No Biopsy needed? PSA=32

[cederpicket]

My PSA went from 10 three months ago to 32 last month. I had UTI and was treated with CIPRO for a week before PSA test. Here are the MRI results i just did last week: Did I escape the Biopsy or still needed?

Exam: MRI PROSTATE WO/W CONT

IMPRESSION:

1. MULTIPARAMETRIC MRI NEGATIVE FOR SIGNIFICANT OR INDEX LESION, INTERMEDIATE OR HIGH GRADE NEOPLASTIC DISEASE.

2. PERIPHERAL ZONE DEMONSTRATES NO CONCORDANT FOCAL ABNORMALITY WITH CHANGES

3. COMPATIBLE WITH CHRONIC INFLAMMATION OR PROSTATITIS.

4. TRANSITIONAL ZONE DEMONSTRATES HIGHLY ORGANIZED BPH NODULES IN UPPER LIMITS OF

5. NORMAL SIZED GLAND.

6. RECOMMEND CONTINUE SURVEILLANCE WITH REPEAT PSA IN 6 AND 12 MONTHS WITH REPEAT MPMRI IF PSA KINETICS ARE ABNORMAL.

7. REPEAT MPMRI IN 12 MONTHS TO CONFIRM STABILITY.

PI-RADS CATEGORY 2

1 = VERY LOW (CLINICALLY SIGNIFICANT CANCER HIGHLY UNLIKELY)

2 = LOW (CLINICALLY SIGNIFICANT CANCER UNLIKELY)

3 = INTERMEDIATE (CLINICALLY SIGNIFICANT CANCER EQUIVOCAL)

4 = HIGH (CLINICALLY SIGNIFICANT CANCER LIKELY)

5 = VERY HIGH (CLINICALLY SIGNIFICANT CANCER HIGHLY LIKELY)

FINDINGS:

Prostate volume = 33 cc

PSA density = 1.02 ng/mL/cc

PERIPHERAL ZONE:

1. Linear and wedge shaped areas of T2 hypointensity throughout the peripheral zone consistent with inflammation/prostatitis.

2. No focal concordant peripheral zone abnormality.

TRANSITION ZONE:

Highly organized BPH nodules.

No focal concordant transition zone abnormality.

Seminal Vesicles: Unremarkable.

Urinary Bladder: Unremarkable.

Pelvic Lymph Nodes: No enlarged or morphologically abnormal lymph nodes.

Suspicious Bone Lesions: None.

Other Incidental Findings: None.

Thank you

[Derf4223]

You are urged to put the details of your posting in your bio, along with city. Its bad kharma not to. Also you are urged to start or amp-up copious amounts of exercise including resistance training, lose any extra weight, and clean-up your diet. These recommendations are not just the usual generic advice but crucial steps to take 1-2-3 years before PCA possibly gets worse along with potential co-morbidity conditions like diabetes and heart disease.

[Tall_Allen]

You may want to request a Prostate Health Index test. It is better at distinguishing inflammation from cancer.

[addicted2cycling]

My understanding is that an MRI scan IS NOT INFALLIBLE whether negative or positive and neither is an interpreter.

[ASAdvocate]

I have low risk Gleason 6 prostate cancer and have been on active surveillance since 2009, with no progression of my pathology. But, my prostate median lobe enlarged and caused acute urinary retention and very painful UTI’s and inflammation in 2022. My PSA spiked from 4 to 116. That had nothing to do with my prostate cancer. I needed an aquablation procedure to fix the urinary blockage and make me normal again.

In your case, it looks to me like a non-cancerous infection, and a that a biopsy is not warranted.

[cederpicket]

Thank you. I am going to be on Active surveillance for another year and see how things are before deciding to put a needle. will do PSA after a month and see if it has come down