Hello, in October of 23 my PSA was tested and was 4.7. I am a 59 year old generally healthy guy. An MRI was performed in February 2024. It showed a PIRADS 5 lesion. I have basically had PSA readings of 2.5 every year since I was 50 years old. After a 14 core trans perineal biopsy a very low amount of Gleason 6 was found in 20% of one core. None of the four cores from the lesion tested positive.
My PSA had dropped to 2.8 by July 2024. In September another PSA test showed an increase to 4.2. I recently met with a well known Urologist who tested me on 10/24. My PSA has now increased to 9.25 while my % free PSA has dropped to 6.8. My PHI score is 33.7. The Dr. does not seem concerned. I’ve never had this kind of rapid increase before. Looking for opinions on this. Was told that an MRI wasn’t necessary as they’re generally good for 1 year. The PHI of 33.7 means there is a 17.9% chance of clinically significant cancer. What do you all think?
Thank you,
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Muskyguy
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Get a DEXA scan. Start exercising a lot now -- aerobics, cardio, and most importantly resistance. Daily if possible. Activity like this is said to greatly reduce odds of PCA, and if you come down with it, odds of PCA getting a lot worse. Does PC run in your family?
Thanks for all the information. Your PSA will bounce around a bit, one needs to look at the long term movement and the velocity of change, how quickly is it spiraling upward.
I know your Urologist is world renown but IMO I would get a second opinion. Active Surveillance (AS) is the normal or standard course forwhat is indicated. That is until it isn't. So to ease your mind get a second opinion and maybe from a highly rated Radiation Oncologist (RO)?
Typically Prostate Cancer (PCa) moves slow so you have time thus why the recomendation for Active Surveillance. But at the same time you want to have or get diverse opinions, become educated and know your path forward. After all the chances of it going away versus getting serious is minimal.
I had this happen on my 2nd negative MRI/Biopsy(I had 3 over 18 months). Although I had lesions, none produced cancer nor did the balance of the cores. After 6 months, psa went up again. Drx said let's wait a year. I said NO. I want another MRI. We did an MRI which had the words "much improved compared to previous MRI". I made him justify another biopsy anyway strictly because of PSA/Free PSA trending up/down respectively. That's when I got my diagnosis. 1 core G8. Stay vigilant. Look at all the data. Good luck to ya!
Great advocacy on the vigilance! I believe with the sensitivity of psa it gives a heads up ahead of significant metastasis in a situation like this. Vigilance is key!
Agree: second (and third) opinions from RO and medical oncologist. I was "on" AS for 7 yrs at Hopkins. I think the uro - also quite prominent in PCa world - screwed up by not recommending treatment earlier than he did. The suspicious/cynical part of me wonders if I were an experiment, as it were. He didn't recommend treatment until PSA rose to 23. In retrospect, in what universe was that good advice? I was stupid (and hopeful, I guess) in not pushing back and getting other opinions sooner. I paid for my delay: IMRT, brachy, ADT and a yr and a half of being miserable. Now, six yrs later and holding...PSA 0.02 (nadir), steady 0.04, otherwise. T back to pre-treatment levels (250ish. Woo-hoo) Cured? Would not bet much on THAT yet. My message: you have time to make treatment decisions; get other opinions.
Thanks for all of your opinions on this. Any recommendations as to a good RO in the Northern Illinois region? Chicago is a possibility. I live approx. 1 hr. Northwest.
good morning- Ed Schaeffer at Northwestern is a surgeon, but supposed to be excellent, and seems honest. He’s got an interview with Petter Attia that deals with everything about prostate cancer. Hard to find surgeons that won’t suggest it if not needed, but they are out there, such as Eastham at MSK in NY. (He’s suggested AS for me until now). It’s worth seeing Schaefer if you haven’t.
Greetings Muskyguy...... "generally healthy guy"....I'm not against being healthy I just want to point out that those dirty M.Fers don't give a shit if we're healthy or not.....they're gonna eat us anyway..... That said, fight them will all the ammunition available. (Geez I think I'm losing my sense of humor)....
Seems logical many of the men who came to realize their "slow growing" PC had spread would like screening do-overs. I certainly would. (Unless of course, one is good with treating this disease as chronic illness with ADT.)
My PSA bounced up and down for years but with "clear" DREs I feel into complacency and missed the very thing we were screening for - prostate cancer. So much for my complacency (active surveillance) that allowed my cancer to grow and spread.
Ten years ago I learned about multi-parametric MRIs; you did not identify yours as mpMRI. Also, I find second independent radiology and biopsy opinions crucial. And a third if the first and second do not concur. In your case which pathology finding is correct - the one you prefer?
I find statements such as 'good for a year' dangerously deceptive . Example: this past April I had a clear liver MRI. Less than three months later additional imaging identified a 2cm metastatic lesion.
IMO do all you can to be sure you know what you are dealing with to avoid wishing you could have a do-over. It is challenging when docs (and some patients too) tell you to not dig deeper, to not worry. I hope this helps. All the best!
And what of a second radiology opinion to concur, or? Nearly seven years ago I had a Ga68 PSMA PET CT and comparative Ferrotran nanoparticle MRI. Although the Ga68 was 'clear' the Ferrotran successfully identified multiple cancerous lymph nodes.
Northwestern Pathologist looked at the one positive core and thought it was atypical cells and not cancer. First Pathologist said Gleason 6. I forgot to mention Decipher score was .17.
If I read correctly you have two different pathology opinions - of which neither align with (singular opinion ?) PIRAD 5 finding. I did seek a third pathology opinion - 2 of 3 concurred and more closely aligned with mpMRI findings. In my case my post RP final pathology turned out worse than biopsy findings - biopsy samples missed the worst bits of tumor. Hope this helps. All the best for your investigative and decision path.
(adding to profile) Yes Genomic Oncotype Dx, only testing readily available in 2015 but not yet 'approved' so no insurance. Score was low intermediate risk - but was upgraded with RP biopsy tissue; the original biopsy samples missed the worst bits (part of inconsistency between mpMPI radiology findings and path findings).
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