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Positive ExoDx urine test with negative MRI

Posted by astrodoc @astrodoc, Aug 11 1:18pm

I am curious if anyone during their treatment had this scenario and what was done about it. I am being followed with basically elevated PSA, not huge but it went up 1 full point in the last 9 months, from 2.1 to 3.2. I'm 64 now.
This prompted a workup with the ExoDx urine test and MRI with and without contrast. MRI was completely clean, nothing, zero, suggesting BPH, but the ExoDx test is off the charts, like 56 or something. My dad passed from prostate CA at 79.
Also on a positive note , I have a low PSA density, 0.05. So currently I am told I should have a PSA redrawn in 6 months and if it goes up a lot then biopsy will probably be done, but not before.
I guess I'm worried despite negative MRI, with the super high ExoDx result, that a biopsy should be done now? Or is 6 month recheck reasonable?
Thanks everyone! God bless you all

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joeelizabeth | @joeelizabeth | Oct 29 10:53am
In reply to @astrodoc "Hi, Thanks for posting this! I think I am in the exact situation as you. PSA..." + (show)
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Hi,
Thanks for posting this! I think I am in the exact situation as you. PSA was 3.2 in March. Exo was I think 53. MRI totally normal. Other data points were normal rectal exam but prostate enlarged, also on MRI. PSA density was low. So the practitioner said I could come back in a year. Now I am a retired doc as I mentioned earlier. I said no I don't want to come back in a year. Make it 6 months. I have a very good friend who is a recently retired urologist and he said they lean mostly into the MRI result so "most likely" I have BPH. He said if it were him he would have no problem waiting.
Anyway, my dad died of prostate CA, so needless to say I am concerned about it. I had a repeat PSA drawn last week and I have a follow-up with the urology office on Nov 3. If the PSA is higher, I am going to request a biopsy. Not sure if they would want the MRI redone or not. Just had it done end of July.
So yeah it's really confusing. If your PSA has been as high as 4.2, with the exo result as you mentioned, and your doc is leaning to biopsy, I would do it without hesitation.
I plan to continue posting updates as they become available.

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@astrodoc Thank you for your feedback. My March PSA was 4.2. My PSA last week was 3.6. My prostate density is 0.11, which i was told for my age (60) was OK. My Exo test was back in July and my MRI September. I fell like i've been following this closely but now feel inclined to have biopsy. I recall my Dad enduring many painful biopsies with negative results. My Urologist insists things have improved. I appreciate your insight. Thank you.

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jeff Marchi | @jeffmarc | Oct 29 11:03am
In reply to @joeelizabeth "I'm a 60yr old male. My PSA has slowly risen and was 4.2 in March, up..." + (show)
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I'm a 60yr old male. My PSA has slowly risen and was 4.2 in March, up from 3.6. An Exo Dx urine test was ordered and it came back at 59. My urologist ordered an MRI, which came back clear of any lesions. My follow up PSA in October was 3.6. My urologist is urging me to proceed with a biopsy due to the Exo DX result. He feels i'm in the gray area right now rather than black and white. He's ok with me waiting 4 months for a follow up PSA but I know he's in favor of proceeding with biopsy now. Very confusing. My father had elevated PSA and enlarged prostate for many years. He was diagnosed with advanced Prostate Cancer at age 87 and passed away at 93. I'm not crazy about a biopsy (who is?) but not sure how to proceed

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@joeelizabeth
How big was your prostate when they did the MRI. A large prostate can cause a high PSA and have nothing to do with cancer.

That Exo DX result is quite high. Was the result really 59 not 5.9? As the below information shows, you are way beyond guessing what’s up if really 59.

A score below 15.6 indicates a lower likelihood of HGPCa, while a score above 15.6 indicates an increased likelihood and suggests a biopsy should be strongly considered, along with other clinical factors like PSA levels, age, and family history.

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joeelizabeth | @joeelizabeth | Oct 29 12:29pm
In reply to @jeffmarc "@joeelizabeth How big was your prostate when they did the MRI. A large prostate can cause..." + (show)
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@joeelizabeth
How big was your prostate when they did the MRI. A large prostate can cause a high PSA and have nothing to do with cancer.

That Exo DX result is quite high. Was the result really 59 not 5.9? As the below information shows, you are way beyond guessing what’s up if really 59.

A score below 15.6 indicates a lower likelihood of HGPCa, while a score above 15.6 indicates an increased likelihood and suggests a biopsy should be strongly considered, along with other clinical factors like PSA levels, age, and family history.

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@jeffmarc
MRI with and w/out contrast: My prostate size: 6.0 x 3.7 x 3.1 cm; Prostate volume 35.8 cc. Prostate density 0.11
PI-RADS score: 2
Recent PSA was 3.6 down from 4.2 in March.
Exo DX; 59

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rider51 | @rider51 | Oct 29 12:56pm

Astrodoc -

Sorry that I missed this back in August and am so late in replying, but I think my history is relevant to your situation. I too had a gradually rising PSA and had an ExoDx urine test in June of 2023. The result was 36 indicating an approximately 36% probability of treatable prostate cancer. I had an MRI that was completely clear but on the recommendation of my urologist had a saturation biopsy which showed small amount (5% of core sample) of 4+5 cancer in two of the 24 cores. I had an RALP in September of 2023 and the pathology results downgraded my cancer to 4+3 with tertiary 5.

So to answer your original question, it definitely is possible to have cancer even though an MRI is clear - my case is one example.

As others have suggested, you could try another of the new blood or urine based tests that are more accurate than the PSA to get another data point. But, I would recommend a saturation biopsy given the relatively elevated ExoDx result.

All the best to you.

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jeff Marchi | @jeffmarc | Oct 29 2:51pm
In reply to @joeelizabeth "@jeffmarc MRI with and w/out contrast: My prostate size: 6.0 x 3.7 x 3.1 cm; Prostate..." + (show)
Profile picture for joeelizabeth @joeelizabeth

@jeffmarc
MRI with and w/out contrast: My prostate size: 6.0 x 3.7 x 3.1 cm; Prostate volume 35.8 cc. Prostate density 0.11
PI-RADS score: 2
Recent PSA was 3.6 down from 4.2 in March.
Exo DX; 59

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@joeelizabeth
Your prostate size is normal and your PSA is only a little above normal.

That Exo DX test really says You need a biopsy. Discuss it with your doctor, The reason you get that test is to find out whether a biopsy is necessary and in your case the test says it is.

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joeelizabeth | @joeelizabeth | Oct 29 3:33pm
In reply to @jeffmarc "@joeelizabeth Your prostate size is normal and your PSA is only a little above normal. That..." + (show)
Profile picture for jeff Marchi @jeffmarc

@joeelizabeth
Your prostate size is normal and your PSA is only a little above normal.

That Exo DX test really says You need a biopsy. Discuss it with your doctor, The reason you get that test is to find out whether a biopsy is necessary and in your case the test says it is.

Jump to this post

@jeffmarc Thank you for your insight.

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