, 2. do biopsy, 3. do another MRI, 4. do a PET scan.
The increase in PSA bothers me. I want to be proactive, but don't want to do unnecessary tests. Any suggestions?
Written by
davenj
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I would not worry over those PSA numbers. You have to look at the big picture. Your PSA is going nowhere. Look for three progressions in row, then see your doctor.
i would say your PSA looks okay, especially as FLA do not reduce PSA to negligible numbers.
that said, i relate my experience as anecdotal info: i had a FLA in 10/2016 and my PSA fluctuated around 2 for several years, then started to climb. repeat MRIs were always equivocal and did not show any lesions. i was told i probably had BPH. PSA, however, continued to rise: 4, 5, 6, 7, 10. CT scan and Nuclear Medicine scan negative.
in AUG 2021, however, a repeat Biopsy (i hate those) showed a disease recurrence. much of the recurrence was IN the ablated tissue. not sure if the ablation obfuscated the MRI.
after alot of research, i realized i needed a full gland treatment and went with SBRT, which i just completed at NYU this past month.
our differences being, my PSA really spiked. continue to monitor, but at some juncture, if things mildly progress, you might consider a repeat biopsy. FLA are a nice low invasive alternative to kick the can down the road, but for a microscopic disease they are often not a cure.... best of luck!
I was diagnosed with 3+4, 2 out of 10 samples had about 5% 4. The biopsy was done with real-time MRI. My pre-FLA PSA was 6.6, so never very high. Also, the genomic test on the tissue rated it low risk.
my pre FLA gleason was mostly 6, with some G7 (3+4). 5/12 in total. genomics low risk. PSA hit 7.2 at zenith. dropped to 2 after FLA and remained there for a few years.
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