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Continued Monitoring or Biopsy?
My PSA has fluctuated all year:
January: 8.1 and 7.8
March: 5.4
June: 4.4
September: 7.1
Dec: 6
%Free PSA between 15% and 16.6%
First MRI: Pirads 3 with a 95ml prostate.
Second MRI: Pirads 2 with 70 ml prostate. No focal lesions
Some characteristics of BPH/Prostatitis. On Tamsulosin
62 years old. Father had radical prostatectomy in 1992 at my age but lived another 25 years cancer free.
When I look at all the numbers like density, velocity and MRI reports I' m inclined to continue with regular PSA tests every 3 or 6 months and MRI's. My urologist thinks I would benefit from a biopsy but offered a standard office transrectal 12 core, essentially blind since there is nothing to target right now. Anything else I should consider that I'm not? Thanks
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@ezupcic
All right, here’s an answer
Get a PSE test. It is 73% accurate and telling you whether or not you have prostate cancer.
If it Says you have it and you get a biopsy. There are a couple more tests like this, but this is the most accurate one.
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1 Reaction@jeffmarc sounds like a good idea. I’ll pursue this with my primary care doctor since my Urologist is not too excited about many of these diagnostic tests. Thanks for helping me navigate this.
@ezupcic Episwitch says it’s 94% accurate but interestingly results are presented as “high/low” likelihood of PC so either way continued monitoring is necessary which I guess is part of the deal with Prostate Cancer.
@ezupcic
I’ve seen 93% and 94% so I figured I’d go with the lower high figure.
@ezupcic
In terms of the PSE blood test, It may not be standard of care yet, but with a 94% accuracy vs 55% for PSA alone, it may be worth considering. It's just an additional component in your toolbox to make a more informed decision with your doctor, whether they use it or not. Here is a link to the product page at Oxford Biodynamics:
https://www.94percent.com/
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2 Reactions@ezupcic True. Sometimes not standard of care, but they’ll do it if you ask. I’ve asked for non-standard tests from my medical team just to get more information. (They rarely say no.)
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1 Reaction@ezupcic so let’s just go in BLIND and see if we find something?? Is he playing Pin the Tail on the Donkey?
If anything, do a targeted transperineal fusion biopsy aimed at that PIRADS lesion, whatever size it is…or just wait until your PSA rises consistently and then you’ll have more to go one.
Maybe it’s just me, but someone offering to do something ‘blind’ to MY body just doesn’t inspire confidence and that warm, fuzzy feeling…. Best,
Phil
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1 Reaction@heavyphil no it doesn’t. But he is highly rated and part of a Urology group that is well respected. At the beginning of all this I even had to suggest a MRI before proceeding to biopsy because he wanted to go straight from an elevated PSA to Biopsy.
Similar situation. PSA between 6 and 11. PI Rads 3 lesion. Free psa 13%. Center of excellence uro had me submit the ExoDx urine biomarkers test. Their breakpoint is 15.6 for cancer/no cancer and I’m 15.37. Since everything is so borderline it’s a biopsy at this point.
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1 Reaction@ezupcic old way of thinking, unfortunately. I have a few well established “groups” like this in my town as well.
They’ve been around forever, have senior partners in their 70’s, have lots of patients, and probably bat around .500…great in baseball, not so much in Urology, Cardiology, et al…
Phil