1. < Prostate Cancer

Biopsy results benign. PSA is elevated. What is the next step?

Posted by frank1956 @frank1956, Feb 25 8:08am

I posted earlier though I can't find my thread. Here 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."

Urologist called me about the results last week. He said he will send my sample for a Confirm MDX test. I looked it up.
"The Confirm mdx test examines your negative biopsy tissue at the DNA level to help identify undetected cancers that may be present anywhere in your prostate."

The result will be back in a month. Meanwhile, he said I will retest PSA in 6 months. I asked about PSMA PET scan. He said they will do it for only positive diagnosis.

I want to self pay PSA 6 weeks after my biopsy. I also want to know what is the protocol for a second biopsy? I am within an hour of driving to UCLA prostate cancer center. Shall I just call them for an appointment for second biopsy now or shall I wait for my Confirm MDX result? Which kind of doctor should I call and ask for? I am on Medicare+medigap, so I hope insurance is not an issue with them. Thank you.

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frank1956 | @frank1956 | Feb 27 7:51am
In reply to @frank1956 "When my urologist called me about the results of my biopsy, all being benign, I pressed..." + (show)
@frank1956

When my urologist called me about the results of my biopsy, all being benign, I pressed for the possibility of cancer being missed. He said that the 3T MRI and MRI fusion transperineal biopsy performed on me, all are the latest technology. If he needs to give a percentage, I am 90% clear. But, I still want to be vigilant, and don't want it grow out of control.

If the Confirm MDX results do show that they found cancer, I plan to have a second biopsy done from UCLA. They have even more advanced biopsy methods. If I am so lucky that the Conform MDX is also negative, I guess I will go on an Active Surveillance mode: testing PSA, doing MRI, until something changes, then go get biopsy from UCLA.

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My urologist uploaded his surgeon's notes on my biopsy:

"Finding 54 g prostate minimal calcifications 2 legions that there were marked and mentioned on the MRI

..................

there is always an additional 1 marked by radiologist which was not mentioned in the report, total targeted lesions 3.

(skipped some more ...........)

Transrectal ultrasound was inserted with above mentioned findings. There were 3 areas marked by radiologist and all were biopsied.

.............. "

Looks like there was a radiologist on site to assist the biopsy? He/she actually found a third lesion, and 54 g prostate minimal calcifications. Are these of any significance?

REPLY
wellness100 | @wellness100 | Feb 28 2:55am

Can you do PSMA Pet scan?

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1 reply
frank1956 | @frank1956 | Feb 28 7:44am
In reply to @wellness100 "Can you do PSMA Pet scan?" + (show)
@wellness100

Can you do PSMA Pet scan?

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I asked my Urologist. He said only when you have a positive diagnosis. I do not know if that is true. I am waiting for my Confirm MDX result. That will tell me if cancer exists or not. If it does, I will reach out to UCLA for a second biopsy consultation.

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1 reply
wellness100 | @wellness100 | Feb 29 7:08pm
In reply to @frank1956 "I asked my Urologist. He said only when you have a positive diagnosis. I do not..." + (show)
@frank1956

I asked my Urologist. He said only when you have a positive diagnosis. I do not know if that is true. I am waiting for my Confirm MDX result. That will tell me if cancer exists or not. If it does, I will reach out to UCLA for a second biopsy consultation.

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Can be due to inflammation.

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shelby29 | @shelby29 | Mar 1 8:14am

I dont think biopsies are always correct. I had a negative one and 1 year later, after psa kept going up, I had another one. Came back gleason 8 and stage t3b. Pretty sure 1st biopsy missed it.

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1 reply
frank1956 | @frank1956 | Mar 1 8:33am
In reply to @shelby29 "I dont think biopsies are always correct. I had a negative one and 1 year later,..." + (show)
@shelby29

I dont think biopsies are always correct. I had a negative one and 1 year later, after psa kept going up, I had another one. Came back gleason 8 and stage t3b. Pretty sure 1st biopsy missed it.

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Yea. This worries me. I plan to have my second biopsy done in UCLA. I called their Radiology department and they said a doctor's referral is required or second biopsy. If my Urologist is not willing to refer me, I can go to my PCP to do it.

Was your second biopsy done at the same location? The same doctor?

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1 reply
shelby29 | @shelby29 | Mar 1 5:31pm
In reply to @frank1956 "Yea. This worries me. I plan to have my second biopsy done in UCLA. I called..." + (show)
@frank1956

Yea. This worries me. I plan to have my second biopsy done in UCLA. I called their Radiology department and they said a doctor's referral is required or second biopsy. If my Urologist is not willing to refer me, I can go to my PCP to do it.

Was your second biopsy done at the same location? The same doctor?

Jump to this post

Yes, but they did more pokes

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