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Positive ExoDx urine test with negative MRI
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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@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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1 Reaction@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.
@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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1 ReactionAstrodoc -
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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2 Reactions@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.
@jeffmarc Thank you for your insight.
@jeffmarc ; i went ahead and got my biopsy. Just heard that 11 cores were negative. 1 core came back with 12% of core showing 3 + 3 Gleason 6. I have a follow up with Urologist after Christmas. The NP suggested I do research prior to the visit. Specifically to learn more about a Decipher Test and an Artera AI Test, which uses AI to look at the tissue on the biopsy in question. I'm not sure how to take this news....I guess it's not the best but could be worse?
@astrodoc ; I took the advice of my Urologist and went ahead with the biopsy last week. They found 11 cores negative and 1 core where 12% showed Gleason 6 3+3. I have a follow up after Christmas to review results and next steps. The NP recommended I do some research on a Decipher Test and an Artera AI Test, which uses AI to look and compare the tissue. So, I guess in my case the elevated Exo test was accurate despite a clear MRI and PSA that dropped from 4.2 to 3.8. Not sure what to think
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1 Reaction@joeelizabeth
You are a perfect case for active surveillance. It can’t hurt to get a decipher test and ArteraAI is more of the same, results can lead to more educated decisions. With such a low percentage of “cancer” in a 3+3 core you should review the doctors that feel people are over treated and would say to you, consider options other than treatment. A 3+3 is not considered cancer by some doctors.
Here are some videos from doctors that discuss who is a good candidate for active surveillance
Here is a video with Dr. Laurence Klotz, one of the experts on active surveillance. He can give you answers as to why you would or would not be a good candidate for active surveillance.
Here is a video by Dr. Epstein discussing active surveillance and more
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2 Reactions@jeffmarc ; thank you for sharing these videos and thank you for encouraging me to go through with my biopsy in one of your earlier posts. My follow up is December 29th.
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