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Misleading PSA and PSMA Test Results
My GP did a yearly PSA. My one and only “abnormal” result was 4.4, Jan of ‘25. He said I could re-test in 6 months or see a Urologist now. I chose option 2. The first Uro did an MRI followed
by a biopsy. Gleason 3+3. Even though it was low grade the biopsy showed multiple sites and he suggested surgery or radiation. Second Uro opinion concurred. A friend of mine had a cryo
procedure done at NYU Langone in NYC and he was my third opinion. He did a PSMA which showed NOTHING, indicating only BPH. Based upon this he recommended active surveillance. July ‘25, PSA 3.4. Jan ‘25, PSA 3.6. MRI showed a new lesion. Biopsy showed a
3+4 Gleason.
2 weeks ago I had a radical robotic Prostatectomy. Biopsy showed it was contained although positive margins on top, lymph nodes clear.
If PSA’s and PSMA’s are the main tools why did they fail me? If a PSA is the follow up for recurrence, is it reliable?
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Best Wishes on your recovery after surgery.
I have had and continue to have the same questions.
I know we are all different.
I have had yearly bloodwork (including PSA) for over 30 years (thru work health program).
In 2025, yearly PSA test went from 2.8 max to 4.0. This started process of MRI’s, PET Scan, and Biopsies. After this 1 (4.0 psa test), I have had four tests at 2.0, one at 2.7, and one at 3.7.
Biopsy last September was 3+3. Biopsy last week was 4 cores of 3+4.
I still have alot of decisions to make.
I have just been trying to balance all the information, knowing we are all different. For some a PSA of 4 is not high or a concern. For some a PSA of 2.5 is a concern.
Best wishes
The PSA test didn’t fail. PSA is not cancer-specific. The PSA number itself is similar to a “check engine” light in a car; it indicates that something may be wrong, and further checks should be made “under the hood.” Might be as simple as a UTI; might be BPH; might be more serious, such as cancer. Just need to have further checks. No need to panic, or rush to a quick treatment decision, or get overly concerned.
Other tests might have then given you the more information you needed to know what was really going on.
With your slightly elevated PSA of 4.4, did they do any other tests to get more information on the status?:
> % Free PSA
> PSA Density
> biomarker (genomic) test
> genetic (germline) test
Did you get a 2nd opinion on both the MRI scan and the biopsy slides?
You mentioned that the “PSMA which showed NOTHING.” What does that mean? In a PSMA PET scan something will always “light up” because many organs, tissues, and fluids express PSMA without being cancerous.
With the next biopsy showing a Gleason 3+4, what % of that was “4”?
Did the MRI report or biopsy report mention anything about extracapsular extension, seminal vesicle invasion, perineural invasion, cribriform pattern, or intraductal carcinoma?
There are so many markers to check to help build confidence in a treatment decision.
Yes, going forward a PSA test is the most reliable test there is; since you no longer have a prostate to produce PSA, your PSA should remain at or near undetectable (i.e., be preceded with a “< “ symbol).
(In my case, I had proton radiation treatments so, my PSA will remain low since I still have a prostate naturally producing PSA (though at a low “new normal”).
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4 ReactionsPSMA is generally used for identify where the disease has metastasized. In years past I have read some studies that indicate PSMA is accurate for 90-95% of patients, so it doesn't catch everything.
From your post, it sounds like your PSA results alongside your health team led to a decision to remove the prostate, so to me that sounds like you used the insight in a proactive manner.
Hope you are recovering well from the surgery, it takes time, but things usually recover well!
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1 Reaction@charlesprestridge
Thanks Charles….best of luck
One things many doctors go by is if there are more than 5 3+3 Results then something should be done. Sounds like what was decided in your case.
I would ask them why there were positive margins. What did the biopsy of the prostate show? Was there Seminal vesicle invasion, Extracapsular extensions or extra prosthetic extensions? Those could lead to Resulting in positive margins.
Your PSA after surgery should be a real indicator of what’s going on. It should show undetectable PSA.
What did they come up for your T stage? Were you a T2 or a T3a or T3b. That information should be in your prostate biopsy.
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1 Reaction@jeffmarc
Hi Jeff
“Was there Seminal vesicle invasion, Extracapsular extensions or extra prosthetic extensions? “
No to the above.
A. Lymph Node, RIGHT PELVIC LYMPH NODE-
Pelvic Cavity:
Two lymph nodes negative for malignancy.
(0/2).
B. Lymph Node, LEFT PELVIC LYMPH NODE-
Pelvic Cavity:
Two lymph nodes negative for malignancy.
(0/2).
C. Prostate, PROSTATE AND SEMINAL
VESICLES:
Prostatic adenocarcinoma, acinar-type, Gleason
score 3+4 =7
Grade group 2
The bladder neck margin is negative.
The tumor involves the apical margin, consists
of Gleason pattern 4, and spans a length of 1.7
cm.
The tumor involves 20% of the prostate gland
tissue.
Gleason pattern 4 is approximately 15% of the
specimen.
Perineural invasion is present.
pT2pN0
@df0403
this actually looks pretty good. Only one, 3+4, surprising to see that the tumor is 20% of Prostate gland. That’s pretty large.
I’m a little puzzled about the pT2p Since T2 is only a, b or c.
You see perineural invasion in almost every biopsy. Mine had it my brothers had it so many people that have had posted them have it.
“The tumor involves the apical margin”. This meant it went to the edge but maybe not beyond it. Did you ask the doctor whether or not that actually means the margins are not clear? In that case, they would say ECE and some situations to imply it was outside.