He tested a level of 4 PSA back in Dec 2023; the doctor did not say much except try to keep your stress level down, etc. He felt things were feeling quite abnormal so went back to doctor April this year and tested a level of 8 PSA so he was finally referred to a specialist. He has been biopsied and they found nothing abnormal. His PSA level is now at 22 but the specialist cannot figure out what is going on. He is scheduled for an MPI (myocardial perfusion imaging) that is estimated for September.
Is his raising level of PSA not concerning?
My parents are planning to return to their home town, Taiwan, to get quicker results and treatment. We live in BC, Canada, so the health care system is extremely slow.
If we are willing to spend the cost to get expedited exams and treatments in either Canada or the USA, is that possible?
We feel like we cannot get answers and do not know how to proceed with this. I am hoping to find some guidance that does not require them to go back to their hometown since it is such a far flight.
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Yes..his level is concerning. However, it's not always cancer and could be BPH, Prostatitis or Bacterial Prostatitis, etc. Obviously I would push the medical system you decide to use as hard as possible for an answer. Biopsies can miss ~25% of Prostate cancers (I was diagnosed after my 3rd within 18 months) so be diligent and proactive as you are. And thanks for caring about your dad!
Was the biopsy a target fusion biopsy or a random pattern? MRI could help solve the mystery. PSMA scan. Does Canada allow for second opinions at a different center?
Yes I believe a rising PSA is of concern and the focus should be to find the cause, to hopefully rule out cancer. I have paid for expedited exams and treatments in US and Europe; I do not know what is available in Canada in private self-pay healthcare.
Back in my diagnostic investigative phase I self-paid for a multiparametric MRI, multiple consultations and genomic testing of my biopsy findings.
My biopsy was positive but did miss the worst bits - despite imaging.
I am not familiar with the Confirm MDx mentioned by Tall_Allen, but with a quick read it seems to be a very useful investigative tool for negative biopsies. I mention this because ten years before my diagnosis I had a 'negative biopsy' - but did not have anything like Confirm MDx. I have since pondered, did my fist biopsy miss the cancer that ten years later had spread out of the gland?
NanoMRI wrote -- " ... My biopsy was positive but did miss the worst bits - despite imaging.
I am not familiar with the Confirm MDx mentioned by Tall_Allen, but with a quick read it seems to be a very useful investigative tool for negative biopsies. I mention this because ten years before my diagnosis I had a 'negative biopsy' - but did not have anything like Confirm MDx. I have since pondered, did my first biopsy miss the cancer that ten years later had spread out of the gland?"
IMO, most likely the 1st biopsy was an *incomplete* biopsy. As has been mentioned, even MRI Imaging can miss PCa and that is why I have Dr. Gary Onik's *Saturation Transperineal 3 Dimension Prostate MAPPING Biopsy*
My 1st biopsy by Dr. Onik yielded 100+ core samples(95% of encapsulated volume of my Prostate). A second biopsy needed 3 years later for a positive Axumin Scan yielded 65 core biopsy 60 of which were in only the remaining left half of my prostate since the right half Gleason10 was cryoablated and just this year another biopsy due to a positive Pylarify PSMA PET/CT scan was 45 core biopsy.
The biopsies are performed using Ultrasound for viewing the path of travel and depth of the needles after passing through a Brachy Grid placed against the perineum. The biopsy of a removed prostate is more complete.
Interesting - first I have heard of this saturation method. Also interesting is that there seems to be a strengthening desire to no longer do prostate biopsies.
If this disease is often as 'slow growing and slow speeding' as thought, yes I am also inclined to think my first biopsy was incomplete and thereby gave my disease time and obscurity to slowly grow and spread until detection ten years later.
Because I chose RP I did get the very complete biopsy and a final Gleason score of 4+3; my first biopsy pathology opinion was 3+3, second and third opinions were 3+4.
I am a 68 year old Asian man. I am in US so the health care system might not be the same as your father. My PSA was 5.3 then I did a MRI and found 2 PI-RADS 4 lesions. A 26 core transperineal biopsy was performed, and all showed benign. This was done in February 2024.
I then did a Confirm MDX test. It shows that I have 36 % chance of needing a second biopsy and I have a 21% of chance with Gleason 7 and 15% chance with Gleason 6.
I then went to a Center of Excellence university for a second opinion. The Urologic Oncologist scheduled a second round of PSA test, MRI in August 2024, 6 months after my first biopsy. If the results show a second biopsy is required, I will then proceed with one.
My latest PSA (3 months after 1st biopsy in May) is now 7.55. I am nervously waiting for my next results in August. I am not sure what will happen to me, but I am doing a lot of research on Tulsa Pro, Proton Therapy, and Brachytherapy.
It would make sense to get an MRI of the prostate, and/or a PSMA (or some other nuclear-medicine) scan. I believe that the PSMA test is more likely to find prostate cancer, if it exists (technically, it has a low rate of "false negative results"). I live in BC. You might contact the private-payment clinic
canadadiagnostic.com
and find out what tests they can do, how reliable they are, and how much they cost. MRI's aren't cheap, but an MRI should cost less than a plane ticket back to China, and their waiting time is measured in days, not months.
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