Choosing Active Surveillance over any further treatment at this time

I can’t imagine having my MRI showing a lesion and not getting a biopsy. Even if my PSA was stable. You have received many great responses so far that are all valid and most suggest further evaluation, PSE, decipher etc.
I have learned many things from this forum and there is no way to compare anyone’s situation with another’s. Everyone is going to have different outcomes when their situations may look identical. You have to take in all the information and make the decision that is right for you. I am 66 and chose TULSA Pro last July for my Gleason 7 (4+3). It was the right choice for me given the information I had and the risk tolerance I was comfortable with. My biopsy only showed cancer in the lesion that was on my MRI. I would push Kaiser for more testing.
Another thing I learned from this forum is you don’t want to roll the dice on cancer breaching the prostate.

I am another one of those people that had a 3+4 Gleason Score after the biopsy but when I had my prostate removed, Gleason was 4+3 which is much more aggressive and needs to be treated. I know a number of people who have the same situation with a higher Gleason after surgery.

Active surveillance may work for you. Just make sure you get your PSA tested every three months. In the beginning.

Dying From prostate cancer is extremely painful. My father died of it, and he was on such heavy drugs in the last couple of weeks that he could barely talk, Definitely could not carry on a conversation.

If you want to have the lowest chance of dying of prostate cancer And the least disruption in your life have SBRT radiation and don’t do ADT. I’d mention other techniques that don’t require radiation, but Kaiser does not use them. There’s one(Tulsa-Pro) that’s $30,000 that is very successful., If you’re interested.

I’m 61. PSA Jan 17 was 8.1, Jan 20 was 7.8, March 20 was 5.4. MRI was PIRADS 3 with no focal lesions but an enlarged prostate (95ml). Radiologist said malignancy less likely. So do I proceed with additional PSA tests, MRI or biopsy? My thought was another PSA in 3 months. But over the last two months I’ve made significant changes to diet, exercise, lost 20lbs and take a prostate supplement. Thoughts?

More tests will confirm things for you. I would ask for a PSE test, as it is 95% accurate for detecting prostate cancer. If that shows something then it goes to a biopsy and additional tests to determine what's going on. It sounds like, from your description, that it may simply be an enlarged prostate rather than cancer, but better safe than sorry. You're still young enough to take care of this.

I’ll ask my primary about the PSE which seems like an option that many Urologists do not mention including mine who suggested biopsy.

One thing not to consider, with a 3+4 gleason score and choosing radiation, there is no need to take testorone therapy. Also, the results of the radiation are equal to surgery with in my mind some additional benefits, such as reduced chance of incontinents by keeping your prostate. Also surgery will result in immediate ED for a extended time, (12-18 months) which may not go away. With radiation there is a potential for ED, but it is over time and not immediate. I am 68, PSA 8.3, 3+4 gleason score and went with radiation. I wan't interested in AS that would have included additional biopsies. I struggled with AS vs. radiation, but surgery was not even in the question with me.

While I would recommend a PSE test. If your doctor won’t do it your doctor may know of another test that works to let you know if you have cancer before a biopsy. If you can’t get a PSE ask if they’ve got something else that’s similar.

The large prostate can be what was causing your high PSA. I know Someonewith exactly the same problem but his PSA was 50 and his biopsies were clear. The fact that it’s gone down could mean your prostate size is reduced as well. Were you taking any drugs for BPH like finasteride ot Dutasteride?

That big drop in PSA Is really positive, Keep it up. 😀

No I haven’t been diagnosed with BPH so I’m not being treated for that although the MRI did confirm an enlarged prostate (95 ml) Here is an excerpt from my radiologist…..“ 1. Diffuse abnormality the peripheral zone. This is a nonspecific finding and can be seen in both acute and chronic prostatitis or other inflammatory process and rarely in diffuse malignancy. Malignancy being considered less likely in the presence of a well defined capsule”…..

At this point the plan is to do another PSA in June unless I can get a PSE sooner. And another MRI in September if PSA increases. I would have more peace of mind if my PSA fell to below 4 but it seems like even at that number Cancer is still possible.

Appreciate your response.

Hi and thanks for the input and comments . Yes , when I had my first PSA test and it came back at 11 my regular doctor at Kaiser told me to make an appointment with a urologist . My first call to them I was told to schedule a biopsy , initially I thought it would be okay until I checked on what a prostate biopsy entailed and saw that it was a very invasive procedure - which normally I would agree to but I have had two close relatives ( my little sister and my grandmother ) the only 2 people in my immediate family that has had even minor clinical procedures - died of blood infections . This is the main reason that I hesitate to get a biopsy until all other avenues of testing are exhausted .
My first Urologist , who since retired , made a " deal " with me and said she would agree to postpone recommending a biopsy if my PSE tests didn't increase materially and in the meantime I would be on AS with regular monitoring . When I had my next urologist appointment I was assigned a new urologist - first thing he said was that I probably have cancer and he was going to schedule a biopsy - when I told him about my AS he got pissed off at me ! He said that's a bad idea - that was before he gave me a dre , which he said was fine ..... and I hadn't received my next PSE test ( I just today gave my blood sample and am waiting for the results ) . Obviously not all urologists think along the same lines - I asked him since he thinks I have cancer what does he think my gleason score would be - do you think it would be a 3+4 or worse ... again he got testy and said there is no way to know without the test but " maybe in that range " so I made a deal with him , if my next PSA test comes back and its increased by a couple points or more over my first one I will risk the biopsy .
When I asked him about a PSE test or some of the genomic testing he said they have no real track record and he would not approve anything besides a biopsy .
Anyway for now I'm just waiting for the lastest PSA test results- hoping for the best .

That is a legitimate concern over infections with a traditional trans-rectal biopsy. Fortunately, there is a newer procedure, the trans-perineal biopsy, that eliminates almost all risk of infection.

Not every practitioner does it yet (or even knows how to do it), but with your family history, I think you could make a strong case even if your insurer baulks at any extra cost.