@kalsen

I do not think you will want to get a PSMA pet until you have more information.

I had a PSMA pet a few months after 1st biopsy because of possible extracapsular extension with a Pirads5 (2cm) lesion. If MRI does not indicate possible ECE and biopsy is 3+3, my inclination would be to defer PSMA pet until future MRI/Biopsy indicated a change.

My experience is to balance tests/info and then try to determine when more info/tests will help.

Last September my MRI indicated Pirads5 lesion with possible ECE. Biopsy had 5 cores of 3+3. However, 5 targeted cores only had 2 positive with small amount of cancer. Random cores had over 90% of the core at 3+3.

Working thru this initial info.

1. MRI indicated lesion may have higher than 3+3 and ECE was possible.

2. Just because targeted needles did not sample lesion well, assumption was cancer was in the lesion.

3. With your Pirads4 lesion (and a decent size lesion), I would ask Urologist to send biopsy off for a Decipher score, even if all positive cores are 3+3. If the Decipher score is 0.3 or lower, it will give some indication further tests may not be necessary for 6 months (followup PSA). If Decipher is approaching 0.5 or higher, more caution and thought may be wise.

4. In my case, I had a repeat MRI/Biopsy in six months due to Pirads5, 0.48 Decipher, and possible ECE. Repeat Biopsy had 4 cores of 3+4. I am working thru treatment decision process. When to schedule treatment, radiation or RP, genetic testing, Prostox test, etc

Best wishes

@kalsen If in US PSMA PET tests typically cost $10K+ and are not likely to be covered by insurance unless biopsy shows at least a Gleason 4+3. They look for metastases of the cancer. Cannot find cancer in the prostate since it will always light up with the PSA present in a normal prostate. As mentioned, the fusion imaging is not the best but should be better than Charles encountered. I got 6 of 6 hits on the 2 targeted lesions and all 3 cores were the same on each lesion. They will also do a TRUS random sample of the prostate. Mine had nothing of interest in the random part. My biopsy was transrectal with only local anesthesia. Had no issues with pain. Drove home within 20 minutes. Only after effect was blood in semen (due to all the holes the biopsy puts in prostate).