PSA 8.6, MRI PIRADS 5, Biopsy scheduled, so a bit worried

Thanks again to all for your input/stories. I thought I had posted an update last week but apparently I didn't hit "post comment".
Had my transrectal ultrasound fusion biopsy on 1/26. Results did show cancer.
Urologist said it was not the aggressive type, that it's very treatable, and I am meeting with him on 2/8 to discuss biopsy results in detail and my treatment options.
My uncle had prostate cancer in his late 50s and had his prostate removed.
My dad had it at 75. Opted for radiation treatment. He's now 81 and no signs of cancer since his treatment.
I will post an update after my appointment this week.

God Bless.

Thanks again to all for your input/stories. I thought I had posted an update last week but apparently I didn't hit "post comment".
Had my transrectal ultrasound fusion biopsy on 1/26. Results did show cancer.
Urologist said it was not the aggressive type, that it's very treatable, and I am meeting with him on 2/8 to discuss biopsy results in detail and my treatment options.
My uncle had prostate cancer in his late 50s and had his prostate removed.
My dad had it at 75. Opted for radiation treatment. He's now 81 and no signs of cancer since his treatment.
I will post an update after my appointment this week.

God Bless.

Good morning and Happy New Year!
I am a 70 yo recently retired Radiologist (Interventional specialty mainly-biopsies, treating cancer by ablation, compression fractures of spine by kyphoplasty etc) but also have read many CT/PET/MRI exams in my 40 year career. I thought I knew a lot about prostate cancer; turns out I didn't.
I routinely had a yearly physical exam which included PSA. My PSA bounced around from 3-5 for a number of years and I finally got a contrasted Prostate MRI on a high field magnet/3T in 2019. It was normal so it gave me a false sense of security. Also sent a blood sample to Mayo for fractionation and they said normal for age. In early 2021 my PSA jumped to 7.5 (yearly rate of rise of 20% or more is the red flag, not the absolute number) so I went to the urologist and had repeat MRI. Now there was a 1 cm enhancing nodule (not good) in my prostate. Biopsy revealed Gleason 7, 8 & 9 cores from the nodule with the rest of the gland negative. Bonescan & MRI (urologist didn't order PET because he didn't believe cancer was outside the prostate) negative for spread. I went into full court press mode and had informal discussions with multiple colleagues (RO, MO, urologists) as well as formal consultations at several medical centers. Elected to have robotic prostetectomy with a very experienced surgeon. Surgery went well. Gleason 9 with extra capsular extension. PSA went down to 0.016 post 6 weeks but then went up to 0.37 two months later. PSMA PET revealed solitary met at T8. Consultation time again. Read extensively. Elected to have SBRT (radiation) at Emory to kill the cancer at T8. Four months later PSA now 4.5. Very rapid doubling time indicating agressive cancer. Again, extensively read literature. Got a zoom consultation with prostate cancer expert at Johns Hopkins with 30 years experienced treating prostate cancer (medical oncologist and head of the prostate cancer research facility there) and liked what I heard from him and his NP. I wanted an Oncologist that just specialized in prostate, not a general medical oncologist. Immediately started on Lupron. Within 2 weeks started chemo with Taxotere at Hopkins and added an anti androgen receptor drug (Darolutamide). Eight weeks after the chemo cycles ended I had full pelvic radiation. My PSA went undetectable after my second chemo session and has remained so for a year. I am now off all medications and awaiting return of my testosterone and hope PSA stays undetectable. That's my journey. Everyone is different.
I will offer my opinion about a few issues as a patient and not a physician. Even as a physician I would never advise anyone on a certain course of treatment because 1) I am not their doctor, 2) that is not my field of specialty, 3) I don't know anyone's full history etc. I am leery of those that make definitive pronouncements about treatments on this and other forums. Having said that:

Become informed as others have suggested. It is your body. Seek second opinions. See at least one Urologist and one Radiation oncologist before making a decision on Radiation vs surgery. There is no right or wrong. Both are good choices depending on the person"s age, health, Gleason score, Imaging results etc.

If you don't feel comfortable with your specialists fire him/her and seek another opinion. If they don't spend adequate time with you and answer your questions find another doctor that will.

In general, seeking treatment at a major medical center/ Center of Excellence is a good idea. If you elect to have surgery, ask your urologist how many Robotic Prostatectomies he/she has done. It should be quite a few but I won't give my opinion to the exact number. I practiced at a major medical center and I can tell you from experience that when a new procedure came out I was much more proficient after the first hundred than I was the first 10. Just something to think about.

Treatments are changing rapidly regarding prostate cancer. Limited metastatic disease (1-3 lesions) is considered potentially curable by many oncologists whereas several years ago it was not.

Don't let this consume you. Live life no matter the result of the biopsy and future treatment. Easier said than done. At your age you need to seriously consider quality of life in your decisions. Ask your doctors how their treatments will impact that.

I wish you well. Numerous people who have gone through this freely gave of their time to me so I feel I should do the same. The above is just my experience and opinion. Not definitive. Good luck.

I have not read all the comments so my question may have been addressed earlier. Did you mri and biopsy show that the cancer is contained within the prostate or is there extraprostatic extention? This could be a factor in your treatment choice. If there is extraprostatic extension I would definitely have a psma pet scan before making a choice. I was 4+3=7 with very minor extraprostatic extension and chose RP. My six week post psa test was higher than before surgery. PSMA pet showed my entire pelvic bowl was clear but it had jumped to my abdominal and chest lymph nodes. I probably would have made a difference choice if I had this info prior. Knowledge is power.

@greg52
I’m 67 years old, had a PSA of 7.8 and my early October mpMRI showed three PI RADS lesions…one 3, one 4 and one 5. So, my situation is similar to yours…except my age.

I too was quite concerned, especially because of what I had read about PI RADS 5 lesions, immediately after I received my mpMRI report.

A few weeks after the mpMRI, my urologist performed a Fusion biopsy of 15 areas (9 cores in the three mpMRI lesions and a standard “random” 12 core sampling).

The “4” and “5” mpMRI lesions came back with Gleason 3+3=6 cores (in only 5-10% of specimen) and the “3” lesion came back benign!

However, 2 of the cores taken in the 12 core “random” sampling came back with Gleason 3+4=7 cores (with 10-20% of pattern 4 cancer).

The lesson here is not to get too concerned about an initial PIRADS 5 lesion AND make sure your urologist also does the standard “random” 12 core sampling protocol, besides sampling the “targeted” MRI location(s), when going for your initial biopsy.

Next week I will review a 2nd opinion on the biopsy pathology and a Decipher Score of the biopsy cores; neither of which I’ve seen - yet - and it’s been 2 months since I made those requests.

I am also waiting to get my first, post biopsy, PSA test (one must wait 3 months for the prostate to heal after a biopsy, before getting another PSA level check).

The main thing I have been doing through all this “wait time” is taking action regarding the things I can control and change.

No matter the outcome of your MRI results and any subsequent options you may (or may not) need to consider…there is one thing that you can definitely do…carefully examine your current diet and exercise routines and read (and take action) regarding that which is known to be best for good prostate health.

During the last 3 months, since receiving my mpMRI results, I’ve implemented a significantly modified diet (primarily whole plant based) and doubled my aerobic exercise routine.

I’ve lost 20 lbs and dramatically improved my overall health (no longer need a CPAP machine, no longer have shoulder inflammation, lowest cholesterol levels in 38 years and my average resting heart rate dropped 10% to 53 bpm).

Obviously, I have no evidence (yet) that this is helping to reduce my PSA; but I will soon find out.

Every man responds differently with news like that which you have just received and my actions may not be appropriate in your situation, for a variety of reasons.

Even so, it seems to me that all of us who have been forced to embark on this unknown journey would benefit from taking action over that which we have the most control.

All the best to you and may God bless you while you wait and give you the courage to change the things you are able to change.

Hi. Your story is similar to mine. Had two abnormal PSA tests (8.1 and 13.5% free psa and 7.8 and 14.6% free psa second). Both within 48 hours of each other. Father had Radical Prostatectomy at 62 but lived until 86. I am 61. MRI scheduled for Tuesday. But in the last 6 weeks I've completely changed my diet, also lost 20 lbs and hoping for the best. Feel great, no symptoms other than weak urine stream. But just feel like my Urologist has already concluded I have cancer and allowing me to do more diagnostic tests because he knows I"m scared of a biopsy.