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Rising PSA - next step options
I have not been diagnosed with prostate cancer, so I hope it's still ok to join this group and ask a question.
I will be 70 this coming January. My PSA is in the normal range (3.54), but has spiked to that level over the past year. My urologist of 20+ years has given me a couple of options. Option 1 is to continue monitoring through PSA blood tests. Option 2 is an MRI. He offered the MRI in his words "to settle your anxiety about continuous testing". He said he did not expect the MRI to show anything concerning. I believe he is being straight with me and not sugar coating things. I'm inclined to proceed with the MRI to 1) put my mind at ease if it shows nothing remarkable and 2) take early action if it does suggest a need for further testing. I actually had a biopsy ~15 years ago because my PCP thought he felt something suspicious. It turned out negative. Lastly, my father died of prostate cancer at age 87.
I guess my question is....would there be any reason not to proceed with the MRI vs. continued screening via blood tests?
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I don't believe anything has "happened" to DREs.
In my case, since my routinely checked PSA was on the high side, I was referred to a urologist who indeed performed the DRE (don't know why my PCP couldn't have / didn't do it).
Based on his finding a nodule, I was then referred for a scan, which led to the biopsy, and the rest, as they say, will be history...
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2 Reactions@sandguy
I saw the post by tjs911 about DREs but chose not to answer as could only give my personal experience with it.
Every time I see my R/O after my radiation treatment he did a DRE. My urologist also did DRE before ordering a MRI with contrast. Doing a DRE is looking for hardness, lumps, etc. which clearly indicate a need to do a MRI or further investigation into why there (this was an answer from my urologist). He went on to say to me that even though a DRE would be normal having rising PSA was ground to so a MRI with contrast as with prostate cancer in early stages you are dealing with it a cellular level.
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2 ReactionsSomething everyone needs to be aware of is this. There's a front and back side of the prostate (anterior, posterior). Posterior is that side adjacent to the rectum. DRE does not address the anterior side of the prostate. While a large percentage of prostate cancers are found on the posterior side of the prostate, not all lesions are found there. Many lesions form on the anterior side as well. Do not put much credence in DRE. If you're really concerned have an MRI performed. And just to be safe................have it read by more than one radiologist..........and make it a radiologist who specializes in reading prostate MRI's. On my first MRI, the radiologist missed my lesion. I went on for two more years before a second MRI ready by a competent radiologist found my lesion on the anterior side of my prostate.
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2 ReactionsI had MRIs done at 3 different centers of excellence. All of them indicated I had nothing to be concerned about. As my PSA continued to rise and I ultimately had a biopsy, my cancer was at a high risk stage and it had spread throughout my prostate and into my seminal vesicles. MRIs are not as accurate as a biopsy and do not tell the whole story. I had a false sense of security after the MRIs and then the doctors admitted they are not fool proof.
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3 ReactionsSir, I would get that MRI. More knowledge the better . Especially if you have PC in the family you have to stay vigilant and test every 6 months , at least . Your PSA is getting up there . Have you had a Biopsy at all for Gleason rates ? You are asking the right questions . Get a second opinion if needed too ! We are here to help you . Most of us started out like you . Great support and knowledge portal ! God Bless Sir !
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2 ReactionsThe best biopsy is one that is MRI guided. In other words, do an MRI, use the results to do extra samples in suspicious areas. If the MRI shows nothing, you can still do a regular biopsy.
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3 ReactionsI agree with posters citing the MRI/Fusion to do the biopsies. That is what I had at Mayo Jacksonville. This is what my Mayo urologist wanted done and why he ordered the MRI with contrast to be able to do biopsies if needed that way.
There was one post about posterior of prostate. I agree . I have a lot of them now.
When I chose to have proton radiation at UFHPTI, as Mayo Jacksonville could only offer photon, when I was having CT scans done to set my simulation bed and treatment measurements my R/O there had told me he wanted to do a catheter (not comfortable procedure at all) with a contrast to look at the back of my prostate. Never heard that mentioned on MCC but now see why as trying to get a good look at back of prostate.
Now I read a poster talking about the back of prostate and it can be a problem. I assume this is what my R/O was trying to see as could not feel. My R/O at UFHPTI has done thousands of proton radiation treatments at UFHPTI as he began there when it opened in 2006 and does 50% of all radiation treatments for prostate cancer at UFHPTI.
Agreed, however, would not take the comfort of a PYRAD 1 or 11 MRI to feel 'home free' in not having prostate cancer. UCSF admitted than more often than not there are things not seen on an MRI that will show up after biopsy.
MRI fusion is actually doing the biopsy. Not just walking away with the MRI results alone.
However, my urologist was fine with walking away after negative MRI results. That was 7 years before the cancer was detected by PSA.