New, PSA 20, Just Starting Process

Should your urologist have to tell you "you have incurable prostate cancer", there is no need to panic.

However at that point be sure that your care gets transitioned to medical/radiation oncology. For low grade PCA its probably perfectly OK to stay with a urologist but your high PSA indicates otherwise is very likely.

Later on, from oncology you might hear the words "advanced" and "high risk" etc. Ask the doctor(s) telling you those words what they mean to a doctor. Again, no need to panic.

Erelong, if you have PCa and need treatment, I recommend getting a bone density (DEXA) scan. Also, if not already doing so, commence weekly exercise 5-6-7 hours or more total, resistance. And that piece of advice would not be mooted if you don't have PCa.

Is there a family history of PCa? Let your doctors know.

Get DNA sequencing (eg DECIPHER).

@jcf58
yep I had many DRE exams along the way ( 5 or 6 in last 6 months) to PC diagnosis..mine felt normal..in fact yrs ago in HOuston I had a doc tell me I would never have any prostate problems that my prostate was small and smooth/firm " like a 20 yr old lad's" and PC would prob never affect me ..and yet here I am !

@widude63 I would find out the volume of your prostrate. As I said mine was 68 which is quite large. My PSA was 7.7. Yours is almost three times mine ! Do lots of checking.

@widude63
Of course it's unpleasant. They're going to stick a needle, a camera (US probe), and snippers up your butt. The good news is it doesn't even last 10 minutes and, in the end, you're going to have a yes or no answer. I found the prep worse than the test.

Uncertainty is certainly a path many begin on. When one feels great it is hard to believe there could be something wrong with you. Couple that with the plethora of information on the internet, the need for clarity takes prominent position. I think you are on the proper road in getting the opinion of a urologist. It is possible that you just have benign prostate enlargement and can take one of many medications that treat such a condition. The important thing in my mind, is to get clarity and proceed from there. All the Best to you on your journey…

@widude63
I understand the desire to get information as quickly as possible and would have probably made the same decision to go with the biopsy now vs waiting 30 days for an MRI.

As you may know, a 'standard' biopsy generally involves 12 cores or samples and there is also what is referred to as a 'saturation' biopsy which involves more cores. The saturation biopsy is more likely to detect cancer if the cancer is very small and confined to a single area of the prostate. The saturation biopsy will involve more discomfort obviously, but as long as you are going through the process anyway you may want to ask for the saturation biopsy to provide a higher degree of assurance of the results.

Hopefully the results of the biopsy are negative, but even if they are I would go ahead and have the PSE test. If the biopsy results are negative but the PSE indicates a high probability of prostate cancer you will know that additional testing is needed - probably an MRI and perhaps a follow up biopsy procedure in 12 months if the MRI doesn't show any suspicious areas.

My prostate cancer journey involved a gradually rising PSA with pretty significant fluctuations up and down over many years, and I had several biopsies which were negative. About 27 months ago I had a regular appointment with a urologist and at that time my PSA was stable from the prior test and the DRE was negative and the urologist basically gave me a clean bill of health for another year. I asked for one of the newer urine based tests and he prescribed the ExoDx test. That test result indicated an elevated risk of cancer (36%) which led to an MRI which was completely clear. I went ahead with a saturation biopsy and that showed a very small amount (less than 5% of the core sample) in two samples of the 24. The gleason scoring was 4+5 so surgery was warranted and I had an RALP six weeks later. Fortunately my gleason score was downgraded to 4+3 with tertiary 5 cells. My experience shows that cancer may be present even though PSA may be stable, DRE may be normal, and MRI may be normal. I would not have known I had cancer as quickly as I ultimately did if it were not for the ExoDx test, so I am a big believer in using those types of tests to supplement the more standard diagnostic steps like the PSA, DRE and even MRI. From what I have learned on this site, the PSE test is now more accurate than the ExoDx test which I had, so I would recommend that.

All the best to you as you move through this process.

Thanks, please also understand, 10 days ago this was all oblivious to me. Right now I’m just trying to be ready for a worst case scenario. Even if there are cancer cells present, if ‘contained’ I’ll just figure it’s my turn.

Once I get this biopsy I’ll have a moment to take a breath, I’m thinking about getting on the MRI schedule. That PSE test sounds good also.

I agree, at 20, something is going on down there. Like I told the urologist, I really don’t care about extra trips to the lav, I can mitigate that. The biggie is the cancer possibility.

Talk to jeffmarc he can help you

I remember those BPH days. Long gaps between PSA exams. Intermittent test based on PC recommended for five years. Bam, suddenly lower back pain, blood urine, increase in urination. Covid happens, lab is closed, PC was online. 4 months pass, PSA exam went from 4 to 118. Bad jackpot, aPC (advanced prostate cancer).

Lesson learned.

@widude63

Wishing you the best possible outcome on your poking and prodding day!