PSMA Pet scan interputation

One reason could be that treatment is not the same if your cancer has spread outside the prostate. If it’s still in the prostate, then they can remove it surgically or with radiation. If it has spread, then those techniques may not work best for you. Eventually, they will want to treat the prostate, but if it has spread a lot that may not be the first step.

Since the PET includes injecting a dye into your system and tracing where that dye shows in your body. This doesn't indicate, necessarily, how MUCH cancer an area has, only that it has it at all. This is to say that it would show in your prostate but not in a way that might indicate the severity of your cancer, but if it also showed up in your bones then they know it has metastasized in your body.

This is why there are different tests for different things. PSA checks if you might be having prostate problems, cancer often being the cause. PSE to determine if it is, indeed, cancer. MRI to get a basic 3D view of the prostate to analyze if a lesion has spread beyond the prostate or bed and to get an idea of things like bulges. Biopsy to get samples of the prostate, particularly around any lesions, to be able to grade it. Decipher to determine if the random samples have genetic markers that make it higher or lower risk, based on hundreds of thousands of data samples from other men and their eventual outcome. Prostatectomy to remove a prostate-contained cancer and conclusively grade the entire thing.

So everything plays a slightly different role. The only ways to determine how much cancer you really have in the prostate is generally biopsy (which isn't conclusive) and MRI and analyzing the prostate post surgery if you go that route.

If I already have a gleason score of 3+4 through biopsy, is there any advantage to getting a PSE? I never had that blood test.

Also, I'm struggling with deciding what treatment to go forward with, including monitoring. I've had 36 biopsy samples, of those three have a Gleason score of 3+3 and one a Gleason score of 3+4. The 3+4 represented 5-10% of the sample. That is the extent of the cancer found. I've been through an MRI that showed two lesions RAD-4, but after guided biopsy didn't show any cancer. In my mind, with only one spot identified, nothing outside the prostate, why risk the side effects of surgery or radiation. I am 66 with a PSA of 8.3. Any thoughts?

They took THIRTY SIX?!? That's a lot!

You might consider a Decipher test of your biopsy cores, this will help determine if the 3+4 you have is aggressive or not. I was the same, a single 3+4 at 5% with the rest at 3+3 so I was on active surveillance until the Decipher said I was high risk, then they wanted to get treatment done. At 66, I wouldn't be surprised if they keep you on active surveillance or radiation, unlikely they would want to do a prostatectomy from what I've come to understand about recommendations for treatment.

I agree with @survivor5280, it would be real interesting to see a decipher test result. The PSE test would not make a lot of sense since you already know you have cancer and have already had a biopsy. It’s just a matter of how much there is and how quickly it grows Noe.

If you have one 3+4 you are a Gleason seven the 3+3’s are not relevant anymore.

PI-RADS 4 is pretty much known to be cancerous. It would be good to know how big they are and where they are. Are any near margins of the prostate.

Yes, you could go on active surveillance. You don’t mention your PSA, which could be useful. What you’re looking for is PSA doubling time. The shorter it is the more likely you have to get off of active surveillance and do something.

The 36 was from two biopsies. The first a guided biopsy taken after the MRI and then the second on a random biopsy 6 months later. Initially my random samples were rated at 4+3 on two samples. I had them sent to the University hospital for a second opinion where they were down graded to 3+3 and 3+4. So at the time of the 4+3 the urologist was surgery. With the changes made by the pathologist at the University hospital, his recommendation hasn't changed.

The PI-Rad 4 were .3cmX.3cm left posterior medial peripheral zone at the apex and the second reported as 1.2cm left anterior transition zone near base. If the guided biopsy was accurate and samples were taken from the two locations, then there was no cancer present in either lesion.
PSA 8.3. PSA went from 2.4 in 2021 to 5.7 in 2023, and now to 8.3 in 2025.

Thanks, I'll look into a decipher test.

It's a judgement call.
Take a look at post a prostatectomy pathology report where the pathologist can eyeball all of it in toto after finely slicing the prostate and microscoping the slivers.
They look at sentinel lymph nodes to see if any escaped. The prostate margins ( its surface) to see if any is there indicating maybe some got out
Etc.
I'd ask your urologist why he still wants to proceed. He may be seeing probabilities based on his experience.
Also the Gleasons scores often change once full prostate is examined
Mine thankfully went from 4+3 to 3+4. Your's may be confirmed so w the prostatectomy, and depending on the amnt of 4 may qualify you for surveillance only

Also

The .3 cm lesions are really small. The other one’s about a half inch long. Your PSA sure has been going up slowly. Yes, the 3+4 does mean you have cancer, but not much. Good to hear you’re going to look at the decipher test.

It’s a surprise to hear that PI-RADS 4 lesions are not cancerous, but that’s good news. Makes active surveillance sound more reasonable.