Rising PSA

[lokibear0803]

A good friend has seen a slowly rising PSA over the last 4-5 years — here’s the most recent history:

May 2018 4.68

Dec 2018 6.04

Jan 2020 7.07

Aug 2020 7.20

Feb 2021 7.75

Oct 2021 7.85

Jul 2022 9.17

Since he’d been at a “normal” PSA 4 previously, it appears this has been rising since at least early 2018, probably up to about 10 by now. His urologist is recommending a biopsy.

It’s been a long time for me since being at a similar point, so I’m not familiar with today’s standard approach — but this seems to be a lethargic response from the urologist. If I understood him correctly, the DREs have shown nothing. So, this could explain the lack of action, and might suggest it’s not PCa…I’m hoping.

Regardless, I wanted to reach out to this group in the meantime. As I mentioned, he’s scheduled for a biopsy in the coming week. Based on advice in this and other forums, I’ve recommended he request a transperineal vs a TRUS, and request anesthesia if he feels he’d want that. I also wonder about first checking for BPH, prostatitis, etc before a biopsy, e.g. getting an mpMRI to help distinguish between prostatitis and PCa.

So, my specific questions:

What are your thoughts on the responsiveness of the urologist? Has this been a timely response, or has there been unnecessary delay?

Is an mpMRI a good idea? Are there any other scans he should get?

Is a biopsy now the right thing to do? Or, alternately, do some scans first, perhaps try a course of Cipro in case it’s bacterial prostatitis, … etc?

How else can he test for something other than PCa before proceeding with biopsy?

What other steps would you suggest?

Finally I’ll be advising him to move on to an oncologist if he in fact has PCa, and perhaps to change to a different urologist in either event — depending on feedback from this group.

Your thoughts are very kindly appreciated — many thanks in advance.

[Tall_Allen]

I wouldn't delay the biopsy to get an mpMRI. Take it one step at a time.

No need for an oncologist - save that type of doctor for incurable PCa.

[lokibear0803 in reply to Tall_Allen]

Thank you, TA. May I ask your thoughts on the timeliness of the urologist’s response?

[Tall_Allen in reply to lokibear0803]

I think your friend should focus on the present moment, rather than the past.

[lokibear0803 in reply to Tall_Allen]

I frankly agree — what’s done is done. My question is solely with eye to present and future — should my friend retain this urologist, or consider other options?

[Tall_Allen in reply to lokibear0803]

One step at a time. If he has PCa, depending on biopsy results, he may wish to enlist a doctors with significant experience, either a urosurgeon, a radiation oncologist, or a the leader of an active surveillance program (always a urologist).

[Tall_Allen in reply to Tall_Allen]

If it comes back as high risk, he should have a bone scan/CT and a PSMA PET/CT.

[lokibear0803 in reply to Tall_Allen]

Many thanks, TA.

[Teacherdude72 in reply to Tall_Allen]

Cannot change the past. Can only engage the future.My comment on the biopsy; Trus reaction is different for each of us. Some feel pain, I didn't, some have blood in urine, I didn't.

Do not delay on biopsy and a lidocaine shot is recommended.

[Seasid]

I would do the PSMA PET/CT scan as soon as possible.

Why would you have nightmares about the situation when it is not necessary and you could know the answer in one week time?

[lokibear0803 in reply to Seasid]

Thank you Seasid. However, his insurance may not cover it at this point. He has Kaiser HMO; not sure what their policies are.

[Seasid in reply to lokibear0803]

The problem with the biopsy is that it can miss the cancer. Ok, you can try to organize the biopsy first if you can do it quickly enough.

Here where I am it is easier to organize a ga68 PSMA PET CT scan than the biopsy.

The biopsy could cause infection.

The best would be to organize bought and find out what is going on.

[Seasid in reply to Seasid]

Can SUVmax values of Ga-68-PSMA PET/CT scan predict the clinically significant prostate cancer?

ncbi.nlm.nih.gov/pmc/articl...

[lokibear0803 in reply to Seasid]

That’s easy to agree with, but perhaps easier said than done. I’m afraid my friend is at the mercy of his HMO.

[Seasid in reply to lokibear0803]

In Australia you could even pay for the scans it would cost him 700 A$ as an Australian resident with the Medicare card.

In UK you could also have a scans privately through Genesis Care.

Maybe he could join a clinical trial for scans comparison. I assume they have that and he is eligible.

Do the biopsy if you cant don't expect miracle from the biopsy. MRI guided biopsy would be the best.

The PSMA PET CT scan was ordered by the RO in order to see if we could SBRT something.

I first thought that I would SBRT my visible mets.

I have a bone met in my neck. That was a main reason that I approched the RO. My PSA was rising from 0.2 to 1.2 with a doubling time of 2 to 3 months.

I wanted to see which mets are turning CRPC. I had 15 mets and I was concerned about the mets in my spine and neck.

At PSA 1.25 a PSMA PET CT scan was performed and I only had PSMA positive cancer in my prostate with the SUV max value of 14.

95% of my prostate was effected with cancer but no mets were visible. Therefore we decided to irradiate my prostate.

Your friend needs a good doctor.

My doctors tried to cure me from infection with antibiotics at PSA 20 and 50.

They were very surprised when the bone scan and the CT scan was full of mets.

You should always consider the worst case scenario and that is prostate cancer and not to try to eliminate infection, inflammation, enlarged prostate etc. And lose your valuable time.

Lot of people have even metastatic prostate cancer with PSA 4.

I would do whatever is necessary to get a biopsy and the PSMA PET CT scan as soon as possible. I would not delay it.

I delayed everything for 5 months and my cancer metastasized. After that the RO called me not very intelligent and I totally agree with him. We all don't want to believe that we can have a cancer.

[cancerfox]

Two years ago, my urologist told me that my prostate felt completely normal. Two weeks later, with a PSA reading of 7.5, I had a biopsy done and the first thing they said was there was a fairly large tumor on my prostate, which they showed me on the ultrasound (they called it a nodule). Gleason 9 for 6 of 13 samples. So much for digital exams! 🦊

Peter in Family Guy

[Seasid in reply to cancerfox]

I agree with you about a value of the digital exam.

[lokibear0803 in reply to cancerfox]

wow, I didn’t realize DREs were at least somewhat (a lot?) unreliable. Thanks for your anecdote.

[lokibear0803]

Thanks you fastonskis…pcri.org is a good idea.