Do I have Cancer or Not?

Please don’t sit there and worry that someone else has your fate in his hands…YOU have it!!
As @clandyboye1 said : Get another Urologist. There are plenty who are pro-active and will understand your sense of urgency. Not saying you need immediate treatment, but perhaps further testing (PSE) to narrow down your condition.

Did you have an MRI Fusion biopsy, where the MRI is fused with the ultrasound so that precise targeting of the region of interest can be done? Second a 0.2mm lesion is very small. Radiologists seem to get more concerned at about 1cm or greater. PIRAD-4 while it is greater than PIRAD-3 (which is equivocal or indeterminant) isn't as great as PIRAD-5. So if you have cancer it's in a very formative stage in my opinion. You have time. Get yourself educated because you will become your advocate with these doctors. Remember, they work for you. Best educational material I found besides Peter Walsh's book is at Prostate Cancer Research Institute website. pcri.org. Go there immerse yourself in all that it has to offer. I spent at least 150 hours watching videos, making notes and getting myself educated on what I had and what treatment options were available. Others have mentioned the new PSE test. See if you can get your urologist to order it for you. The claim is with 90 to 95% accuracy this blood test will tell you if you have prostate cancer. I think the reason Active Surveillance is being suggested is because there's still uncertainty about your situation and they want to watch it to see what transpires. Prostate cancer, unlike other cancers is very slow growing, unless it's highly aggressive. And should it be, I would think you've found it at a very early stage given the size of the lesion. You need more information in my opinion in order to make informed decisions about a diagnosis and treatment. And once you get there...........get a second opinion or even a third opinion for centers of excellence before you decide on a course of action. You most likely have plenty of time in order to do all of that. This is typically the case.

Around 48% of men your age have prostate cancer. Many are Gleason 6 like I was in 2017 when I was diagnosed with cancer or irregular cells. Some refer to Gleason 6 as irregular cells and others refer to it as cancer. The label does no change what it is. In 2023 my MRI showed a lesion and a biopsy confirmed Gleason 7 cancer. In 2024 I had a HIFU procedure to remove all Gleason 6 and Gleason 7 from one side of my prostate. I still have Gleason 6 on one side of the prostate. I am 58. Do I have cancer? It doesn't matter, as long as I get my MRIs any future cancer growth will show up and I will deal with it. So far no negative side effects from the HIFU.

Yes I’m 77 I’ve been cancer free for 14yrs now. When I started having regular PSA tests they were telling me different stories. They told me not to worry about it, another Dr told me I should start biopsies. My wife said go get a biopsy! This went on for about 2yrs. My first biopsy was negative along with 3 others. The last one almost killed me due to infection. Cancer was finally diagnosed and at that time nobody really knew or explained much about procedures. I opted for seed implants and radiation therapy for 1yr. My ED started sliding down hill slowly pills worked for awhile then I had to go to TriMix and now Quadmix. There’s some pain and the shots are not real easy but it’s worth it to me because I still have a great sex drive. Good luck my friend

I had an MRI and after they found PIRADS 3 and 4 lesions they did a rectal biopsy targeting those lesions. Only the 4 showed anything suspicious with Atypical Glands suspicious for cancer. That was 6 months ago and I thought my appointment last week would show rising PSA and a rebiopsy. Urologist said PSA only rose from 3.44 to 3.58 and that he didnt want to turn me into a pin cushion with more biopsies and that we can wait another 6 months. I argued that I had a very large PSA jump from 2.48 to 3.44 and though the last test on January 29th only rose by .14 I now had 3 separate PSA tests now showing a consistent rise. I also said are not the lack of basal cell markers on the ASAP findings usually a sign of malignancy? Urologist stated there are not enough cells to verify that and its always possible that this 0.2mm focus for all we know could have been crushed making them look like atypical cells. Has anyone else going through all this ever had a similar experience? I'm 48 now and under the old standard a normal PSA use to be 4.0 or below but the new standards changed it to 2.5 and below for men in my age group. It is the Rads 3 and 4 along with Atypical glands that worry me. Should I just relax or am I at a very real risak that any unfound cancer will use this time to metastasize beyond a chance to 100% cure it. Cancer can be cured if you catch it early but only if its caught early.

You could get a PSE test to see if there is truly prostate cancer in your body. It is 94% accurate.

Another test that does almost the same thing is the Artera AI test. It uses AI to analyze Digital images of your biopsy.

These test are designed to tell you what’s going on without having to do another biopsy, And they essentially tell you, whether or not you need a biopsy.

I find the PSE test to be amazing. Why is the Urologist not the first to see this??? If it's that effective, should it not be industry standard practice? I am screening other Uros even out of state to get another opinion.

I know they push the PSE for other things as well, but it's mainly been researched for general screening, as far as I've read — it tells you if there's likely a problem that would justify further investigation, like an MRI and biopsy. You've already had your MRI and biopsy.

I am not a doctor, but here is my thinking based upon my learning. I'd advise you..........spend some considerable time at pcri.org viewing all that they have to help get yourself educated. That was my fortunate first step after my diagnosis. I stumbled upon this website by accident. It was invaluable to me. You have a very tiny lesion. Generally there's concern when the lesion is 1cm or greater. Remember, this cancer grows very slowly as a general rule, unless it's highly aggressive. I'd ask........are you a patient at a center of excellence? Do you have high confidence in all who are treating you? Was your biopsy a targeted biopsy using ultrasound MRI fusion.........or was it the standardized 12 core random biopsy. You need to make sure the region of interest shown on your MRI was in fact targeted and hit. You want to be working with facts/data you are confident in. It is that basis from which you'll make decisions. Have you sought a second opinion for a center of excellence. Insurance pays for this. While you might be concerned about offending your current urologist, it's not an uncommon practice for folks to get second and third opinions. Be confident in the data you have. Your urologist's reaction regarding let's wait another 6 months doesn't strike me as out of the ordinary for something a small as your lesion. PI-RAD 3's come and go. The PI-RAD 4 is the lesion of interest. That's the one you want to make sure was hit. At the same time 0.2cm is small to hit well I'd imagine. Try to calm down. I believe you have plenty of time. My lesion was 2.0x1.2x1.4 cm when it was first discovered. My MRI further indicated further protrusion and no bulging on the prostate capsule. If you have prostate cancer, you've caught it at a very early point. And your PSA rate of increase is slow. They look at how long it takes for PSA to double as an indicator for cancer as well. Getting yourself educated on this disease will help calm your fears and concerns. You're in a good position...........if you have cancer, you caught it very early. Just make sure you've been treated by a highly experienced doctor, you're sure your MRI was read correctly by whomever the radiologist was. I had two MRI's, one in 2022 and another in 2024. The radiologist who read the first MRI missed my lesion. I walked around for 2 more years with this cancer growing inside me, until a more competent radiologist read my images from 2024. By then, I had a PI-RAD 5 lesion. I learned an important lesson..............trust but validate with second and third opinions. It's our lives we're dealing with and these processes are not flawless. Following this mistake I'll never trust the system with a single answer again. I'll always seek a second or third opinion if it's something serious.............and from a center of excellence and highly experienced doctors.

@theanomaly Do you have BPH .? Many factors other than cancer can influence the "SMALL " change in your PSA . Your PSA Doubling time is not concerning . I believe I inquired earlier : " Did you ever get a 2nd or 3 rd opinion of your Biopsy Gleason Score results ?
Are you aware that people with very low PSA numbers can have cancer , while others with very high numbers. Do not have cancer .?
Are you also aware that your PSA can be in the thousands ? . The highest recorded PSA was over 23,000 . Yes : Twenty three thousand .