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PSA of 4.1 when never previously higher than 1.0
Prostate Cancer | Last Active: Jul 9 8:26am | Replies (38)Comment receiving replies
Stage 3 metastatic prostate cancer patient here weighing in.
Speaking for the rest of our group I’m glad you’re here asking such an important question. I hope you don’t have to join our community but if you do, we’ll be here for you.
A marker of prostate cancer is often a short period of time in which your PSA value doubles. As a matter fact it’s called doubling time. A doubling time less than 12 months is highly suspicious for aggressive prostate cancer. Based on the numbers you shared, your PSA has doubled twice in 12 months. It’s not necessarily cause for panic, however it is cause for further investigation in a timely manner. While it’s true that prostate cancer is typically slow moving, that’s not always the case.
In 2020 my PSA doubled in less than 12 months. At my request, my physician ordered a PSA 4K test. That test came back with an opinion of high likelihood of significant disease. I then had an MRI, which showed a PI-RADS 4 lesion. I then had a mapping biopsy that resulted in the diagnosis of prostate cancer. I was treated with low-dose Brachytherapy and thought I’d beat it. In 2023 my PSA started to rise again and doubled twice in the period of 11 months. An MRI revealed two large lesions and lymph node involvement. I then received a PSA-PSMA scan, which confirmed the very high likelihood of the return of prostate cancer. Since then I’ve had salvage radical prostatectomy and I’m currently undergoing 24 months of first and second generation ADT as well as eight weeks of IMRT radiation.
Based on my experience, if I were in your shoes, I would ask my physician to either give me a PSA–4K test or PSA–ISO test as soon as possible. If either of those tests reveal a high likelihood of significant disease, I would ask for a three Tesla MRI as the next step. If that comes back with a high PIRADS score I would request an MRI guided FUSION biopsy. I would not settle for anything less. The first time I was biopsied in 2020 I did not receive an MRI guided biopsy and the inferior biopsy I received missed significant high risk disease, which is why I’m in the mess that I am in.
The bottom line is you always have to be your own advocate. Good luck to you and please let us know how things work out.
Replies to "Stage 3 metastatic prostate cancer patient here weighing in. Speaking for the rest of our group..."
I had an MRI T3 which indicated a T2 Signal & PI-RADS 5 following which I had a MRI Fusion Biopsy . The pathology results were negative . The recommended number of cores for the fusion Biopsy is 2 to 4 . I had 5 cores taken .
Unhappy with the conflicting results given the T Signal plus the Rads 5 . I proceeded with a 2nd
T3 MRI , this time with contrast , followed by a 2nd MRI Fusion Biopsy . This time my new Urologist took 16 Cores. The result 6 Cores were Gleason ( Grade 1 ) 3+3 = 6 Cancer .
I am 84 years young . Why did my original Urologist - The previous Head of Surgery and Head of Urology, at a leading big city hospital , not take more samples at the 1st Biopsy . Particularly given my age to prevent the need for a 2nd Biopsy .
It makes you wonder , when typically the more cores are more accurate .
p.s. Both Biopsies were "Transparineal " NOT " the more risky for infection " Transrectal " .
p.p.s. Most Urologists term the MRI Fusion Biopsy -- REAL TIME . This is incorrrect as
images can be slightly distorted in tthe fusion process .
The latest " REAL TIME BIOPSY " is called "An IN-BORE or Gantry Biopsy "
You are in the MRI machine during the Biopsy . Most clinics and hospitals have yet to
catch up with this new procedure -- Equipment costs .
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Sorry to hear you’ve gone through all this and wish you the best outcome. Thanks for all this info. It’s very helpful. I hope it’s unnecessary, but I’m pretty worried. As I said above, if my urologist doesn’t respond in one day, I’ll go to his office and speak with his pa or nurse to ensure he sees my message and gets back to me quickly with a plan for further evaluation.