PSA/MRI not too bad, Biopsy not too good. What??

Thanks, Brian. 2200 combinations is mind-blowing! Since MRI and PSA weren't very good indicators, I keep thinking the only way to know what's happening inside the prostate is to remove it. Big decisions ahead for me.

I think a lot of other people have answered this question. There is a second option. There is a way to get your MRI analyzed by a different place using AI.

If you’re at all interested, here’s info on how to do it. You do need to install GOTO Meeting to attend the presentation

One innovative example of AI in prostate cancer detection is ProstateID, developed by Bot Image™, Inc. This medical imaging software leverages AI for the interpretation of magnetic resonance imaging (MRI) scans. ProstateID is designed to assist radiologists by improving the detection and assessment of lesions that may be indicative of cancer.
ProstateID utilizes a pixel-wise random forest learning-based method to analyze MR images. The software automatically registers, segments, and examines the prostate gland to identify suspicious abnormalities. This advanced approach not only aids in accurate detection but also enhances the characterization of lesions, providing comprehensive diagnostic insights.

From Rick Davis At ancan.org
Now there's an affordable AI-validated option that's proven very reliable* - ProstateID
Join us on Wed. Sep 17th at 6.30 pm Eastern in the AnCan Barniskis Room https://www.gotomeet.me/AnswerCancer Free and drop-in

Founder and Developer, Randall Jones, PhD explains the technology and its uses.
Hosted by AnCan Advisory Board Member and prostate cancer peer, Cdr. Mike Crosby

Thanks again, Jeff. I really like the sound of a second opinion/AI MRI reading, will work to make it happen.

Perhaps. Buy do we have to be absolutely sure before treatment?

I don’t know of any other medical procedure where we first amputate “just to be absolutely sure.” The axiom in medicine used to be “first do no harm.” We should follow that axiom with prostate cancer treatments.

There are a dozen different datapoints related to prostate cancer we can potentially collect before making a treatment decision. We should make use of all of those diagnostics.

Long distance Layman view:
2 brothers w/ PCa; 1 treated and 1 passed (sincere condolences).
And after years of AS, your condition is progressing.
Mayo should provide expert input, however it sounds like you have reached the point of treatment.
Best wishes.

Thank you!

You want to be very careful here. I am 77. I have been on AS for 21 years at a top 5 prostate hospital. About 15 biopsies until 2025 have always been 3+3 or a few times negative. Due to a PSA in the 20s a biopsy was done June 2025 which showed all 3+3 except in one area three samples of 3+4 with less than 5% pattern 4 with no large cribriform. The PSMA was clean. I wanted to continue with AS but the hospital refused and instead recommended 28 radiation treatments. I went to another top 5 prostate hospital to see if it would continue me on AS with my 3+4. The new hospital obtained my biopsy sample and had its pathologist, fellowship trained at a leading institution, examine it. He read the sample as 3+3 !!! The urologist at the new hospital recommended AS and offered, but didn’t recommend as necessary, a Decipher test if it would make me feel more comfortable continuing AS. I requested it although I don’t think it is necessary. We do not yet have the Decipher result.

great info, thank you! You were diagnosed at about the same age as I was. 21 years of AS is amazingly great, I had hoped to get many more years myself.

It will be interesting to see what next steps are recommended by my Mayo Team, but seems like a PSMA would make sense for me.

Glad you have done well all these years and hoping your Decipher results are good news. Once you get the Decipher results, please share here if you would like.

Thanks, again!

Actually, the PSE test could be more important than a decipher test. The PSE test Is 94% accurate in telling you whether or not you do have prostate cancer. You have had a lot of biopsies, but it’s designed to prevent biopsies if it doesn’t find prostate cancer.

If it does find it, then treatment is important.

On the cribriform and ultraductal issue you can ask your attending doc outright. My guess is they would have said something if they saw any.

It seems to me that you may want to really consider getting the thing out ASAP.

Once it's in a pathologist's hands you'll get the real skinny. And now with Decipher they can use the tissue to come up with a good prognosis on aggressiveness etc. Further if they get in early enuff they can spare one or both of your erectile function nerve bundles.

The operation is quick and you're on your feet in a day or two. Bowel movements can be agony for awhile tho.

If you just go back and read the litany of all the rigormoreroll you've been thru to date in having it stalk you and w your family history, I'd just get it out.
Then you'll know how much
further or little treatment you'll need in the future.

If it's slipped out of the prostate capsul, you'll find that out. And that's not a death sentence. They can do a lot to cure even then.

But they have to first know and a prostatectomy in my opinion gives the most info..

Recall an adage constantly ringing in my ears as an Infantry 2nd Lieutenant going thru Infantry Officers Basic at Ft Benning enroute to Nam-

"Lieutenant-
Always bring me the bad news first.
Good news takes care of itself."

Has your doc talked to you about the possibility of a cure with a prostatectomy?

Good luck!!