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PSMA negative, Biopsy positive

Prostate Cancer | Last Active: Feb 14 7:05am | Replies (23)
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@edtrucks

I am 66, had two lesions found in my MRI that after targeted biopsy showed no cancer. At the time PSA 7.0. Two other needle biopsy showed 6+6. Monitored for 6 months. Had a second biopsy December of 2024, 16 samples, with two showing 4+3, intermediate unfavorable. PSA 8.3. The two samples had only < 5% and < 20% cancer, and both were in the same area. My urologist recommends surgery. I have a PSMA PET scan scheduled this week, although after reading comments I am not sure the test will provide too much useful information. With only 2 samples out of 31 showing cancer, both in the same location, and low percentages of cancer in the samples, is this truly unfavorable and required either removal or radiation?

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Replies to "I am 66, had two lesions found in my MRI that after targeted biopsy showed no..."
icorps | @icorps | Feb 11 11:55am

I'd be inclined to follow your urologist's rec.
His concern is that you now have a high risk Gleason score of 4+3. The PSMA can detect prostate cancer at your PSA level fairly well so my guess is the uro wants to see how much there may be elsewhere. That'll give a road map to the lhmp node lesions he'll remove. Chances are he'll remove nearby ones not registering lit PSMA on the likelihood they're harboring micro metasis.
You might talk w him about using radiotherapy such as SBRT to go after the problem. It too can go after nearby lymph nodes not registering PSMA.
One benefit to the surgical removal is that they'll biopsy the lymph nodes and thereby get a better grasp of your pc's aggressiveness, if that hasn't already been done w tissue from your prostatectomy. Also the removal may suggest a pattern of potential metasis.
The surgical removal of lymph nodes is still considered a Gold Standard in ascertaining BCR lymph cancer potential.
Good luck!

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