In 2020 at age 66 years I was diagnosed with prostate cancer. DRE was negative. TRUS Prostate biopsy positive: Gleason score 7 (3+4) left lateral base, Gleason score 6 (3+3) left lateral apex. Treatment plan: Active Surveillance.
In February 2024, Rise in PSA 12.8, compared to 5.8 six months earlier. DRE negative. MRI was ordered, date of exam 2/20/2024:
1.) 0.7 cm lesion within the left anterior peripheral zone of the prostate apex similar to 2020. PI-RADS v2.1 Category 4.
2.) 0.7 cm lesion within the posteromedial peripheral zone of the left base, not well appreciated on 2020. PI-RADS v2.1 Category 4.
No evidence of adenopathy, capsule, or seminal vesicle invasion.
Urologist recommend fusion biopsy.
Written by
BobDad
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Thank you for the reply. He recommends fusion biopsy, which I had expected he would. But, I have kept my PSA at 5.0 +/- for four years now, which has been acceptable for my urologist, and I had hoped to continue to do so. The recent PSA spike to 12.8 in January was a surprise but it corresponds with my recent testosterone replacement therapy that my PCP prescribed late last summer (daily androgel). Once we saw the 12.8 PSA, I immediately stopped the TRT, and PSA dropped to 6.4 in March.
I am surprised they gave you testosterone therapy (androgel) knowing you had prostate cancer.
I got my endocrinologist to subscribe me androgel when my psa was 3.6 woth no cancer diagnosis. They wanted to keep a sharp eye on my psa so they scheduled a test in 30 days at which time my PSA jumped to 5.6. We immediately stopped androgel and scheduled biopsy.
Thank you! I enjoyed your informative contributions here! I'm dragging my feet on scheduling the biopsy because 1. I prefer transperineal vs transrectal for fear of infection and cancer spread, but admittedly I am just coming up the learning curve on validity of this concern, and on my options are. Another reason for hesitation is that my PSA recently dropped from 12.8 in February 2024, to 6.4 two weeks ago, in March. It seems that the PSA spike from October '23 (5.8) to Feb '23 (12.8), was the sole reason for the recent MRI, and it has quickly reversed once I stopped androgel TRT that had been prescribed last summer 2023. I suspect the PSA spike was TRT-related and not cancer related. Urologist at Dana Farber hasn't yet commented on the PSA drop.
Cancer feeds on T. What makes you think the PSA rise was not cancer-related?
I'm a big fan on transperineal biopsies, but you need someone with experience. Otherwise, you are probably better off with a transrectal and some good antibiotics.
MRI fusion biopsy is a good idea. Hold out for transperieal without relenting!
Discuss a more robust version of AS. The PSA density is another piece of information you can use. The previous MRI/PSA calculation can be compared with the upcoming tests.
Discuss using Decipher genetic tests on your next biopsy tissue if positive. Do the mpMRI 3T with and without contrast. Medicare will cover all but your copay as the MRI is part of the AS program you already are on.
Coordinate your care between your PCP and urologist. TRT and 3+4 is playing with fire. Maybe get a second opinion on the next pathology read of the biopsy material.
Make sure the biopsy is fusion TARGETED AND SYSTEMIC with the appropriate number of cores per your prostate size.
Watch the Prostate Cancer Research Institute YouTube videos. Alex and Dr. Scholz do an excellent job of explaining the technicalities, options, new research, morbidity, and mortality of PCa. Using very palatable language.
I also like videos by Dr. Cooperberg from the University of California SF. Cutting-edge stuff.
Personally, I would wait for the results of another PSA check before having a biopsy. (I tend to lean away from treatment and tests, and my own experience with a biopsy was atypically bad.) This is not medical advice, just something to think about. Maybe you should ask the urologist if that would be a reasonable choice.
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