PSA & MRI suspicious but biopsy benign

You may have already researched this...back when I was getting diagnosed, I learned (from WebMD):

• For PSA between 4 ng/mL and 10 ng/mL, about 25% of men in this group likely have cancer.
• For Free PSA concentration of more than 25%: about 1 in 10 men ages 50 to 59 will have cancer. For those 70 and older, it’s 16%

You might also ask the urologist about the Prostate Health Index (PHI). It's a number calculated from the total, free, and p2 PSA levels, and is a bit more predictive than the free PSA % by itself.

This is an example of why it's called the Art AND Science of medicine...

lyricw,

My age, PSA, PI-Rads are all similar to yours. I too got benign results on my biopsy recently. I wonder what your doctor has advised you to do. It has been 4 months since your results.

How big is your prostate? What is your PSA density?

I am not sure if you are addressing me, or the OP, lyricw.

In my case, my prostate is 47cc, and PSA density is 0.12

@lyricw I had lesion on right anterior apex, they can't reach that well with trans-rectal. Only transperineal biopsy can you properly sample. Is that what you had?

I am not OP but from my other thread, this is my data:
"I was tested with PSA 5.3 on November 2023, and 3T MRI shows 2 lesions (6 x 9 mm and 5 x 3 mm). Both PI-RADS 4. The locations are:

T2 signal 4 o'clock left lateral lower mid peripheral zone.
T2 signal right 7 o'clock upper mid peripheral zone.

I had a MRI fusion transperineal Prostate Biopsy few days ago. The pathology report shows all 13 diagnosis benign. The detail of diagnosis shows each diagnosis with the corresponding number of cores. (See attached). Total number of cores added up to 26."
To answer your question: in my case, it is a MRI fusion transperineal Prostate Biopsy. So, this is very puzzling, though I read that up to 40% of biopsies did not capture the cancer. It may require a second, or even a third biopsy to really find it, if the PSA is elevated. I intend to find a center of excellence to do a second biopsy when my prostate is healed.

I had PIRAD 4 and PIRAD 5 lesions that were both 3+3 Gleason upon TRUS targeted fusion biopsy.

As far as I know, the PIRAD scoring system doesn’t tell you anything about the aggressiveness of your PCa. It certainly didn’t in my case.

Instead of subjecting yourself to additional biopsies, with such a favorable initial biopsy result, you may want to ask your doc about the genomic ExoDx test. It only requires a urine sample to perform the test.

ExoDx test has Level 1 evidence, based on a 1000+ patient study, with a 91 % Negative Predictive Value (much higher than the PSA test). It designed to indicate the likelihood of GG2 (or greater) PCa. I’m going to ask to have this done before deciding on having my next biopsy, due in October.

ExoDx test is covered by Medicare.

You can read much more about it (including study trial paper) here:
https://www.exosomedx.com/physicians/exodx-prostate-test

I did do the ExoDx urine test before biopsy. My score is 18.77. Normal range is 0 - 15.6. Mine is a little higher the normal upper range. My Urologist mentioned this score to me, and I believe he accounted for this information before he recommends the biopsy.

Read your other post to get more background info.

From what you’ve indicated NONE of your 13 core samples came back with 3+3 Gleason, even those targeting your PIRAD 4 lesions, correct?

Were all 13 cores “benign”?

Sometimes a core will come back “suspicious” or HGPIN, but not cancer.

All BX sites came back benign except core pirad 4 area& it was focal atrophy with inflammation. I just did 6 month PSA & it fell from 5.0 to 4.1. Urologist email message “PSA stable. I suppose I will get another PSA in 6 month via internist yearly checkup.